Permit q CITY OF TIGARD MECHANICAL PERMIT
'' - a COMMUNITY DEVELOPMENT Permit #: MEC2009 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued:
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 300
Subdivision: Lot: 0
Project: Horizon Pediatrics
Project Description: Replace 3 ton RTU gaspack.
Owner: FEES
MCFADDEN, ARTHUR L Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE Permit Fee 05/27/2009 $181.10
#800 Plan Review 05/27/2009 $45.28
PHONE: 12% State Surcharge 05/27/2009 $21.73
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: VB
Occupancy Grp: B 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 $248.11
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 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 ification Ce r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued j // 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.
Mec Inical Permit A I 1 lication I /-_- ,p FOR OFFICE USE ONLY
City of Tigard ,n / �� Date/By: % 'Z ( v l : ` 4 Permit No.: • Zvi Q 0 4
III ° 13125 SW Hall Blvd., Tigard, OR 97223 IC�t --et plan Review . .
0 ; . Phone: 503.639.4171 Fax: 503.598.1960 q Date/By: ' & r
TI GA RD Inspection Line: 503.639 5..I. t Date Rea.yBy: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: IMI Supplemental Information
TYPE OF WORK V r 7OMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition /alteration/replacement ' 1� permit fees* are based on the value of the work
erformed. Indicate the value (rounded to the nearest dolla0 of all
❑ Demolition 0 Other: MAY 2 1 2009 mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ $7,200.00
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessor gt1'l dQg TIGARD RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi - family ❑ Master builder ❑ Other: BUILDING DIVISION For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Ln Air conditioning or heat pump
Job site address: 9735 SW Shady (requires site plan showing placement) 14.00
City /State /ZIP: Tigard, OR 97223 Fumace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 300 Project name: TFigard A9eaical M_++LI
hf i Tpn Gas heat pump 14.00
Cross street/directions to job site: Pvc, ll^A \ '1 Y t C S 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
gas pack Gas fireplace 10.00
Push/Pull 3 ton
g P 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
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: same as below
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: Willamette HVAC Clothes dryer (gas)
Other:
Address: 3075 SW 234 Ave Ste 206 MECHANICAL PERMIT FEES*
City /State /ZIP: Hillsboro OR 97123 Subtotal
Phone: (503) 628.6841 Fax: (503) 848.2597 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: 56951 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
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: 5/21/09 • Fee methodology set by Tri-County Building Industry Service Board
1:\ Buildin $8ermitsMEC- PermitApp.doc 01/19/07 440 -4617T (I I /02 /COM/WEB)