Permit CITY OF TIGARD MECHANICAL PERMIT
°F 1 a COMMUNITY DEVELOPMENT Permit # MEC2011 -00468
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/25/2011
Parcel 2S113AA00300
Jurisdiction Tigard
Site address 16330 SW 72ND AVE B3
Project A Cut Above Subdivision ROSEWOOD ACRE TRACTS Lot C
Project Description Bathroom fan installation
Contractor GOHMAN MECHANICAL Owner. PACIFIC REALTY ASSOCIATES
14505 SE HWY 212 ATTN N PIVEN
CLACKAMAS, OR 97015 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE 503 - 658 -1892 PHONE
FAX 503- 658 -6925
FEES
Specifics Description Date Amount
Type of Use COM Permit Fee 10/25/2011 $69 06
Class of Work ALT Type of Const 12% State Surcharge - Mechanical 10/25/2011 $8 29
Occupancy Grp Occupancy Load
Stories
Project Valuation $450 00
Fuel Air Handlers
Fuel Types Units < 10000 cfm
Gas Pressure Units > 10000 cfm
Furnaces Boilers 8 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 $77 35
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 -0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987. ° •! • •
Issued By / / . - Signature:
Call 50 y 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 FOR OFFICE USE ONLY
City of Tigard ® Date/By Received I0 M
Date/By /r 7/ Permit NO . _
,iw u 13125 SW Hall Blvd, Tigard, OR 9722 V (s/ , " �(Dr
•• ° Phone 503 718 2439 Fax 503 6 960 Plan Review Other Permit
'�
T I GAR U Inspection Line 503 639 417 ( r t,� \
Date Ready /By IN ® see Page 2 for
Internet www Tigard -or gov ,r 9 SO Notified/Method Supplemental Information
TYfE OF WORK Ot.f.Q \Vv� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
L —F � ' / y i x • xV 1... Mechanical permit fees' are based on the value of the work
p New construction Addition /alteratsQn performed Indicate the value (rounded to the nearest dollar) of all
% Uxy mechanical materials, equipment, labor, ovefhad, and profit
❑ Demolition ❑ Other '�1�� —C/\
Value $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
(J
❑ I - and 2 -family dwelling Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other Description Qty Fa fatal
JOB SITE INFORMATION AND LOCATION Heating/touting:
S' `� �J / r� Air conditioning
lob site address I (n3 3 O V (/V / O"c 5-4--- (requires site plan showing placement) 46 75
r Furnace 100,000 B I U (ducts /vents) 46 75
Gty /State /ZIP
I ) 01 {a ,' Furnace 100,000+ BTU (ducts /vents) 54 91
Suite /bldg /apt no I 3 Project name A C - A bout • Heat punt')
(requires site plan showing placement) 61 06
Cross street/directions to Job site Duct work 23 32
I lydronic 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 2332
/�
Gas fireplace 33 39
—I- P- Ras 172-00/14. F4grJ Flue vent for water heater or gas
weN% l M.'? , fireplace 2332
Log lighter (gas) 23 32
Wood /pellet stove 33 39
Wood fireplace/insert 2332
❑ PROPERTY OWNER El TENANT Chimney/liner/flue/vent 23 32
Other 23 32
Name Environmental exhaust and ventilation.
Address Range hood/other kitchen
equipment 33 39
City /State /ZIP Clothes dryer exhaust 33 39
Single -duct exhaust (bathrooms,
Phone ( ) Fax ( ) toilet compartments, utility rooms) I 23 32 )3, 3)
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23 32
Business name Other 23 32
Fuel piping:
Contact name $14.15 for first four, S4 03 for each additional
Address Furnace, etc
Gas heat pump
City /State /ZIP Wall /suspended/unit heater
Phone ( ) Fex ( ) Water heater
Fireplace
E-mail
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name
(jphnno, n nnec,ha ry } c ) Ant , Other
Address /e.E S o' S£ 1--it Way a, a MECHANICAL PERMIT FEES*
City /Stale /ZIP ( M,aat4 -y'%n A'S D Subtotal
0S5- �SLn d Fax (303 t (�- c �7 Minimum permit fee ($90 00) fiJf{. U6' I
Phone (9)3)
5 l s Plan review (25% of permit fee)
CCB lic I I q 5 S o2 State surcharge (12% of permit fee) $ -1
TOTAL PERMIT FEE 1 77. '' ,j ` - ''
Authorized 51 ure / This permit application expires if a permit is not obtained within 180
g / � days aver it has been accepted as complete.
Print name if Mar C ca o h /t^,( /' Date / --42 --42 s a / I ' Fee methodology set by Tn- County Building Industry Service Board
11BuildiagWermits \MEC PermitApp doe 09/09/10 4404617T (I l /02/COM/WBB)
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
$500.0 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.
1 1Baddmg \Perm,ts \ MEC- PennitApp doe 09/09/10 2