Permit •
y CITY OF TIGARD MECHANICAL PERMIT
.- COMMUNITY DEVELOPMENT Permit #: MEC2011 00587
13125 SW Hall Blvd Tigard OR 97223 503.718.2439 Date Issued: 12/27/2011
''TIGARD Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11701 SW PACIFIC HWY
Project: Arby's Subdivision: 2006 - 016 PARTITION PLAT Lot: 3
Project Description: Replace existing gas rooftop unit.
Contractor: BLAIRCO INC Owner: PACIFIC CROSSROADS PROPERTIES IN
7609 MACARTHUR BLVD BY WYSE INVESTMENT SERVICES CO
VANCOUVER, WA 98664 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 360 - 695 -1476 PHONE:
FAX: 360- 699 -9310
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/27/2011 $347.71
Class of Work: ALT Type of Const: VB Plan Review 12/27/2011 $86.93
Occupancy Grp: A -2 Occupancy Load: 12% State Surcharge - Mechanical 12/27/2011 $41.73
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 12/27/2011 $12.50
11x17)
Project Valuation: $10,000.00
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 $488.87
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: curb adapter
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 b calling 503.232.1987 or 1.800.332.2344.
Issued By: y' Permittee Signature: t
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 Application . • FOR OFFICE USE ONLY
R
City of Tigard
Date/By: �� PermitNo.: /
M il I
13125 SW Hall Blvd., Tigard, OR 9722 ECEIVED y. ��� '� `
Phone: 503.718.2439 Fax: 503.598.1 Plan Received
evle \ Other Permit: DateBy�G�,�
TIGARD Inspection Line: 503.639.4175 Date Re 11:3 1 Juris: ® See Page 2 for
Internet: www.tigard- or.gov DEC 2 0 2011 Notified/Method•) el 1/ r Supplemental Information
f i1 n i OF TICARD - 4' � �
' n .s " T.l'PE OF W tFI✓r OMMERC IAL ,FEE *. SCHEDULE - 'USE
f �i LDING! D i v in Mechanical permit fees* are based on the value of the work
New construction _ Addition /altera ` t o n replacement performed. Indicate the value (ro ' • -. - ear- dollar all
❑ Demolition ❑ Other: .r. echanical materials, ea �. ent, labo - ' - r eas, and profit.
.. .7 4 i tailL Ar Value: $ `el2CJ
- °, ., CATEGORY..OF, CONSTRUCTION '. RESIDENTIA . EQUIP,MENT„ /SYSTEMS FEES* _ =
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special in • lion use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description j Qty. - Ea. Total
:.•.' JOB SITE`_ INFORMATION -_AND` LOCATION -; Heating /cooling:
Air conditioning
Job site address: // 70 / 5 t ,/ /,4 L Z 1.( ( //, / (requires site plan showing placement) 46.75
City /State /ZIP: f <4 A 0 / 12 d 7 7 2. Z 3 ' Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91 1
Suite/bldg. /apt. no.: Project name: 4 2 /3 v ' 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:
°DESCRIPTI,ON;OF' :WQRK° _ '; �' " .- . " Water heater 23.32
Gas fireplace 33.39
RE, e /zc, £ lc . Z r ,1 Ai C 6 5 ,>R Od / Flue vent for water heater or gas
7p el A/ f, f fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
❑ ��P.ROP.ERTY OWNER A.' - _r <. - ' ' . '❑ ,T,ENANT ,� � Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Phone: Single -duct exhaust (bathrooms,
( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑,,,APPLICANT ' - - ❑ ,CON TACT . PERSON, ' s Attic /crawlspace fans 23.32
Business name: 6 L d �. C t, r� Other: 23.32
Fuel piping:
Contact name: S7'", f U liz ,� 44 r/71. b r., A_ ,L tL $14.15 for first four; $4.03 for each additional
Address: 7‘01 G' 44 L 4 117 L ,V Furnace, etc.
w
Gas heat pump
City /State /ZIP: l/4yee24 f/,J it ter ig /l ' e 6 Wall /suspended/unit heater
Phone: (340 ) 495_ /q 76' Fax:: (R 6.99- fe3 /67 Water heater
Fireplace
E -mail: 5 t2ZG4. 4 & W y sp 4514 ea / - /k' lJ tN'6 r CO/V\ Range _
. " . , , _ - -. • - CONTRACTOR °,',. " , . Barbecue
Business name: J� /4 GD Clothes dryer (gas)
Other:
Address: J(e, 9 4, /,�.�iJX�nkL v MECHANICAL FEES* .
e
City /State /ZIP: Subtotal
i/R w ��66 q` ,,00��
Phone: ( 360 ) 4 /i 176 Fax: (N6 ) x? r_ C l3C CJ Minimum permit tee ($90.00)
Plan review (25% of permit fee)
CCB lie.: " C� S 75 Q State surcharge (12% of permit fee)
49� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: t /- ' 1'/E eZ c 12- Date: /2 -, 1 q,-// * Fee methodology set by Tri- County Building Industry Service Board
(:\Building \Permits \MEC- PermitApp doe 09/09/10 440 -4617T (I I /02 /COM/WEB)