Permit CITY OF TIGARD MECHANICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00465
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/12/2012
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 140
Project: House of Bread Subdivision: 2004 -015 PARTITION PLAT Lot: 2
Project Description: Extend gas line for oven and connect 10" vent through roof.
Contractor: ROTH HEATING & COOLING Owner: SN PROPERTIES PARTNERSHIP
PO BOX 1265 1121 SW SALMON ST
CANBY, OR 97013 PORTLAND, OR 97205
PHONE: 503 - 266 -1249 PHONE:
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/12/2012 $69.06
Class of Work: ALT Type of Const: Plan Review 09/12/2012 $17.27
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 09/12/2012 $8.29
Stories:
Project Valuation: $500.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: 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 $94.62
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
Utili o ifica i. Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
o irect questions to ' UN . • cal g 503.232.1987 or 1.800.332.2344.
Issued By: 4 ' i Permittee Signa re:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
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 Auulicatio Mk OFFICE USE ()NE N'
City of Tigard CEC EIVED D /By 4 / 2- • / Permit No.: Vte)at/.�
13125 SW Hall Blvd., Tigard, OR 97223
1 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.1960 S EP 1 1 2012 Date/By: Other Permit:
. l . I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard -or.gov
CITY OFTIGARD 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 N Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $ 500
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMEEMS FEES*
❑ I - and 2- family dwelling .RI Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
� �(( [� Air conditioning
Job site address: ( (0 o Sll�t Q'\Cih
L . W (‘W site plan showing placement) 46.75
r /� n V Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: `u
L (I mu) t `v 1 "ZZ Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: (L rJ Project name: f 4 `3 C�� Heat pump
'0 V � " p (requires site plan showing placement) 61.06
Cross street/directions to job site: - I - 1 ( !J 4 b „n � � , vo _^ Duct work 23.32
np ` Hydronic hot water system 23.32
v ■ \ ) V l t V \ L I 1 4 ' T - 1 1 p 6 L5 c.'J T3 Gfd Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
(� Gas fireplace/insert 33.39
N `J ^ 1 L X1 A C1A/4 Flue vent for water heater or gas
tAyUAILkic i 0 u r /�t yt `/� k (_- fireplace 23.32
V -1 1 I Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER 1 TENANT Chimney/liner /flue /vent 23.32 iilt Other: 23.32
Name: t ;N`t ok a . 1 Q Environmental exhaust and ventilation:
Address: I q S ljv €ifop IC. l P( Range hood/other kitchen
1 equipment ment 33.39
City/State /ZIP: - rt (0 MLI) q, 1.1.4 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (9' 1415 91 oZ Fax: ( ) toilet compartments, utility rooms) 23.32
[APPLICANT 10 CONTACT PERSON Attic/crawlspace fans 23.32
Business name: P I , k b i lr11�, l�� t„. �,"�/�(t n t ( a.
Fuel piping: 23.32 _
Contact name: p 1 ` �' 1
D A—MA OA 1 \ $14.15 for first four; $4.03 for each additional
Address: I Q_
^f+ v� (6 S t t ko % ,a, ,p
s "Z9 0 Furnace, etc.
` Gas heat pump
City /State /ZIP: -r--1 b MA ci 1 V2- 4 Wall/suspended/unit heater
Phone: (93 . „ Q t b 3 O 1, f Fax:: (13) Slgi - 3 qq O Water heater
Fireplace
E -mail: P6 V& jt k'. CW\QS ` W / # Range
CONTRACTOR Barbecue
Business name: R n-/'t 4 6 Clothes dryer (gas) v `
Other:
Address: P10. 6 ta7C ('Z (OS MECHANICAL PERMIT FEES*
City/State /ZIP: C' l• `6y d t 9 "7 0 /3 Subtotal 69,04”
) e- rr -- Q Fax: (c�ti) Minimum permit fee ($90.00) .
Phone: (W
Z 6 10 _ 1ZA I 0� 1 Z-�n 17 3 l -7 lb Plan review (25% of permit fee) /7, ,'L1
CCB lic.: / y' r State surcharge (12 %ofpermit fee) 4 .
$. 1
�•
' ( J
r i I TOTAL PERMIT FEE l This permit application expires if a permit Is not obtained within 180
Authorized signature: Y /// I `F ' * days after it has been accepted as complete.
Print name: 4.-T,7- T .e.../ i L 1( Date: 91 if ` / 7.......• * Fee methodology set by Tri- County Building Industry Service Board
\
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Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
'Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
• fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional,$100:00 or I
fraction thereof, to and including
$50,000.00.
•
$50,000.01 to $100;000.00 $1,363.71 for the first $50;000.00 and
$2.49 for.each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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