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Permit CITY OF TIGARD MECHANICAL PERMIT ° COMMUNITY DEVELOPMENT Permit #: MEC2009 -00208 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009 Parcel: 2S112DD01600 Jurisdiction: Tigard Site address: 15495 SW SEQUOIA PKWY 150 vormsmisossmoossisommdibiba Subdivision: Lot: 0 Project: Acceleration Chiropractor Project Description: TI- relocate ducts & grilles. Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee 05/13/2009 $72.50 #300 12% State Surcharge 05/13/2009 $8.70 PHONE: Contractor: OHAC INC PO BOX 241 DUNDEE, OR 97115 PHONE: 503 - 538 -2953 FAX: 503- 691 -8556 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: Vent Systems: ' Total $81.20 Hoods: Comm Incinerators: Required Items and Reports (Conditions) Woodstoves: Gas Fireplaces: 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 1 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted • the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may • stain a f• py o/ he rules Issued By: jAcl Permittee Signature: .L Call 503.639.4175 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. Mechanical Permit Appli -; � FOR OFFICE USE ONLY amity of Tigard �L Date/By: / 3 D j Permit No.: )1 te _ 9 00 a7 • 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review C Phone: 503.639.4171 Fax: 503.5401 3 2 009 Other Permit: Inspection Line: 503.639.4175 Date/By: T I G A It D p Date Ready/By: 1 ® s: See Page Z for Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: CP• Supplemental Information aul'DING DIVISION TYPE OF WORK 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, overhea , and rofit. CA G RESIDENTIAL EQUIPMENT / SYSTEMS FEES* RY OF CONSTRUCTION Value: $ ` /�<� El 1- and 2- family dwelling Commercial /industrial 1:1 Accessory building El Multi-family ❑ 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: r / Air conditioning or heat pump l S 9j ,$ t vo (requires site plan showing placement) 14.00 City /State /ZIP: p ,.4,, /� / Furnace 100,000 BTU (ducts/vents) 14.00 (/r , /�, Suite/bldg. /apt. n / 4, 6 „,,/ ' ,roject name: � G�l Furnace 100,000+ BTU (ducts/vents) 17.90 ''// 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 �DES�CRRIPTION OF WORK Water heater 10.00 /4 , (// - - 3 "(WAS Gas Flue vent fireplace f 10.00 for water heater or gas fireplace 10.00 • Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent Other: 10.00 /f�� 10.00 Name: // Environmental exhaust and ventilation 400 Address: f'" 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 Business name: Other: 10.00 �� Fuel piping Contact name: c1t.:L ( 4.1 12.0`C/7 $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: (�� / k e e' - l ke .� I js 661-.....-.. Range CO 11f7C f Barbecue Business name: Obi--4-t„ Clothes dryer (gas) - 1/-1...,4 ' Oth er: Address: MECHANICAL PERMIT FEES* City/State /ZIP: / O. a/ / 7 //c Subtotal Minimum permit fee Phone: (j ) �L �1 ( 0 � Fax: (.6j3) ,s F 7 7 y ($72.5 Plan review (25% of permit fee) ) - ©- CCB lie.: l 7z/z.,4„ surcharge (12 %of permit fee) . 70 TOTAL PERMIT FEE / C) Authorized signature: T his permit application expires if a permit is not obtained within 180 ��� /// days after it has been accepted as complete. Print name: C ' � . , , t 1 4 ) A - r 1 Q Date: yt. - r5 • Fee methodology set by Tri- County Building Industry Service Board I:\Building\PermitAMEC- PermitApp.doc 01/19/07 44 617T(I1 /0 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