Permit w p Y I l� �CC (_&) Aira c i ri Q
CITY OF TIGARD BUILDING PERMIT
1 °. COMMUNITY DEVELOPMENT Permit #: MEC2009 -00082
T l GAR I) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/02/2009
Parcel: 2S112AD01000
Jurisdiction: TIG
Site address: 14945 SW SEQUOIA PKWY 180
Subdivision: Lot:
Project: SCS Engineers
Project Description:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI Permit Fee 03/02/2009 $72.50
PORTLAND, OR 97224 12% State Surcharge 03/02/2009 $8.70
PHONE:
Contractor:
GOHMAN MECHANICAL
412 S BEAVERCREEK RD #602
OREGON CITY, OR 97045
PHONE:
FAX: 503- 655 -0514
Specifics:
Type of Use:
Class of Work:
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $1,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $81.20
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by 503.24 6699 or 1.800.332.2344.
Q C U( N � ' ngl
Issued By: 1 ® Permittee Signature:
Call 503.839.4175 by 7:00 a.m. for an Inspection that business day.
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.
•
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00082
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/02/2009
TIG g Parcel: 2S 112AD01000
• Jurisdiction: TIG
Site address: 14945 SW SEQUOIA PKWY 180
Subdivision: Lot:
Project: SCS Engineers
Project Description:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI Permit Fee 03/02/2009 $72.50
PORTLAND, OR 97224 12% State Surcharge 03/02/2009 $8.70
PHONE:
Contractor:
4Oh rvul.. , " 11461.4614 Gc
cSZ
PHONE:
FAX:
Specifics:
Type of Use:
Class of Work:
Dwelling Units:
Stories: Height: ft
Bedrooms: Bathrooms:
Value: $1,000
Floor Areas:
Total Area:
Accesso•y Str1 :ci
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mazzanu
Total $81.20
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors Manual Pull Stations:
Accessible Parking:
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 wor suspended for more the 18F
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r -s e set forth in O •
952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by callin. ' .3.24 %.6699 or 1.8!I '.234 .
Issued By: Permittee Signature: 4111/
Call 503.639.4175 by 7:00 a.m. for an inspection that busines day.
This permit card shall be kept in a conspicuous place on the job site until completion of the •roject.
Approved plans are required on the job site at the time of each inspection.
i ►
Mechanical Permit Applicati FOR OFFICE USE ONLY
City of Tigard RECEIVE Received ^ Permit No.: • Date/By: . Il i M. • 13125 SW Hall Blvd., Tigard, OR 97223 2��9 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 MAR 0 2 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 Date ReadyBy: El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method:
Supplemental Information
BUILDING 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 Value: $ (� p
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
r'
Air conditioning or heat pump
Job site address:
/ y 9 y 3 --- �1'L/ ��/./ I tre0 /?< (requires site plan showing placement) 14.00
City/State /ZIP: 779;44/2- 61- ' Furnace 100,000 BTU (ducts/vents) 14.00
_ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: / 8' a Project name: SG S L 71J9 /kT .s Gas heat pump 14.00
Cross street/directions to job site: 7 Duct work a 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
Flue /vent for any of above 6.80
Subdivision: Lot no.: Other: 10.00 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/� 1 7 —1 Gas fireplace 10.00
/� 7 5 sc (c�. , » ')J j%
7s &i S Flue vent for water heater or gas
fireplace 10.00
rii ��vL' t--Y7 5 7)1v % c.,g /LL 5 Log lighter (Ras) 10.00
CC Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 10.00
� Other: 10.00
Name: / / u / Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms, nn
Phone: ( ) .Z y -C_-;?--,-1:5 .6 Fax: ( ) toilet compartments, utility rooms) Q. 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 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: 9 ��
.4
Business .
Clothes dryer (gas)
Other
Address: /{,/gyp 5" 52: /(1W (/ Oa / a MECHANICAL PERMIT FEES*
City /State /ZIP: L /<.C1tn .t S Subtotal
9 7
Phone: (�J) G S� -• / c-c 9' Fax: (y o3) C C 1 Minimum 25% o fee nnit fee)
?L�
oZ Plan review (25% of permit fee)
CCB lic.: // 9 95- State surcharge (12% of permit fee) . / 6
TOTAL PERMIT FEE S ` .2. O
Authorized signature: � , This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: t �/: .�, t y , ,,, � Date: 3 Ia�� • Fee methodology set by Tri County Building Industry Service Board
I:\ Building \Permits'MEC- PcrmilApp.doc 01/19 /07 44 / 046171'(11 /0LCOM/WEB)
•
Mechanical Permit Application - City of Tigard
Page 2.= Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
- $50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
I:\Building\Permits'MEC- PermitApp.doc 01/19/07 2