Permit CITY TIGARD MECHANICAL PERMIT
PERMIT #: MEC2004 -00021
DEVELOPMENT SERVICES DATE ISSUED: 2/3/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BD -02600
SITE ADDRESS: 16875 SW PACIFIC HWY
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 4 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU:. AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install refrigeration unit and 3 coils. Valuation = $3816
Owner: FEES
SPACE AGE FUEL INC Description Date Amount
PO BOX 607
GRESHAM, OR 97030 [MECH] Permit Fee 2/3/04 $116.20
[MECPLN] Plan Rev 2/3/04 $29.05
[TAX] 8% State Surchari 2/3/04 $9.30
Phone: 503 665 - 5693 Total $154.55
Contractor: •
CHILLER TECH INC
DBA: JFI
PO BOX 925 REQUIRED INSPECTIONS
CLACKAMAS, OR 97015
Phone: 503 Cooling Unt Insp
Cooling Unt Insp
Reg #: LIC 132428 Final Inspection
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 -00
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Issued By: � ermittee Signature: ter ��,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical PernflE t ED FOR OFFICE USE ONLY //r 'L
City of Tigard Date/By: / — p5/ B) Pemtit No.: MC(�,a oa 7 — Opa l /
13125 SW Hall Blvd., Tigard, OR 972 ii Al 4 Plan Review
Phone: 503.639.4171 Fax: 503.5981 2 ii 20 07 � 10,. y ,•; Date/By: R r tt ' O y A� Other Permit:
Inspection Line: 503.639.4175 � 114,.. l l Date Ready /By: Jura; l71 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: /4 C., Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
ew construction ❑ Addition/alteration/replacement AI �� Mechanical permit fees are based on the value of the work
42 /y performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: 6 7 /1/ mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 38
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: / �j 5 S (L, ` r � ? Air conditioning or heat pump
(Q,) / (requires site plan showing placement) 14.00
City/State/ZIP: Ki uNol C4 Or Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 11.90
Suite/bldg. /apt. no.: '
Project name: �� �c Q 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
s'412 qr 1) l Flue vent for water heater or gas
3 fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
❑ PROPERTY OWNER ❑ TENANT Other: 10.00
Name: \� c_e 4 FiJ'& Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
VO Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: -7-- C� T��� Z N Fuel tin
piping
0 Contact name: ) 9E F --,z x - $5.40 for first four; $1.00 for each additional
Furnace, etc.
CO Address: / 3 g� Ei f7' '/(‘,P Gas heat pump
Ickh City/ State/ZIP: ter 01 9)0(i ti(i Wall/suspended/unit heater
Phone: ( ) S3 ✓ Z3 (, Fax:: Ste' 7 _ 3 S" 3 i, Water heater
( Fireplace -Dal E -mail: V -P) i re PAN_ r CO ,,,,•■__, Range
CONTRACTOR , , Barbecue
eJ Business name: F 1 Ci. J T"2' t �, �' i . Clothes dryer (gas)
Other:
Address: 1 3 6 ,Z 77� /E /2 MECHANICAL PERMIT FEES*
City/State/ZIP: C 0,.- q w ¶L f Subtotal l 1 C. 20
�� Minimum permit fee ($72.50)
Phone: (SM S ? 2 3 A, Fax: V' s . ) C S 3 S-35 Plan review (25% of permit fee) 29 , 05
CCB lic.: / ?Z k? ..11 * ill State surcharge (8% of permit fee) 9 , 3 0
` TOTAL PERMIT FEE 6 S
Authorized signature: This permit application expires if a permit is not obtained within 180
j � d ays a it has been accepted as complete.
Print name: b p•\ 1" t Y Date: V • Fee methodology set by Tri -County Building Industry Service Board
i:t Building \Pemdls\MEC- PcrmitApp.doc 12/03 440- 4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: 4:1 ,"+ii: y • ,
Total Permit Fee: 0! it /ot?
$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
$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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