Permit I „ CITY OF TIGARD MECHANICAL PERMIT
I , - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00269
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivlslon:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Install hood, exhaust fan, make -up fan and associated ducting.
Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: BENNETH, CATHERINE MCNICOL
2000 SE HANNA HARVESTER DR 3830 ROBIN CREEK LN
MILWAUKIE, OR 97222 WEST LINN, OR 97068
PHONE: 503 - 656 -7400 PHONE:
FAX: 503 - 655 -0620
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/30/2012 $459.47
Class of Work: ALT Type of Const: VB Plan Review 05/30/2012 $114.87
Occupancy Grp: A -2 Occupancy Load: 12% State Surcharge - Mechanical 05/30/2012 $55.14
Stories: 1 Info Process /Archiving - Lg $2.00 (over 05/30/2012 $10.00
11x17)
Project Valuation: $14,350.00 Info Process /Archiving - Sm $0.50 (up to 05/30/2012 $16.00
11x17)
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: 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:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $655.48
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Make up air
Duct Work: unit
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by callin 503.232.1987 or 1.800.332.2344.
Issued By: /d) Permittee Signature: on/ i i;1-` 0 / 6 6. / e� j 7On/
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 and Received Permit No. �J/
III ty of Tigard RECEIVED Date/By: 5 /m I : �e i t 4 '
° 13125 SW Hall Blvd., Ttgard,OR 97223 Plan Review ► , E ��
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: ' Other Permit: d 1 9 0 /062.. e 0 G Y i
T I G A RD Inspection Line: 503.639 MAY 16 2012 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF W *TY OI''I'IGARD COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
LDINC DI VISION 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: $ $14,350.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building For specsl information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE, INFORMATION AND LOCATION Heating/cooling
Air
Job site address: 12785 SW Pacific Hwy conditioning pin
(reqguires s site pl showing placement) 46.75
City/State /ZIP: Tigard OR 97223 Fumace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Burgerville #45 Tigard Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: . Other fuel appliances
- ' DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Install provided hood, exhaust fan, make -up fan and associated ducting. Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
❑ PROPERTY OWNER ® TENANT Other: 23.32
Name: Burgerville #45 Environmental exhaust and ventilation
Address: 12785 SW Pacific Hwy
Range hood/other kitchen
N'Y equnipment 33.39
City/State /ZIP: Tigard OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Portland Mechanical Contractors Fuel piping
Contact name: Paul Hettervig $14.15 for first four; $4.03 for each additional
Address: 2000 SE Hanna Harvester Drive Furnace, etc.
Gas heat pump
City /State /ZIP: Milwaukie OR 97222 Wall /suspended/unit heater
Phone: (503) 656 -7400 Fax: : (503) 655 -0620 Water heater
Fireplace
E -mail: paulh @pmc -g.com Range
CONTRACTOR Barbecue
Business name: Same as above Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($90.00)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: 151807 State surcharge (12% of permit fee)
l TOTAL PERMIT FEE
Authorized si natUre:� T his permit application expires if a permit is not obtained within 180
g -I `41.-
days after it has been accepted as complete.
Print name: Paul Hettervig Date: • Fee methodology set by Tri County Building Industry Service Board
I:' Building \Permits\MEC- PermitApp.doc 10/01/09 440-4617T (I 1/02/COM/WEB)