Permit ,, CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2011 -00298
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2011
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14411 SW PACIFIC HWY
Project: Rialto Subdivision: CANTERBURY SQUARE Lot:
Project Description: New gas line to service kitchen appliances under new Class I hood.
Contractor: PROKITCHEN LLC Owner: KOLVE, G C
5591 SE DEL RIO CT 14389 SW PACIFIC HWY
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503 - 530 -6428 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/28/2011 $96.69
Class of Work: ALT Type of Const: Plan Review 06/28/2011 $24.17
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 06/28/2011 $11.60
Stories: Info Process /Archiving - Sm Sheet (up to 06/28/2011 $0.50
11x17)
Project Valuation: $1,400.00
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 $132.96
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: 6 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 " ' ca ion - • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir-ct questions to OU b ca • 13.232.1987 or 1.800.332.2344.
Iss ••d By: • / , Permittee = gnature:
Call 503.639.4175 by 7:00 a.m. for the next available inspec n date.
This permit card shall be kept in a conspicuous place on the job site a it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicati `II W CEIVED FOR OFFICE USE ONLY
II Cl of Tigard Received / ® / Permit No.: f/g l ,/ /J Fi
° 131 Hall Blvd., Tigard, OR 97223 JUN 2.8 2011 Date/By: C! �(�' C/1
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit:
f I G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: furls: El See Page 2 for
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Internet: www.tigard- or.gov
BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL 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: $ l l `'tom . tl
CATEGORY OF CONSTRUCTION RESIDENTIAL.EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling fal 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: k t.t l\ Ilk � , ,�' ti (requires site plan showing placement) 46.75
v Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: --` ic a.c Cr\ , C -? LZ rj, Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt.no.: Project name: - 2,, 6, AO rpc,(t1 2zby,,.1 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 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
• \ t, Gas fireplace 33.39
- p,, t --1 11.., 1/1 Q.,� l V TS ic-4_1C_ r l(� �t.. S L-t --1 Flue vent for water heater or gas
70 'L - u (a. j 404 z 1 ^ c P p l. t A ti, to. C t �,." t_C fireplace 23.32
_ Log lighter (gas) 23.32
� - x_ 1. QA P S S •�.... 1 UD Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
I � Other: 23.32
Name: 2 i ( i F !. 0 tk Environmental exhaust and ventilation:
Address: (� l l W Range hood/other kitchen
� 1 C �, t equipment 33.39
City /State /ZIP: �� _f� � 2 Z. 4 Clothes dryer exhaust 33.39
Q' 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: $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
CONTRACTOR Barbecue
Business name: ? 1 I VA,--\ - Clothes dryer (gas)
Other: tk.i Cu ICI b,l..
Address: . MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: Fax: Minimum permit fee ($90.00)
( 3) 3 p - C Q L ` ( ) Plan review (25% of permit fee)
CCB lie.: 19b 4,, Z State surcharge (12% of permit fee)
TOTAL PERMIT FEE 4.1.,Y
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 1
l� rte L � ✓ jZ C � rr o � Date: � -•�,_ / l
* Fee methodology set by Tri- County Building Industry Service Board
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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.
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