Permit a CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2009 -00250
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009
Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10260 SW NIMBUS AVE M4A
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: Pro Video
Project Description: Relocate (2) registers.
Owner: FEES
ROBINSON, CONSTANCE A & Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT
Permit Fee 06/01/2009 $72.50
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Mechanical 06/01/2009 $8.70
PHONE:
Contractor:
GUILD CONSTRUCTION INC
PO BOX 674
BEAVERTON, OR 97075
PHONE: 503 - 957 -1173
FAX: 503 - 291 -1532
Type of Use: COM .
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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�6f iication - .ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or ect q uestions to • ■ ' by - g 503.246.6699 or 1.800.332.2344.
I sued By: ` // y Permittee Signature: . t i c
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.
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Mechanical Permit Applicati ?EC l / r FOR OFFICE USE ONLY
Illq City of Tigard
I. V ', ' "� " �` Date/By: Permit No.: W Ee pt: �J 9_., d • 13125 SW Hall Blvd., Tigard, OR 97223 JUN 01 20 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
TI G A R D Inspection Line: 503.639 Date Ready/By: h�ris: ® See Page 2 for
�?�
Internet: www.tigard - or.gov CITY T GAAD Notified/Method: / t oo Supplemental Information
1)11,X,\iq DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ 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.
CATEGORY OF CONSTRUCTION Value: $ C)ilD(t..
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
Master builder For special information use checklist.
M ulti -famil
❑ Multi-family ❑ ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 D Vl) / Al. 4,14 A 1) Air conditioning or heat pump
(requires site plan showing placement) 14.00
Furnace 100,000 BTU (ducts/vents) 14.00
City/State /ZIP: D l ►� � 5 D� Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: MC/ A Project name: p VT v)e/I "CD 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
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
R j Gas fireplace 10.00
e- e- tCect:e -e-2C /.d I id, G Z -Ld Flue vent for water heater or gas
✓ � G fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
q PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00
A,- / Other: 10.00
Name: eft ;1SDK / _ i4sYA.wc A,- l!6�K X 3JNtcQ" Environmental exhaust and ventilation
Address: / � Range hood/other kitchen
1 D 2 �l D $ �/ L�,�1 A equipment 10.00
City/State /ZIP: PO Y').1dt K, IL' Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
t Other: 10.00
Business name: ra k) t /� ��e�
Fuel t
�` piping
Contact name: K.G 1 k X0,, ZY $5.40 for first four; $1.00 for each additional
Address: PO /3 p /97 Y Furnace, etc.
Gas heat pump
City /State /ZIP: A in) v - / 0 i IL_ Wall/suspended/unit heater
Phone: (6j9 — 13 " ) _ f / �� Fax: : ( 03 2 ' i — >S 3`_. Water heater
_Fireplace
E -mail: Range
,,,000 i1 CONTRACTOR Barbecue
Business name: /^ , e v , 5 4,, K ( 7 ) by � �e_
Other: dryer (gas)
`/
Address: p 6 7 V MECHANICAL PERMIT FEES*
City /State /ZIP: 8 i9 � • 0t✓vio K Cit. -C l0T s ^6 Subtotal n
Minimum permit fee ($72.50) 7�
Phone: (5 D3) q 3' 7 — ) / 1) Fax: (S®3) 2' / —/ S 3 Z Plan review (25% of permit fee)
CCB lie.: /0q)/6 State surcharge (12% of permit fee)
TOTAL PERMIT FEE 0 / , ao
• h s This permit application expires if a permit is not obtained within 180
Authorized signature: ✓ . t J days after it has been accepted as complete.
name: K.,,V l ..„, K d y (/` Date: /„ -) : 0 1 • Fee methodology set by Tri- County Building Industry Service Board
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I:\ Building ermits\MEC- PermilApp.doc 01/19/07 C 440-4617T(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$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
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$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.
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