Permit „, ''.., CITY OF TIGARD MECHANICAL PERMIT
IN d. t Permit #: MEC2009 -00403
COMMUNITY DEVELOPMENT
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
T iG A� �?. Parcel: 2S 104 DC04100
Jurisdiction: Tigard
Site address: 13534 SW CLEARVIEW PL
Subdivision: Lot: 0
Project: Beale
Project Description: Install refridgeration lines for (3) ductless split systems.
Owner: FEES
BEALE, ALLEN M & Description Date Amount
13534 SW CLEARVIEW PL
TIGARD, OR 97223 Other, Heating /Cooling 08/05/2009 $30.00
12% State Surcharge - Mechanical 08/05/2009 $3.60
PHONE: Minimum Fee Adjustment - Mechanical 08/05/2009 $42.50
12% State Surcharge - Mechanical 08/05/2009 $5.10
Contractor:
ROSE CITY REFRIGERATION HTG & AIR
PO BOX 19207
PORTLAND, OR 97280
PHONE: 503 - 636 -5371
FAX: 503 - 655 -4669
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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 $81.20
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699or 1.800.332.2344.
Issued By: V cA In p k UliU.A-) Permitte e Signature:
” 1h �
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 FOR OFFICE USE ONLY
City of Tigard Ei CEIV° `eeBea y' ' Pe No : 700 lo 0
1 13125 SW Hall Blv1d., Tigard, OR 97223 ,,
' . NU Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
1 1 i i DateB
�' ` Other Permit. � LI Z �� • GG 3 `��
Inspection Line: 503.639.4175 7 20 Ready/By: El 0
Date/By:
Read See Page 2 for
TIGARD Internet: www.tigard or.gov • Notified/Method: Supplemental Information
CITY OF TIGAR r •
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❑ New construction ig] Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition - ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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, ; =. [ CAT,EG.C)RY GONSTRUCTxON` ., � ,,<
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1 -and 2-family dwelling ❑Commercial /industrial ❑ Accessory building " �-, ID NT MVIZ /`S STEMW -P 4
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
;xtr: �•. _: "?;; -.� s wxx. , r�, �. .: : =r = .z .,»< ; ��ax�.+�,,,r =a, °s g ar q ,+.- a,. ro„- xi^z saa a� � . ,,�, nom..: =sR � t��r x%.
i * ' 'V s ry J CI B, STT�E ,INFORMASTI AN D L'UC O t §<,: :, n ...,, =a' Heating /cooling
Job site address: / 3 53 ci 5 � C/ �vie ,9 J ' e Air conditioning
fires s to plan ng or showing p pump
l/ (requires site Ian showin placement) 14.00
City /State /ZIP: 77". I l� 9 7Z2 3 Furnace 100,000 BTU (ducts /vents) 14.00
/ Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
`,,,iv',: ? "% ;a: ti<. »wa - {' 9.n - :cm r rt ac.- : ea: va r�.- :wemv:% ..rx c, x �4^ - } , ,, � -
� � � �, ��a" �c�. � ��~� Water heater 10.00
.: '.:f' a , ;,.; s ' ; D JCRIP OF WCIRK . : », :' ?I, ":� �+ � k
. . �£ Gas fireplace 10.00
f / ,' y4 i e..,s,"F(O el L / j -3s�r- Flue vent for water heater or gas
�/ fireplace 10.00
Gt aci -� 5,4 t 6�J.S 4 m. T Log lighter (gas) 10.00
/ Wood /pellet stove 10,00
Wood fireplace /insert 10.00
n = . b ,,: x,. :. ;., v, ::,:g-wr
Chimney/liner/flue/vent 10.00
` ; `PRO O N Ii ° ,, , ;n fir -x,
.a Y
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_- �== ;�`�.. z , �d . .. ?,3=.,, � _ -- •� arr�»;.: _ _ - .a, . _,,. ,€_., . �,>ax�, ,'�r,:,a �-� Other: 10.00
Name: / / €4i /i?e {t e_ Environmental exhaust and ventilation
42 Range hood/other kitchen
Address:
J3 S 3 / so- C/ die t / //a C e equipment _ 10.00
City /State /ZIP: / , ' _�,W 0e 9 7 2z3 Clothes dryer exhaust 10.00
, j J ■ Single -duct exhaust (bathrooms,
Phone: (So 3) 5 `j 4012 73 Fax: ( ) toilet compartments, utility rooms) 6.80
:,:g" . :.:::......:..:?:.s.;: .: ;r - xecc eap k ;,;"d z "=x":a ``::=n � .��:"; . .si - „x:, t : �.S;v-.'t4 IT3..11i
`_ ,t ° , , .k 0 ; , - „, n� s : [- C Attic /crawlspace fans 10.00
''� { fl bra
/S 6;47 - n.. n Other: 10.00
Business name: ifOSe /_,/ �/% //e Fuel i io
PP 1;
Contact name: 1. 7�"G W $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: (50y) 5/9 _ 1 3 3 a Fax: : ( ) Water heater
Fireplace
E -mail: Range
h".,tii:" 2+ ;.f.. ='TT. ,,
} . 4 s a.. .: " sA,. ;., ro CONTRACTOR `, '. Z �' e xa',, ': Barbecue
Clothes dryer (gas)
Business name: f e C, A � .0 A{/e
d S ` j Other:
Address: t�d g / 20 7 I v ET2� FEES* , ;
City /State /ZIP: ,e, r f /zi-1 Q, g 72FC) Subtotal
/
rO /� S Fax (S - S) _ _ c Minimum permit fee ($72.50)
Phone: (k
4v �- 3 7 t� S S - ��O / Plan review (25% of permit fee)
CCB lie.: /6,3 2 S State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized Signature: ` - This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Fee methodology se t by Tri -Count Building Industry Service Board
Print name: tea/ /� j,-� � Date: 8_,---_,,,, * BY y Y g ry
I'\ Building \Permits \MEC- PermitApp.doc 01/19/07 440 -4617T (11 /02 /COM/WEB)
•. ., •
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Apiivait-Fee•t''':""''' 4 ' " • •
.
$1.00 to $2,000.00 Minimum.fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1: \Building\Permits\MEC-PermitApp.doc 01/19/07 2