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Permit a CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 00062 Date Issued: 02/02/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113AA01000 Jurisdiction: Tigard Site address: 16578 SW 72ND AVE B9 Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C Project Description: TI 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: 503 - 624 -6300 FAX: 503 - 658 -6925 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 02/02/2012 $285.89 Class of Work: ALT Type of Const: IIIB Plan Review 02/02/2012 $71.47 Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 02/02/2012 $34.31 Stories: 1 Info Process /Archiving - Lg $2.00 (over 02/02/2012 $2.00 11x17) Project Valuation: $7,800.00 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 $393.67 • Hoods: Comm Incinerators: Required Items and Reports (Conditions) Woodstoves: Gas Fireplaces: 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 follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -0s -0090. You ma o•tain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. left - J ar Issued By: • •rmittee Signature: �� Call 50 &Mr .y 7:00 a.m. for the next available inspe ion 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 Received '4\1°) Date /By: '� xT' Permit No.: 13125 SW Hall Blvd., Tigard, 97223 ��! ' iii C Da Plan �, Othe Permit: 8 / f � . >> 1 Phone. 503.718.2439 Fax: 503.598.19 Date/By: drlkl T LGA R D Inspection Line: 503.639.4175 � ,�01`l, Date ReadyBy: JJJ kids: Iiii See Pag for Internet: www.tigard- or.gov `` . Notified/Method: �' /� / 1 877— — p7.6 Supplemental Information TYP F WORK C `�t a s v COMMERCIAL FEE* SCHEDULE — USE CHECKLIST r� � Mechanical permit fees* are based on the value of the work ❑ New construction ddition /alteration/repluce W performed. Indicate the value (rounded to the nearest dollar) of all ❑Demolition 0 Other: V) AV' mechanical materials, equipment, labor, overhead, and profit. Value: $ • CATEGOR CONSTRUCTION RESIDENTIAL EQUIPMENT / YSTEMS FEES* ❑ 1- and 2- family dwelling 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: / 6 R S 7 1v 0 /L . (requires site plan showing placement) 46.75 City /State /ZIP: � ✓ - ` J 7 w Furnace 100,000 BTU (ducts /vents) 46.75 / i X 7a TZ D a a 7 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: 61 Project name: Sp�� < Heat pump vv l (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 fireplace 33.39 — ,f7z - mot/ / k0UC 1 yl On. l ^ p - ' E pi P/ iv Flue vent for water heater or gas _ 7- �.� ` V 5 fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: /D/2 ��0 5 / Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Fax: Single -duct exhaust (bathrooms, Phone: ( ) ( ) 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 E -mail: Fireplace Range CONTRACTOR Barbecue . Business name: �©Aj �'YL d-r,./ /1 e --Z-',--1/<--- Clothes dryer (gas) Other: Address: /c/5-- O S S . Lt- , 7, ,..2 / 2 MECHANICAL PERMIT FEES* City /State /ZIP: e_L.4 c ,&, „a �%L ,70 /S— Subtotal Minimum permit fee ($90.00) Phone: (5 g. ) 3 - - - 1/4 z _ / fi e a Fax: ( 1) 3 ., GI Plan- review- (25 %of- permit- fee) - CCB lie.: / / e: 9S1,2_ State surcharge (12% of permit fee) TOTAL PERMIT FEE �y�, 6, 7 � This permit application expires if a permit is nut obtain d within 180 Authorized signature: days after it has been n accepted as complete. mplete. Print name: 3-----.2. ‘5y,1 v /.y �, -v`T' Date: ,V37/ ` / � * Fee methodology set by Tri- County Building Industry Service Board C\ Building \ Permits \ME 0 C- PermitApp.doc /009/10 ` 4 0 -461 T (11 //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. 1.\Buildin \Permits \MBC- PermitApp. 09/09/10 2