Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2012
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY M
Project: Sushi Hanna Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: TI
Contractor: H M & V CONSTRACTORS Owner: PACIFIC CROSSROADS PROPERTIES IN
PO BOX 1231 BY WYSE INVESTMENT SERVICES CO
CLACKAMAS, OR 97015 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 734 -4490 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/25/2012 $487.41
Class of Work: ALT Type of Const: VB Plan Review 01/25/2012 $121.85
Occupancy Grp: A-2 Occupancy Load: 12% State Surcharge - Mechanical 01/25/2012 $58.49
Stories: 1 Info Process /Archiving - Lg $2.00 (over 01/25/2012 $4.00
11x17)
Project Valuation: $15,478.00 Info Process /Archiving - Sm $0.50 (up to 01/25/2012 $14.00
11x17)
Fuel Air Handlers
Fuel Types: 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 $685.75
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Make up air
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. Y•u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.198 • • •
.. — r J
Issued By:410
� � � __ -- P-rmttee Signature:
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 .� V FOR OFFICE USE ONLY
of Tigard -A,�I R eceived permit No.:
'� 13125 SW Hall Blvd., Tigard, OR 97223 s r ` Date /By: _ ���� 714 7•, � Plan Retie Other Permit: / /.
IN
_ 96
Phone: 503.718.2439 Fax: 503.598.10 3 Date/By: 1 �
Inspection Line: 503.639.4175
T I G A R D P 12 A` Date Ready /B �� See Page 2 for
Internet: www.tigard /3 I1G�R 0,` Notified/Method: � : S Informati
ANN- O � nl v �sl . --
TYPE OF WOR `�, „, -,� COMMERCIAL FEE* SCHEDUL - USE CHECKLIST
.” Mechanical permit fees* are based on the value of the work
c ' 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: $ (3 Si 7S
CATEGORY OF CONSTRUCTION RESIDENTIAL.EQUIPMENTJ SYSTEMS FEES*
❑ 1- and 2- family dwelling 5 J 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: j/ W S L' fe,:r .� C r7 �' , ( ()Li 1 — a (requires site plan showing placement) 46.75
City /State /ZIP: � Furnace 100,000 BTU (ducts /vents) 46.75
l iri ( Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: &lc b /" 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
/ / / ` / Gas
i / fireplace 33.39
/ y/ f S rl �✓ ✓i G3 l Yea./ ` I / Z / /� _ T 770/ ` I e - Flue vent for water heater or gas
/ylSA,L C )i / )4,-,..„ )4,-,..„ !/-f/y /.(e -- ✓j!1 (�/ 2/ Loog g
fireplace lighter 23.32
ghter (gas) 23.32
( YI S •44 kA:flA G i 40..,... E X k 4Cf(}5 I' / 4 ( vt Wood /pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ 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
N Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
t
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: ay / 0 vp s Fuel piping
fik Contact name: �� J��� $14.15 for first four; $4.03 for each additional
Address: nn Furnace, etc.
V` !� • '). t3e) / /03/ Gas heat pump
0 City /State /ZIP: c L / ,.� Wall/suspended/unit heater
Phone: (,....3 ) 73 / 6 /4( 9V ,� Fax: : ( ) Water heater
171 y c / Fireplace
E -mail:
/t U (r0✓,f4' 10/5 �' yrif f , CG> ✓�' Range
g
/../ fry CONTRACTOR Barbecue
/ Clothes dryer (gas)
Other:
Business name: \ ��� 1i� ��, j
n � n
Address: l� Soy / Z3/ ( A y . f . G ,,�,� ( '7 '- )/S MECHANICAL PERMIT:FEES*
City /State /ZIP: J '� / Subtotal
Phone: (E3) '31./ ZJ4' 9'') Fax: ( ) Minimum permit fee ($90.00)
review (25 %of permit fee)
)
4),9......„ lic.: j g -29 / g . 9'/I °L, State surcharge (12% of permit fee)
( 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: C.`_, (U 7.1.e_. Date: Q/.— /3 -- 26 z * Fee methodology set by Tri- County Building Industry Service Board
C\ Building\ Permits \MEC- PermitApp doc 09/09/10 440 -4617T (I 1/02 /COM/WEB)
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.
L \Building \Permits \MEC- PermitApp.doc 09/09/10 2