Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00204
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Installation of (2) new cooler units and (1) cooler unit moved from different location.
Contractor: AMERICAN REFRIGERATION INC Owner: PACIFIC REALTY ASSOCIATES
575 MARKET ST 15350 SW SEQUOIA PKWY #300
EUGENE, OR 97402 PORTLAND, OR 97224
PHONE: 541 - 688 -0939 PHONE: 503 - 624 -6300
FAX: 541 - 431 -0251
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/12/2011 $1,799.46
Class of Work: ALT Type of Const: IIIB Plan Review 05/12/2011 $449.87
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 05/12/2011 $215.94
Stories: Info Process /Archiving - Sm Sheet (up to 05/12/2011 $3.50
11x17)
Project Valuation: $67,402.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $2,468.77
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Walk in
Duct Work: coolers
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti - _ - er. Those . es are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUN 'by . ing 513. .1987 or 1.800.332.2344.
Issue. By: / � ( Permittee Signature: A.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1 FOR OFFICE USE ONLY
J v Received
lig City of Tigard � l L J A Date/By: ma Permit No.: N 2,t, I'� n/1 7�ci
n 13125 SW Hall Blvd., Tigard, 23" h N rr rrra 0`v CJ�d�
Plan Review' 1 ',
Phone: 503.718.2439 Fax: 503.598 1 0 ! Other Permit:
DateB
Inspection Line: 503.639.4175 'Vim' 1 1 2011 L
Tl GA RD Date ReadyBy: .turfs: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method 7 /g Supplemental Information
CITY OF TIGARD _
Tyr E�eF`� t O' I ~1 Gild 4 �' , hi OMME • IAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ 6 7 � 610,9.,a0 CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: JS yr to . S („4.3 `i?, A_ �t rk cu... ._ /� (requires site plan showing placement) 46.75
(/`�' Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: - V Cy- / o" Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no.: 1 Project name: jylin.unOi c sw Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system _ 23.32
Residential boiler (radiator or
hydronic) _ 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances: _
DESCRIPTION OF WORK • Water heater 23.32
y 1 Gas fireplace 33.39
1 n5�aAk (91 E (,1..1CN L� cad ( --r Flue vent for water heater or gas
c9 - /0-.---0 fireplace 23.32
nn / - Log lighter (gas) 23.32
` ®I-'-r Pi __ / 9 /CL '�0"'_. Wood/pellet stove 33.39
Wood fireplace /insert _ 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
� ''AA �.. -- Other: 23.32
Name: p t.L-f , 'uv 1 Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: "'T` ei c,,,-- (`. , cre— Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: OY� $14.15 for first four; $4.03 for each additional
14-al-ex Fumace, etc.
Address: Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Gat Phone: (51i )6,51-,_ d ' 3 5 0' 1-4-0-1 5 Water heater
E -mail: 1 Fireplace
Range
CONTRACTOR Barbecue
Business name: A -erP 72..2._- -r -4" _ Clothes dryer (gas)
1 T Other:
Address: S 7 J / {N1 - It g / MECHANICAL PERMIT FEES*
City/State /ZIP: Col 1 .. e 0./' Oi'7YpZ Subtotal
Phone: 6 ) (i.A 8 o - _ y Fax: f I ) 3 1 _ ,2..5. Minimum permit fee )
3 1 0 aL Plan review (25% of permit rmit fee fee)
CCB lic.: / / 01, 73 (a 110 / State surcharge (12% of permit fee)
,` ( TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name Date: 5—/ / —p2 d ( ( * Fee methodology set by Tri- County Building Industry Service Board
I.\ Buildineermi / \MECC- ` P ' e _ rmitApp doc 09/09/10 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: .Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
l: \ Building \Permits\MEC- PermitApp.doc 09/09/10 2