Permit • -
q CITY OF TIGARD
MECHANICAL PERMIT
. 2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00358
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07!20(2009
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11701 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Arby's
Project Description: Replace rooftop unit with same.
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Description Date Amount
BY WYSE INVESTMENT SERVICES CO, 1501
SW TAYLOR ST STE #100 Permit Fee 07/20/2009 $206.30
12% State Surcharge - Mechanical 07/20/2009 $24.76
PHONE: Plan Review 07/20/2009 $51.58
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503 - 261 -9814
Type of Use: COM
Class of Work: ALT Type of Const: VB
Occupancy Grp: A -2 Occupancy Load:
Stories: 1
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 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 $282.64
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 to follow the rules adopted by the Oregon
Utility N. • cation Cen - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire ct questions to OUN . •.Alin 503.246.6699 or 1.800.332.2344.
Issued By: / A,C� Permittee S gn /. /�� ��`
Call 503.639.4175 by 7:00 a.m. for an inspection that busines(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 ApplicatioJ FOR OFFICE USE ONLY
g Date of Tigard • • • • • • Date ei�cd • f
�I 2 ,„ b p Perm ��VF�C/ it No.: ,t� ��sr
City :, : G (:�% �/ 46,
q i .
13125 SW Hall Blvd., Tigard, OR 97223 • • ' • • • • Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � � L• 20 2609 • Date/By, �� / '2 D Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready :y: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF 'WARD. otified/Method: Supplemental Information
BUILDING DIVISIt•)M • • • • • • •
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 CONSTRUCTIO
• • • • • • • • • • • • • Value: $ $8,581.00
N . •
• • ••• • • • • • • • RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ® Commercial /industrial €] Acssstebtylcring; : : • •
_ For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 11701 SW Pacific Hwy Air conditioning or heat pump
(requires site plan showing placement) 1 14.00
City/State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Arby's 448 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 exisitng 5 -ton gas /electric rooftop unit with new 5 -ton and economizer Flue vent for water heater or gas
Old unit weight is 685lbs, new unit weight is 569lbs fireplace 10.00
Log lighter (gas) 10.00
use adapter curb @ 90Ibs Wood/pellet stove 10.00
All ducts to one room, no smoke detector. Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ 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
Business name: Heat Relief heating and cooling Other: 10.00
Fuel piping
Contact name: Tom Sorensen $5.40 for first four; $1.00 for each additional
Address: 13122 NE David Circle, Suite 800 Furnace, etc.
Gas heat pump
City /State /ZIP: Portland, OR 97230 Wall/suspended/unit heater
Phone: (503) 261 -9915 Fax: : (503) 261 -9814 Water heater
Fireplace
E -mail: hroffice @heatrelief.org Range
CONTRACTOR Barbecue
Business name: Heat Relief Clothes dryer (gas)
Other:
Address: Same MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 122424 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: Y /'Z✓ _ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Tom Sorensen Date: 7 - - 2009 • Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 /07/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 � � ��4 ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 F'' J..
INSPECTION WORKSHEET FOR DAT TIME: T 1-- PAGE:
SITE ADDRESS: ( 1. 7D1 6 W 1'a.e.1 -C-1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 1'
DESCRIPTION: Rep kite 1:: e4 kef-
OWNER: p b PHONE #: ,y -- oc 1 .7 1 -_ , 9,902
CONTRACTOR: /7 PHONE PHONE #: '103— J , / b J5
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions:
*- 0 r -6 • '..41 Mlle
o
A PASS [II PARTIAL APPROVAL E] CANCEL 111 NO ACCESS
❑l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: U— r � ' �/ OL& Date: i Phone #: 503
P � ) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171
Ai , l�
Inspection Requests (24 Hrs.): (503) 639 -4175 ....�� `__..
INSPECTION WORKSHEET FOR DATE ` -- TIME:S II or PAGE:
SITE ADDRESS: ! 1101 6 C' ) - 0-10), CLASS OF WORK:
SUBDIVISION: L T #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: L i 9 h+ ( � x..1--U r_s
OWNER: Pi-V.-by/6 PHONE #: 503
CONTRACTOR: / .
(.....)--r1 er . PHONE #:56 3 _ b i Ig 4 55 _ 0.,
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions: - )
)4DAss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /--‘. °6 Phone #: (503) 718-