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Permit • v CITY OF TIGARD MECHANICAL PERMIT 4 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00545 °� I �! DATE ISSUED: 9/15/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135DD-03301 SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G SUBDIVISION: HOFFARBER TRACTS NO.1 LOT: 002 JURISDICTION: TIG . Project Description: Valuation: $1500. CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1 OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS: STORIES: 1 BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS FURN > =100K BTU: 8 < = 10000 cfm: OTHER UNITS: > GAS OUTLETS: 10000 cfm: Owner: FEES TIGARD PROPERTIES INC Description Date Amount 8320 NE HWY 99 [MECFI] Permit Fee 9/15/200E $72.50 VANCOUVER, WA 98668 [MECPLN] Plan Rev 9/15/200: $18.13 [TAX] 8% State Surcharf 9/15/200° $5.80 Phone: 360 - 574 - 6255 Total $96.43 • Contractor: • PMSI LLC 21195 NW EVERGREEN PKWY #204 REQUIRED ITEMS AND REPORTS HILLSBORO, OR 97124 Phone: 503 - 466 - 2222 Reg #: LIC 158286 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: � /(2� Permittee Signature: o7) a • Call 503 - 639 -4175 by 7:00 a.m. for inspections 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. r echanical Permit Applica 6^ o_ , F OR OFFICE USE ONLY ty G4rigard• � Date/By: -4( lJ PermitNo.G 2` SW Hall Blvd., Ti ard, OR 97223 g Plan Revi ne: 503.639.4171 Fax: 503.598.1960 ® oar�d Date /By: �� Other Perm ection Line: 503.639.4175 _ j � /, C_ Date Ready /By: y ® See Page 2 for rnet: www.ci.tigard.or.us e �' /�y ®: "' Notified/Method: `1 /� Supplemental Information 770 to TYPE OF WO 1QrV /s / 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: $ 1 1 f j - ©0 , (ICI RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist. Description i Qty. I Ea. I Total JOB SiTE INFORMATION AND LOCATION Heating/cooling Job site address: t 10145 .)r 1Cy, , 'l � - �' l Air conditioning or heat pump t ,p Ub (requires site plan showing placement) 14.00 City/State/ZIP :' - 'r n, y-d 0 Ol'� -a ` "' t 1 I Fumace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name.) Arj(1 C Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 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. 10.00 Subdivision: I Lot no.: Flue/vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 --:-..",-N, 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 _ Range hood/other kitchen Address: equipment 10.00 City/State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 tZt APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Business name PMSA tA-- _ Other: 10.00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address:a1 �� (r`y . , n /1n� Furnace, etc. 1p(r 't'F-tiJ , .FLU Gas heat pump �r� City/State /ZIP: • �esyn J� `eX1 t1 �.4V ∎ .D4 Wall/suspended/unit heater Phone: Z q‘ Fax: : ( )L4‘434) • DeQ --11 Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Clothes dryer (gas) Business name: Ot er- a1 Address: MECHANICAL PERMIT FEES* City/State /ZiP: �, V" J Subtotal Phone: ( ) Fax: ( ) ' / ` Minimum permit fee ($72.50) Sp - fl Plan review (25% of permi: fee) % • 50 q CCB lic.: , 5 D. $ ^ l � S tate surcharge (8% of permit fee) 5 . !� TOTAL PERMIT FEE \—•� ` This permit application expires if a permit is not obtain within Authorized signaturl �__ days after it has been accepted as complete. Print name: , � ry 1 � , Date: ? ..4 • Fee methodology set by Tri-County Building Industry Service Board Qb, 13 i:\ Building \Pcrmits'MEC- PermitAppp.doc 12/03 440-4617T (I1 /02/COM/WEB)