Permit CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00377
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
Parcel: 1 S126DB02800
Jurisdiction: Tigard
Site address: 9370 SW GREENBURG RD 103
Project: Dr. Orazio Subdivision: 1991 -018 PARTITION PLAT Lot: 1
Project Description: Replace existing heat pump located on ground.
Contractor: WILLAMETTE HVAC LLC Owner: FRANKLIN COMMONS ASSOCIATES, LLC
3075 SW 234TH AVE. #206 BY NORRIS & STEVENS
HILLSBORO, OR 97123 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 259 -3200 PHONE:
FAX: 503 - 848 -2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/25/2012 $297.13
Class of Work: OTR Type of Const: VB Plan Review 07/25/2012 $74.28
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 07/25/2012 $35.66
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 07/25/2012 $4.50
11x17)
Project Valuation: $8,200.00
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: 1
Appliances
Vent Fans: Vent Systems: Total $411.57
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, wor suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Cente Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or ' ect questions to OUNC . • ailing 503.232.1987 or 1.800.332.2344.
1/1 Jel infe(6107A—
Is9 ued B y - Permittee Signature: K
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.
1
Mechanical Permit Applicat' FOR OFFICE USE ONLY
City of Tigard CRIED Dat Received e/By: 7 ( Mil Permit No.AlgP,, .
II - 13125 SW Hall Blvd., Tigard, OR 97 Plan Review a her Permit:
Phone: 503.718.2439 Fax: 503.598.1960 JUL 1 Date/By:
2 012 ,�,�'��
T I G A R D Inspection Line: 503.639.4175 Date Ready : y: Juris. ® See Page 2 for
Internet: www.tigard- or.gov
CITY Internet: Notified/Method: �i W Supplemental Information
TYPE OF '1ORP`NG DIVISION 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.
Value: $ $8,200.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- 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:
Air conditioning
Job site address: 9370 SW greenberg rd (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: Tigard OR
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 103 Project name: Dr Orazio 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
push /pull 4 to _ �' Gas fireplace /insert 33.39
'' U _ i.1 �[...i 1 — IL j t _ .r��. Flue vent for water heater or gas
fireplace 23.32
Itlik Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State/ZIP: 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
Business name: same as below Other: 23.32
Fuel piping:
. Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: Willamette HVAC, LLC
Clothes dryer (gas)
Other: ■
Address: 3075 SW 234' Ave Suite 206 MECHANICAL PERMIT FEES*
City /State /ZIP: Hillsboro, OR 97123 Subtotal
hone: (503) 2593200 Fax: (503) 848.2597 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
/CCB lic.: State surcharge(12 %ofpermit fee) w
t. TOTAL PERMIT FEE 751/4.'57
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: michael malstrom Date: 5/29/12 • Fee methodology set by Tri- County Building Industry Service Board
1: \ Building \Permits \MEC- PermitApp.doc 03/07/12 440-4617T(11/02/COM/WEB)
■
Ii CITY OF TIGARD FEE AND PAYMENT HISTORY
i 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
MEC2012 -00377 - 9370 SW GREENBURG RD 103, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee 230 - 0000 -43102 $297.13 $297.13 $297.13
Plan Review 230 - 0000 -43111 $74.28 $74.28 $74.28
12% State Surcharge - Mechanical 100 - 0000 -24001 $35.66 $35.66 $35.66
Info Process /Archiving - Sm $0.50 (up to 230 - 0000 - 43135 $4.50 $4.50 $4.50
11x17)
Totals for Fees $411.57 $411.57 $0.00 $411.57
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $411.57