Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2011 -00273
1312 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
TIGARD 9 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Store Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: Installation of split system.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: PPR WASHINGTON SQUARE LLC
4474 SE MILWAUKIE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97202 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
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PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/21/2011 $439.15
Class of Work: ALT Type of Const: IIB Plan Review 06/21/2011 $109.79
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 06/21/2011 $52.70
Stories: 2 Info Process /Archiving - Lg Sheet (over 06/21/2011 $2.00
11x17)
Project Valuation: $13,600.00 Info Process /Archiving - Sm Sheet (up to 06/21/2011 $8.00
11x17)
Fuel Air Handlers
Fuel Types: Units < 10000 cfm: 3
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: 1
Appliances
Vent Fans: Vent Systems: Total $611.64
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You ay obtain a copy of the rules
or direct questions to OUNC by calling 503.232,.!; or 1.801 3 _ • .
Issued By: v �'� ' Permittee Signature: ' ; ��' 1 / � ' „` / ,
C • - 75 by 7:00 a.m. for the next available inspection date. ` L
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.
I _ y Mechanical Permit Applon 4 \'' l�t-�'' FOR OFFICE USE ONLY'
111 City of Tigard �� Date/By d Permit No.: '2, .....40 . q 13125 SW Hall Blvd., Tigard, OR 97223 1 5 20\1
t Plan Review V , +
Phone: 503 Fax: 503.598.1'9 0 I DateBy: ' ` Other Permit:
TI GA RD Inspection Line: 503.639 Tx,, OF TIC Pd' D Date Ready /: y ( / / , Juris ® See Page 2 for
Internet: www.tigard- or.gov , �11 p 4 15151 011 Notified /Method: ( 0 7 4 Supplemental Information •
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Mechanical permit fees* are based on the value of the work
❑ New construction VA Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
3 .. .. Value: $ � �(QC0 , O
LATE YO12Y OF �COIVSTItLIC aI N' :
.. �>� -F 4 � 0 .. ^•', a° " > ;«• SD IENTIAL -E UIPMENT: /E SYST, S S •.
❑ I- and 2- family dwelling izr Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total
.e,. f :- ,:, , i .'•t Heating/cooling:
JO IIVF`OTLIYT" LC}CATIQN. ;
^ !;e, „:._ �`��� - -^ ., w _ : >...: _ x •.> •,�, >�,�_ m,> :• �,.,,,, � .. e . _ �_ _`. ° .:.
"� Air conditioning
Job site address: \ (requires site plan showing placement) 46.75
q5�0 I�.Y1S11(,r�
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: -- Tigard , c
1`,_ q a 2- ) Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: �P Heat pump
1 (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
(1 \ ” r- on + `A 1 \ -� �� Hydronic hot water system 23.32
Vv �Y Residential boiler (radiator or
fi n ��,r 1 , hydronic) 23.32
_�— _, 1�l Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.:
Other fuel appliances:
`:` Water heater 23.32
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.., z-•''�::�� : >i . ...�:tt;. -, ^ -. .:4. , . • aka.. � > �: •_� �_•, , : �,� ;,�r�'s .
�,., .tip � , ..... .. .. .. ... s� „
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
,- y user /flue /vent
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PRO P It RT�Y .9)Y: V ER ` ' T ? ; >'
Other:
Name: Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
._. ®•APPLICANT:.. ^ _= i ? > CO NTA CTrP ER S ON `- =:n` << Attic/crawlspace fans 23.32
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Business name:
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
;' iifi GONTR 1CT .. Barbecue
Business name: it C. ill , 1 a „- Pt( - Clothes dryer (gas)
L4Lfl �. p '!
Address: p, I p Other
1"51 I UVC1�, k,�� [ 1VC / _ �,' �, '`NECIIANICAL�PERNIIT�F EES'��, ,� >0`
City /State /ZIP: r tiiknOt t O q ' l � (J ' . Subtotal
Phone: ( . ��) Fax: C�`�I L , 53' Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: J Li 14 1 State surcharge (12% of permit fee) / f
TOTAL PERMIT FEE �� ` `
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Authorized signature: P G /i n ' /y am n ` t 1 This permit application expires if a permit is not obtained wi hin 180
L/t IY.V I f .XL-0
days after it has ha has been accepted as complete.
Print name:' -g g ! as A y U r • Date: , . , 1 I * Fee methodology set by Tri- County Building Industry Service Board
1 .\Building \Permits \MEC PermitApp doe 09/09/10 440 -4617T (11/02 /COM/WEB)