Permit i�.
•
!p CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00290
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/18/2007
PARCEL: 2S 102AC -01704
SITE ADDRESS: 12720 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD DENTAL
Project Description: Remove and replace existing rooftop, heat/cool unit. Project value: $4,000.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
RCIK BRAEM Description Date Amount
12720 SW PACIFIC HWY
TIGARD, OR 97223 [MECH] Permit Fee 5/18/2007 $118.50
[MECPLN] Plan Rev 5/18/2007 $29.63
[TAX] 8% State Surcha 5/18/2007 $9.48
Phone: Total $157.61
Contractor:
AIR MASTERS
RICHARD ALLEN CAMERON
2858 LIVINGSTON ST NE REQUIRED ITEMS AND REPORTS
SALEM, OR 97303
Contact #: PRI 503- 244 -8880
FAX 503 -585 -2991
Reg #: LIC 149532
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: 9 / / Permittee Signature:
C 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.
•
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard `� rig PI rved
• 13125 SW Hall Blvd., Tigard, OR 24,; ,6.11g �24,; g I ea R L 14 .. 1 � •
1111 II Phone: 503.639.4171 Fax: 503.59 .106t1' � 1 - _ . , � I. . • evie Other Permit: 1
D. may: • Zoo – 0 _
T I G n K D Inspection Line: 503.639 Date ReadyBy: 0 See Page 2 for
Internet: www.tigard- or.gov FvIl AY 1 8 2007 Notified/Method: a Supplemental Information
HYP OF Vyb t a COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
❑New construction Additio a 1oTrp}aTi>�i t Mechanical permit fees* are based on the value of the work
' n TTOT(Th performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, I r, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S 0110
RESIDENTIAL RESIDENTIAL EQUIPMEI4T / SYSTEMS FEES*
❑ 1- and 2- family dwelling EI ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 2 7 z0 S (it) PAC-L F I C K Loy Air conditioning or heat pump
11( (requires site plan showing placement) 14.00
City/ State/ZIP: -77 G , OR , 9 7Z2.3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: l Project name: Gas heat pump 14.00
Cross street/directions to job site: D iv c-77..y' alt= 1,t�/ 11 Duct work 14.00
( I 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: 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
I�--t/ ✓k.f j /LtPJ4 -6L EX( S-r1A1( poo .P Flue vent for water heater or gas
/urot_ of.i It' P a /,1 fireplace 10.00
1t tri ALIT f Log lighter (gas) 10.00
Wood/pellet stove 10.00
�/ Wood fireplace/insert 10.00
(1 PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00
Other: 10.00
Name: 21 c...4 z 2A e Environmental exhaust and ventilation
Range hood/other kitchen
Address: I Z 7 2,0 5 r,J P4Gt Ftc l- h.4.J/ equipment 10.00
City/State/ZIP: -n 0-4 , 9 7Z.Z3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( 5b3) g'1 1 _ b NZ Fax: ( ) toilet compartments, utility rooms) 6.80
[3'APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: n ►t - Other: 10.00
'12– v 4s.rvis atipI'I,/,— , _ 4 - G Fuel piping
Contact name: 2 644 C.-Al l $5.40 for first four; $1.00 for each additional
Address: Z �S� LI ∎/ I S F . Gas heat p ea t etc.
hump
City/State /ZIP: 4/i t O /( ' , 730 ( Wall/suspended/unit heater
Phone: ( 3) . 2 ,0,1_ 8-g'0 Fax: : (5O3) S {fS Za S i Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: A 2 _ t 4.37.-cfcS 1 -i,,y ,Q .. C Clothes dryer (gas)
Other:
Address: Z -s �b / k- I V /A/ (r 5'/19+J) S i • N, MECHANICAL PERMIT FEES*
City/State /ZIP: SA-u p 9 7 30 I Subtotal / y} &-13 ®
I Minimum permit fee ($72.50) f
Phone: ( Sa3) Z44– n b Fax: (17)3) syS= Z q I Plan review (25% of permit fee) aq - 142 ,
CCB lic.: / 41 53 Z • State surcharge (8% of permit fee) . f{
•
TOTAL PERMIT FEE f j / (
//
Authorized signature: /it This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Z( t e vii I Date: si O / Zo01 I • Fee methodology set by Tri -County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 04/06 /06 440- 4617T(I1 /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
$1.35 for each additional $100.00 or
fraction thereof, to and including Z O
$50,000.00. Z 3
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and �—
$1.25 for each additional $100.00 or CP O
fraction thereof, to and including Lf 0
$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 4 (0 3�
fraction thereof.
72.5
Note: All new commercial buildings require 2 sets of plans. 41(17,S°
>
5-13 214
1:\Building\Pertnits\MEC- PermitApp.doc 12/30/05 2
a ToP 00 0(Ts
"---› 61 ),/
_L___1/(4/
'T1 5-eA S 4-71 r - �'� "TO 11.450 T
City of Tigaid
dip o = d Plans OFFICE COPY
By ,Ge Date 5 : tR kl