Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00515
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/09/2012
Parcel: 2S112AA00900
Jurisdiction: Tigard
Site address: 14140 SW 72ND AVE 100
Project: Polycast Subdivision: 1992 -007 PARTITION PLAT Lot: 1
Project Description: Installation of approximately 180' of 21b gas line.
Contractor: CROREY MECHANICAL ENGINEERING & CONSTRU( Owner: WALTON CWOR NELSON 13 LLC
PO BOX 1066 BY CTMT - WALTON RE TAX
CANBY, OR 97013 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE. 503 - 266 -9086 PHONE:
FAX 503 - 266 -9766
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/09/2012 $235.31
Class of Work: ALT Type of Const: Plan Review 10/09/2012 $58.83
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 10/09/2012 $28 24
Stories: Info Process /Archiving - Sm $0.50 (up to 10/09/2012 $0 50
Project Valuation: $6,000 00 11x17)
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 $322.88
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units
Gas Outlets 5 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 = w. • suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules ado.ted by the Oregon
Utility Iotification Cente . • •se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai' a opy of the rules
or .• ect questions to OUN ►'.y c - I . 503.232.1987 or 1 800 332.2344.
Iss ed By: 4 ' 7 Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 Application FOR oFFlc;i; USE ONLY
City of Tigard Date/By. iv it ._ Permit No Nee AWA,.DDS', S
° 13125 SW Hall Blvd., Tigard,OR 97223
C Phone: 503.718 2439 Fax. 503 598 1960 Plan Review
Date/By ,- ; ,- ors (Q MMI Other Permit
T7 G A R D Inspection Line: 503 4175 Date Ready :y Juris ® See Page 2 for
Internet www.tigard- or.gov Notified/Method Supplemental Information
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, overheard profit
Value: $ bOoln
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES * - r
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: pi pi A t, 7/a A) U (requires site plan showing placement) 46.75
Q �/ Fumace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: 7 T
I O 1 11,/ 1 Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Q s 9 , Heat pump
1 V n /N 7 (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23 32
. t Hydrontc hot water system 23 32
NORrh 4 A) 1 TA fAr', 7a MG/ Residential boiler (radiator or
hydronic) 23 32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: A I Lot no.: Flue /vent for any of above 23 32
Other 23 32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK J Water heater 23.32
/�
I Gas fireplace/insert
AM IN e( AnAt On goet 4 I 1 Flue vent for water heater or gas
,■ Am 41.2n)d( g F -I AC.t �t t/ fireplace 23.32
plc /
/ Log lighter (gas) 23.32
Wood/pellet stove 33 39
Wood fireplace /insert 23.32
❑__ PROPERTY OWNER' ❑ TENANT Chimney /liner /flue /vent 23 32
Other: 23 32
Name: �8 fi C4s Environmental exhaust and ventilation:
Address: p i Yo S O 7 2 N cP � 4 Range hood/other kitchen
/ T equipment 33 39
City /State /ZIP: ri. a A n rp op, 7 2 X2.'1 Clothes dryer exhaust 33 39
( Single -duct exhaust (bathrooms,
Phone: ( SoD 62_41 d y y y F ax: ( ) toilet compartments, utility rooms) 23 32
❑ APPLICANT ❑ CONTACT PERSON . Attic /crawlspace fans 23 32
Business name: Other. 23 32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
I Clothes dryer (gas)
Business name: 1i, 20 R ey Merit Art) it A ( Other.
Address: 1 • D r t- k i 0 :Co MECHANICAL PERMIT FEES*
City /State /ZIP: Ckf, /� OQ CI 70/ 3 Subtotal & 7 � /
Phone: (&S) 2 f` pp Nell, 4. �8¢. Minimum permit fee ($90.90). • 56
b� ' 9 Fa ( ) 6 qJ , s Plan review (25% of permit fee) 5 8.8 5
CCB lic.: 6S SF-7 Z State surcharge (12% of permit fee) as.
TOTAL PERMIT FEE ,ASOI• $S
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: jt ` 'r M CR0 y Date: f ) — 9 _ I . • Fee methodology set by Tn- County Building industry Service Board
I \Budding\Permits\MEC- PermitApp doe 03/07/12 440 -4617T (I 1 /02/COM/WEB) (3p-2-. v t ¢
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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
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.
I:\ Building \Permits\MEC - PermitApp.doc 03/07/12 2
Building Division
. " Over- The - Counter (OTC) Mechanical Permit
TIGAR Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: CCA Oregon Specialty Code:
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: L i.,T j Roof Top Unit (RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line (�
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets e�
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $$ FEES DUE
$ Z' 3 Mechanical Permit Fee
$ 6 3 Plan Review
$ Z 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ ;
`3C3 Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ 3 7 2 , • S TAL FEES DUE
*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:\Buildmg\Forms \OTC -MEC docx 01/13/2011
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Permit Nu ber MEG2012 - 00 S
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By: A fr Date: ANN
Approved plans
shall be on job site.
OFFICE COPY