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Permit a CITY OF TIGARD • MECHANICAL PERMIT 111 s : COMMUNITY DEVELOPMENT Permit#: MEC2009 -00373 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2009 Parcel: 1 S134BC00300 Jurisdiction: Tigard Site address: 12272 SW SCHOLLS FERRY RD Subdivision: Lot: 0 Project: Greenway Pub Project Description: TI Owner: FEES FW OR- GREENWAY TOWN CENTER LLC Description Date Amount PO BOX 790830 Permit Fee 07/29/2009 $81.70 SAN ANTONIO, TX 78279 Plan Review 07/29/2009 $20.43 PHONE: 12% State Surcharge - Mechanical 07/29/2009 $9.80 Contractor: HVAC INC 5188 SE INTERNATIONAL WAY MILWAUKIE, OR 97222 PHONE: 503 - 462 -4822 FAX: 503- 462 -6555 Type of Use: COM Class of Work: ALT Type of Const: VB Occupancy Grp: A -2 Occupancy Load: Stories: Fuel Air Handlers Fuel Types: Units < 10000 cfm: Gas Pressue: Units > 10000 cfm: Furnaces Boilers & Compressors Furnaces < 100K BTU: - 0 - 3 HP: Furnaces >= 100K BTU: 3-15 HP: Floor Fumaces: 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 $111.93 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: 1 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 . issuan , .r if wo i - spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utili otification Center. ose ; - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ay obtain a co.y oft ., rules or . irect questions to OUNC . ailing .03 4 ...6699 or 1.800.332.2344. i I sued By: / �L1 / i Permittee Signature: ' 1 I •, Call 503.639.4175 by 7:00 a.m. for an inspection that busine-- day. This permit card shall be kept in a conspicuous place on the job site until co • leti , n of the project. Approved plans are required on the job site at the time of each ins . • ion. Mechanical Permit Application co order (sr:. o\ LV City of Tigard �r ©� lt Permit Nn.: �P�,g� • 13125 SW Hall Blvd., Tigard, OR 97223 � • r • �� 17- f7 Phone: 503.639.4171 Fax: 503.598.1960 JUL 2 3 20 0 9����� Other Permit: T t G A It D Inspection Line: 503.639 Date Ready/By: ® See Page 2 for Internet: www.tigard- or.gov CIT �/ OF TIG, ARD Notified/Method: � ,) ' (Q _ 4 E Supplemental Information BUIi DING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST 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 $ 2 l 4 U 1) El 1 -and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g . Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description + Qty. I Ea. + Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 1 � S n ',� Air conditioning or heat pump a � J / �/y YO S (requires site plan showing placement) 14.00 City/State/ZIP: 1 ) � q,,'Y) -. 3 Furnace 100,000 BTU (ducts/vents) 14.00 �' — W pup ( ley ^ Furnace 100,000+ BTU ( ducts/vents) 17.90 Suite/bldgJapt. no.: Project name: Y , 1 rC l n 1 Gas heat pump 14.00 Cross street/directions to job site: Duct work 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 Water heater 10.00 Yr t �"� 1 nn I n� /,� 1 .^ � � ,� Gas fireplace gas 10.00 I14 ` It t' I (Y iO Y t/v / 1 i�/ Flue vent for water heater or OM A Ar . fireplace 10.00 VI t� �rW , I I 1 l Log lighter (gas) 10.00 y t to 9 . IS `-) / t , A ' re' a, I ._ 44 ' . Wood/pellet stove 10.00 / / Up i i 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/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 [a APPLICANT ili CONTACT PERSON Attic/crawlspace fans 10.00 U P L. � Other: 10.00 Business name: Fuel piping Contact name: 1 VA $5.40 for first four; $1.00 for each additional Address: S 1 S ►��(� ,� Furnace, etc. Mk n f Gas heat pump City/State/ZIP: i L Vv t m b V Wall/suspended/unit heater Phone: (S 5) 4, b� . 4 g 2� Fax: : (SO3) ub �- Water heater A� � '^ `' � n t �Vt,� Fireplace E -mail: `10 ki 4p h,votc y `/ ` ( NV it r v n Range CONTRA(:I R Barbecue V n r t , n Clothes dryer (gas) Business name: C J l.J V l r Other: C) I Address: t aS -D4 MECHANICAL PERMIT FEES* City /State/ZIP: < d " "" t/' 111000 Subtotal Phone: ( ) I Fax: ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lie.: S 6� 11-61 State stircharge (12% of permit fee) TOTAL PERMIT FEE JJ ( ( R3 Thi pe rmit application Si a li expires if a permit is not obtained within 180 fig I ' days after it has been accepted as complete. Print name: V (kv D- 2 { w l Date: '� / a3 I • Fee methodology set by Tri -County Building Industry Service Board I:\BuildingTermits I• itApp.doc 01/19/07 l 440-4617T (I l/ 7JCOM/WEB)