Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/18/2011
Parcel: 1 S 135 BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 308
Project: Westside Endodontics Subdivision: TIGARD MEDICAL MALL Lot:
Project Description: Push /pull 3 ton gas pack.
Contractor: WILLAMETTE HVAC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY SKLARZ, ERIC
HILLSBORO, OR 97123 621 SW MORRISON ST, STE 800
PORTLAND, OR 97205
PHONE: 503 - 628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Specifics: Description • Date Amount
Type of Use: COM Permit Fee 05/18/2011 $254.98
Class of Work: ALT Type of Const: Plan Review 05/18/2011 $63.75
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 05/18/2011 $30.60
Stories: COT Address Fee 05/18/2011 $50.00
Project Valuation: $6,680.00
Fuel Air Handlers
Fuel Types: Natural Gas 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 $399.33
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
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 N cation Ce r. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0090. You may pbtain a copy of the rules
or dir questions to OUN a ing 3.232.1987 or 1.800.332.2344.
Issu d By: Permittee Signature: y• 11/1„,1
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 A 1 1 lication FOR O T Permit No.: OFFICE, USE ONLY ,y
III g 1 � ""- � (�
City of Tigard t I�
DateiB v�d � ® J/ LY � �f�ll -€30 .0 ,2?
q 13125 SW hall Blvd., Ti ard, OR 97223 Plan Review
- Other Permit.
'" Phone: 503.718.2439 Fax: 503.598.1960 Date /By:
TIGARD Inspection Line: 503.639 MAY 8 20 Date Ready /By. luris 0 See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
CITY
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�- : C0141NIERGIA S EE* SCHEDULE USE CHECiC1,15
" ' n" 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: $ f: r: '''',1':' ,.CATEGORY _OF .CON ,, ., • , Ili z
�•x
<. ;, s �RES[DE N TIAL E QUIPMEN3' /.SYSTEMSFEE .,;,> �: °=
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
'„JO =';SITE '''INFORIYIA'" '' AND,,LO'GA ION '''''
Heating/cooling:
- • -• -- �• � �" Air conditioning
Job site address: 9735 SW Shady Ln (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75 •
City /State /ZIP: Tigard OR Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 308 Project name: Westside endodontics 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: Lot no.: Flue /vent for any of above ❑ ❑ ❑
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF ; _<:, °, „' ' Water heater 23.32
Gas
push /pull 3 ton gas pack Flue vent fireplace f o e
for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
:> , , • • , V) ,,, ,.( fix) Chimney /liner /flue /vent 23.32
t 'R . OPE �` 1 : , ° TENAN1I>', : w` ` � : _
Other: 23.32 •
Name: Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39 •
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
ice•' -- ❑ _„ s '',!' ❑. Attic /crawlspace fans 23.32
e API?LiG'YNT.. CONTACT'PERSON � >, ".::��`,
Business name: same as below Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
, ,,./:, ,\,. w . "'% "' COVTRA T.OR ', ;z', ' . Barbecue
Business name: Willamette HVAC, LLC
Clothes dryer (gas)
Other:
Address: 307.5 SW 234 Ave Suite 206 „' 1 i .HA
,. ,;,,. y ,,
MECArICAI,!PERMIT 1, , .. ' ='� �3:��`-
City /State /ZIP: Hillsboro, OR 97123 Subtotal a6-€, 4V
Minimum permit fee ($90.00) i
Phone: (503) 628.6841 Fax: (503) 848.2597 Plan review (25% of permit fee) 4 5.
CCB lie.: 56951 State surcharge (12% of permit fee) a g (06
c TOTAL PERMIT FEE 3c�c'. 3 2
Authorized signature: This permit application expires if a permit is not obtaine within 180
days a i t has been accepted as complete.
Print name: Michael Malstrom Date: 5 /9/11 * Fee methodology set by Tri- County Building Industry Service Board
l: \Budding \Permits \MEC- PermitApp doc 09/09/10 440 -4617T (11/02 /COM/WEB)