Permit 1,1 n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Pe rmit #: MEC2009 -00175
Date Issued: 04/22/2009
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S136AD04000
Jurisdiction: Tigard
Site address: 11505 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Pacific Terrace)
Project Description: Replace (5) vandalized RTU's.
• Owner: FEES
PACIFIC TERRACE COMMERCIAL LLC Description Date Amount
BY EDITA M SMITH, 833 NW 170TH DR Permit Fee 04/22/2009 $380.00
BEAVERTON, OR 97006 Plan Review 04 /22/2009 $95.00
PHONE: 12% State Surcharge 04 /22/2009 $45.60
Contractor:
• WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123 •
PHONE: 503 - 628 -6841
FAX: 503 - 848 -2597
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Natural Gas 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:
Alr Conditioning:
•
Heat Pump: '
Appliances
Vent Fans: Vent Systems: Total $520.60
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 -0100. You may obtain a copy of he rules
Issued B : 0 � / �� `, Permittee Signature:
V"
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.
Mechanical Permit Application FOR OFFICE USE ONLY
Iii
City of Tigard ► B L �� B 1 / B i - i Date
/By: , '' ei 7 </ / Permit No.:�G ")^:9 - 7'3'
I 13125 SW Hall Blvd., Tigard, OR • Plan Review y v
' Phone: 503.639.4171 Fax: 503.598. 9 pp Date/B / I 1� /PA Other Permit:
T 1 G A RD Inspection Line: 503.639 A� R2�1 2 Q @�9 Date ReadyBy: ' ff Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE �� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollai) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ $21,000.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 11505 SW Pacific Hwy Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: Tigard Or Furnace 100,000 BTU (ducts/vents) 14.00
7
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 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
Gas fireplace 10.00
Replace 5 RTU's like for like due to vandalism Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00 _
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: 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
Other: 10.00
Business name: Same
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Willamette HVAC Clothes dryer (gas)
Other:
Address: 3075 SW 234`" Ave Suite 206 MECHANICAL PERMIT FEES*
City /State /ZIP: Hillsboro OR 97123 Subtotal gep, (PC
Phone: (503) 628.6841 Fax: (503) 848.2597 Minimum permit fee ($72.50) CI"' t/
Plan review (25% of permit fee) 95 ell
CCB lic.: 56951 State surcharge (12% of permit fee) n ` 1/! • Cp
.-- n n TOTAL PERMIT FEE
Authorized signature: /u '7 This permit a expires if a permit is not obtained
wit in 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 4/21/09 • Fee methodology set by Tn-County Building Industry Service Board
I:\Building■PermilskMEC- PermitApp.doc 01/19/07 440 -4617T(II /02/COM/WEB)
.1114 ° Building Division
• Over- The - Counter (OTC) Mechanical Permit
T I G A K D Check List
Description of Project:
r i
PLIk
GENERAL INFORMATION
Class of Work:* Lr Floor Furnace: Evap. Coolers:
Type of Use:*
T tit
Unit Heaters: Vent Fans:
Occupancy Group: Vents w/o AppL: Vent Systems:
Stories: ( Boilers, Comp, Heat Pump, A /C: Hoods:
• Fuel Types: 0 - 3 HP: Domestic Incinerator.
ELC / GAS / OIL / OTHER 3 - 15 HP: Com. /Ind. Incinerator.
Max Input: BTU: 15 - 30 HP: Repair Units:
Fire Dampers: 30 - 50 HP: Wood Stoves:
Gas Pressure: H / M / L >50 HP: Clothes Dryer.
No. of Units: Air Handling Units: Other Units:
Furnace <100k BTU: <_10,000 CFM: Gas Outlets:
Furnace >_100k BTU: >10,000 CFM: 5" 0 S
Tot.3
Notes:
C _
INSPECTIONS I I FEES DUE
Post /beam mechanical $ Permit Fee
Gas line $ State Surcharge
Mechanical rough -in $ Plan Review Fee
Fire damper $ Additional Permit Fee
Duct work $ Additional Plan Review Fee
•
Smoke detector $ Investigation Fee
Investigation inspection $ Misc. Fee
Misc. inspection $ Hourly Rate Fee
Final inspection $ Hourly Rate State Surcharge
$ Total Fees Due
OTHER PERMITS REQUIRED I
Building Electrical
Plumbing Site Work
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
•
I:\Building\Forms \OTC - MEC.doc 09/22/06