Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00488
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2009
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 200
Subdivision: TIGARD MEDICAL MALL Lot: 0
Project: Aesthetic Medicine
Project Description: Push -pull 2.5 ton condenser.
Owner: FEES
MCFADDEN, ARTHUR L Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE
Permit Fee 09/16/2009 $118.50
#800 Plan Review 09/16/2009 $29.63
PHONE: 12% State Surcharge - Mechanical 09/16/2009 $14.22
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
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 $162.35
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, 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 calling 503.246.6699 or 1.800.332.2344.
Issued By: /:9 Permittee Signature:
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 Application FOR OFFICE USE ONLY
Receiv
• . ° 13125 SW Hall Blvd., Tigard, OR n ff,/�w� L / ' f -
0
City of Tigard CSI /��
Date/By: r � / Permit No.: �/
V C Plan Review
Phone: 503.639.4171 Fax: 503 DateBy: I<J • 1 Other Permit:
T I G A It D Inspection Line: 503.639 SEP 16 2009 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: BM Supplemental Information
CITY OF TIGARD
TYPE BUI NG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition/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, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ $4,000.00
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2-family g ® Commercial /industrial ❑ Accessory building
❑ Multi- family 0 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: 9735 SW Shady Ln Air conditioning or heat pum
(requires site plan showing placement) 14.00
City/State /ZIP: Tigard OR 97223 Furnace 100,000 BTU (ducts/vents) 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 200 Project name: Aesthetic Medicine 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
Push/pull 2.5 ton condenser Gas fireplace 10.00
Flue vent 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 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
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Same as below Other: 10.00
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
E -mail: Fireplace
Range .
CONTRACTOR Barbecue
Business name: Willamette HVAC Clothes dryer (gas)
Other:
Address: 3075 SW 234 Ave Ste 206 MECHANICAL PERMIT FEES*
City /State /ZIP: Hillsboro OR 97123 Subtotal
Minimum permit fee ($72.50) / / . So
Phone: (503) 628.6841 Fax: (503) 848.2597 Plan review (25% of permit fee) 29 63
, CCB lic.: 56951 State surcharge (12% of permit fee) /9...2.2..
TOTA PERMIT FEE /4� ,�
A ,
Authorized signature: t Thi permit application expires if a permit is not obtained within 180
/ / days after it has been accepted as complete.
Print name: Michael Malstrom Date: 9/16/09 • Fee methodology set by Tri -County Building Industry Service Board
• 1:\Building\PermitsUMEC- PermitApp.doc ,01/19/07 . 440 -4617T (1 I /O2JCOM/W EB)
• Building Division
Over- The - Counter (OTC) Mechanical Permit
T i c A K° Check List
. Description of Project:
GENERAL IN - • ` TON
Class of Work:* h L-r Floor Furnace: Evap. Coolers:
Type of Use:* co Unit Heaters: Vent Fans:
Occupancy Group: Vents w/o / ...: Amok Vent Systems:
Stories: Boilers, Co up, Heat Pum.W Hoods:
Fuel Types: 0 - 3 HP: Domestic Incinerator.
ELC / GAS / NG / OIL / OTHER 3 - 15 HP: Com. /Ind. Incinerator.
Max Input BTU: 15 - 30 HP: Repair Units:
Fire Dampers: :0 - 50 HP: Wood Stoves:
Gas Pressure: H / M / L >50 HP Clothes Dryer.
No. of Units: Air Han. .. Units: Other Units:
Furnace <100k BTU: <_10,000 . : Gas Outlets:
Furnace >_100k BTU: >10,000 CFM:
Notes:
INSPECTIONS I FEES DUE
Post /beam mechanical $ Permit Fee
Gas line $ State Surcharge
Mechanical rough -in $ Plan Review Fee
• Fire damper $ Additional Permit Fee
Duct work $ Additional Plan Review Fee
Smoke detector $ Investigation Fee
Investigation inspection $ Misc. Fee
Misc. inspection $ Hourly Rate Fee
• Final inspection $ Hourly Rate State Surcharge
$ Total Fees Due
OTHER PERMITS REQUIRED
• Building Electrical
Plumbing Site Work
•
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
I:\Building\Forms \OTC - MEC.doc 09/22/06