Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2012 -00294
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Tesla Motors Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: New ductwork, grilles and ceiling exhaust fan.
Contractor: ARROW MECHANICAL Owner: PPR WASHINGTON SQUARE LLC
10330 SW TUALATIN RD BY THOMSON PROPERTY TAX SERVICES
TUALATIN, OR 97062 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Specifics:, Description Date Amount
Type of Use: COM Permit Fee 06/05/2012 $319.61
Class of Work: ALT Type of Const: IIB Plan Review 06/05/2012 $79.90
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 06/05/2012 $38.35
Stories: 1 Info Process /Archiving - Lg $2.00 (over 06/05/2012 $4.00
11x17)
Project Valuation: $9,000.00
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 $441.86
•
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
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 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 calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature
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 A licati FOR OFFICE USE ONE) City of Tigard C EIVE D Received
��' ME ed Permit N� fir o�O/o2
• 13125 SW Hall Blvd., Tigard, OR 97223 ��oZ J�
;� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 UN 042012 Date/By: E �� to O the r Penn _
Inspection Li 503.639.4175 ��� ��-S'�
TIGAI:p DateR - . :y. ® See Page 2for
Internet: www.tigardor.gov CITY OFTIGARD Notified/Method: IMI Supplemental Information
BI HI DING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLLST
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: $ 90/94),
- RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2 family dwelling IN Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ - '.� ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
q W 0 I JOB SITE INFORMATION AND LOCATION Heating/cooling:
te r c5 (�� AA-) C 7 3 � ,?
Air conditioning
(requires ite pl
Job sit t• •,:.. . - � 1 ��� ( requmes site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/ State/ZIP: /CARS G)Z c 7 ZZ3
/ Furnace 100,000+ BTU (duds/vents) 54.91
Suite/bldg. /apt. no.: 0,06 I Project name: Ta mai Heat pump
(requires site plan showing placement) 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
� a-) J� ) }C Gas fireplace 33.39
q IZ/ ��� /��� CG/LJn�/ Flue vent for water heater or gas
Ft90 - fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32 I
Name:
Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawispace fans 23.32
Business name: 44J "t�/i e ,e4e_ �� iv25, i�e, Other: 23.32
Fuel piping:
Contact name: /(' (/ j Z O 4 ��'/
(.� cam- f° $14.15 for first four; $4.03 for each additional
Address: /0e33) c y3 'TiJ x-.) , /L"j) Furnace, etc.
Gas heat pump
City/State/ZIP: 704/_.477,/3 6SL
97G6 Z Wall/suspended/unit heater
Phone: (fp ) 67z -1 S6 5-- I Fax: : ( 5- 9/ _ 4 77 Water heater
Fireplace
>'` 1�
E -mail: t /ZOt.-- 3 1�eg1L a F ' ' — Cc ?' - Range
CONTRACTOR Barbecue
Business name: , ZIoCJ Mr J y ap¢(_ ea, // ZS., � d . Clothes dryer (gas)
_ Other:
Address:
Lv 336 a -) / J j/\-, 7 i 4 / ) MECHANICAL PERMIT FEES*
City/State/ZIP: 7 ? 3 / 6Z.... fill 7% Subtotal
Minimum permit fee ($90.00)
Phone: (p.3 ) 692_ / 5 - 6 I Fax: (53) el/-4:3 7 Plan review (25% of permit fee) —
CCB lie.: $/ 93 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized Sigma This permit application expires if a permit is not obtained within 180
L�-" days after it has been accepted as complete.
D.. ..a ^•• -�•-• r�..�... I • Fep me]hnMlnav cet by TriC'minty Rnildino rnAnary Servirr Rnard
` e / f sxCLc i j4f t^o -41- -1a
' PI o Building Division . •
Over- The - Counter (OTC) Mechanical Permit
TIGARD
Check List
Project Description: 1 I
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: ACE Occupancy Group: PA Type of Construction:
*Type of Use: erg& Oregon Specialty Code: Zo 15
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work ' Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $ q'(;O, I FEES DUE
3 / 49 I $ Mechanical Permit Fee
$ - , - 4 Plan Review
$ - 3 . 3 State Surcharge
$ A . CO Info Proc /Arch, Lg (over 11x17 $2.00)
$ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff: yy /. GPlo
Date /Time: $ TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
l:\Building\Forms \OTC - MEC.docx 01/13/2011