Permit p CITY OF TIGARD MECHANICAL PERMIT
IS COMMUNITY DEVELOPMENT Permit #: MEC2012 -00326
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2012
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE# 230
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: Installgrilles, insulation and ductwork.
Contractor: HVAC INC Owner: TRIANGLE POINTE LLC
5188 SE INTERNATIONAL WAY 901 NE GLISAN ST, #100
MILWAUKIE, OR 97222 PORTLAND, OR 97232
PHONE: 503 - 462 -4822 PHONE:
FAX: 503 - 462 -6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/26/2012 $462.01
Class of Work: ALT Type of Const: Plan Review 06/26/2012 $115.50
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 06/26/2012 $55.44
Stories:
Project Valuation: $14,500.00
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 $632.95
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 Notif • . ion : ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 ou . obtain a copy of the rules
or direct q , estions to O NC •, . -Ilin. 503.232.1987 or 1.800.332.2344.
Issued B . // k Permittee Signature: 1 4
Call 503.639.4175 by 7:00 a.m. for the next available inspection
Tjl
This permit card shall be kept in a conspicuous place on the job site until comple on of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application r, ,-1, e + 3 FOR OFFICE USE ONLY
of Tigard .: ;1 + 1' s� C, a✓ Penult No.:// , ,/,..... ,
V 13125 SW Hall Blvd., Tigard, OR 9723
2 6 202 D a
Plan Review
° Phone: 503.639.4171 Fax: 503.598.1960 t e B y: Other Permit:
T 1 G A R D Inspection Line: 503.639 .30 Date Ready/By: tuns. RI See Page 2 for
Internet: www.tigard - or.gov ■� Notified/Method: Supplemental Information
Olf TYPE OF Wp]( �`N = (V 6" iv, COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ddition/alteration/replacement Mechanical permit fees' are based on the value of the work
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 Li aSID
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building
❑ Multi- family 0 Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: (,, Air conditioning or heat pump
133` '3 Sin) `o' y (requires site plan showing placement) 14.00
City/State/ZIP: •- fl (A , 3 �� �3 Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
�� Suite/bldg. /apt. no.: •e7 6 Project name: Le ip Q ,,A4— Gas heat pump 14.00
Cross street/directions to job site: 4 (( )1/ Duc 10.00
"""`" '" 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. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK 1 Water heater 10.00
9 Gas fireplace 10.00
� • i� l� S l t�S Vl/l / Flue vent for water heater or gas
� , V "`� fireplace
lighter (gas) 10.00
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
Address: Range hood/other kitchen
equipment 10.00
City/State/Z1P: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
4))\)!‘ t , Other: Business name: L. V F uel t m P'P
Contact name: �� Q $5 .40 for first four; $1.00 for each additional
Address: —+ • [ 1 Furn etc.
\ ��
Gas heat pump
City/State/ZIP: 1 a-- --) ry Wall/suspended/unit heater
Phone: (S13)1.4 V.).--- Lt �i �ta' I. I Fax: (g3) " V/ d "(p \1 ' � Water heater
/� ( �, /� Fireplace
E -mail: '.)0&,t &pv,VU-UV \utl► < ' r Range
CONTRACTOR Barbecue
Cl
Business name: 'C ( � r ` a "V "j t
O hthes dryer (gas)
` ry It J Other:
Address: � MECHANICAL PERMIT FEES*
City/State/Z1P: Subtotal
Phone: ( ) I Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: '- 1 - 1 f State surcharge (12% of permit fee)
•
i TOTAL PERMIT FEE Q,'f ?,Q5
Authorized signature: I ( (0 ' This permit application expires if a permit is not obtained within 80
days after it has been accepted as complete.
Print name: . ` .� ri l t. ` - Date: / rnip- ' Fee methodology set by Tri- County Building industry Service Board
I :1Building\Permits\MEC- Permit pp.doc 01/19/07 440-4617T (I1 /02/COM/WFB)