Permit .11 CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: MEC2009 -00239
Date Issued: 05/27/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQILOIA.P_IMIY 1-70
Subdivision: Lot: 0
Project: Spec Space
Project Description: TI - Relocate (2) bath fans, (2) supply grilles & (2) return air grilles.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
Permit Fee 05/27/2009 $72.50
#300 12% State Surcharge - Mechanical 05/27/2009 $8.70
PHONE:
Contractor:
GOHMAN MECHANICAL
14505 SE HWY 212
CLACKAMAS, OR 97045
PHONE: 503 - 658 -1892 •
FAX: 503 - 658 -6925
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: 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 Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 2 Vent Systems: Total $81.20
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 4
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 Noti • • . •n - - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may • • tain a copy of4. rules
• Issued = : / Permittee Signature: _ �
Call 503.639.4175 by 7:00 a.m. for an inspection that business • • y. '
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.
r Mechanical Permit Application FOR OFFICE USE ONLY
Received
1 • City of Tigard Date/By: D' / Perm No.:
13125 SW Hall Blvd., Tigard, OR 97223 r, A ~ , ( 0 9 � 0 „ � _%
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date the Permit:
Inspection Line: 503.639.4175 D
T I G A R D Date Ready/By: /u2 ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: j) Supplemental Information r (.J
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: $ /
RESIDENTIAL EQUIPMENT' / SYSTEMS FEES*
❑ 1- and 2- family dwelling .ommercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: 15 j '5k.' -V UO /A PieWy
(requires site plan showing placement) 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.:
/ 7 J p.:;__2 3,Z - / 7 a 5 C I C G 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
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
2 Gas fireplace 10.00
12 — %3A7W f 4.V S 2 SvPPL'A le qR 1 LLCS _ Flue vent for water heater or gas
02 - Z 7U,e JU Awe__ c121 L (C S Log
fireplace 10.00
Log 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: i',dG j U S 7 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
❑ 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
�� Clothes dryer (gas)
p
t
Business name: am ON 1/1/ 7 T0(1...- Other:
Address: /45 -- 05 51z= 1 v ,2 / MECHANICAL PERMIT FEES*
City/ State/ZIP: ! Subtotal
_ Minimum permit fee ($72.50) '7 A. 572
Phone:
(C ),5 ' ` g Q Fax :X c S � ' 9c2 Plan review (25% of permit fee) _ rf
CCB lie.: //q55— 2 State surcharge (12% of permit fee) i.70
TOTAL PERMIT FEE _ Q, i . AO
L This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name3 /7A, 1 Date: `J / 2 7 e li I • Fee methodology set by Tri -County Building Industry Service Board
I:\Building\Permits\MEC- PermitA oc 01/19/07 44 4617T( 1 /02ICOM/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.
1:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2