Permit illil CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe
COMMUNITY MEC2012 -00670
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S 110AA01200
Jurisdiction: Tigard
Site address: 14300 SW PACIFIC HWY
Project: Dr. Dvid Wilson Subdivision: CANTERBURY PLACE, AMENDED Lot: 8
Project Description: Replacing (2) existing RTU's with new. Like for like change outs
Contractor: ROTH HEATING & COOLING Owner: WILSON, DAVID DR.
PO BOX 1265 14300 SW PACIFIC HWY
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503 - 266 -1249 PHONE: 503- 639 -4330
FAX: 503 - 266 -3478
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/18/2012 $436.61
Class of Work: OTR Type of Const: Plan Review 12/18/2012 $109.15
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 12/18/2012 $52.39
Stories: Info Process /Archiving - Sm $0.50 (up to 12/18/2012 $2.50
11x17)
Project Valuation: $13,450.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 - 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 $600.65
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 -0090. You may s stain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ! / / 1 L / -4 Permittee Signature: �.
Call 503.639.4175 by 7:00 a.m. for the next available inspection d
This permit card shall be kept in a conspicuous place on the job site until compl= , n of the project.
Approved plans are required on the job site at the time of each ins. - ion.
Mechanical Permit Applicati BECEI M ED FOR OFJl( I'SF ONLv
City of Tigard DEC 18 2012 Date/By: a / 1C //c?" yr/ Permit No.: I'^ EC ) /�— Ca& et
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' I Phone: 503.718.2439 Fax: 503.598.196(jn fl Y of TIG 0 p n Other Permit:
lV� �t t1 l!C flaAfiU Date/By:
T I G A RD Inspection Line: 503.639 Date Ready/By: Juris El See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: r16 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, overhead, and profit.
Value: $ $13,450.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
. Air conditioning
Job site address: 14300 SW Pacific Hwy. (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: Tigard, OR 97224 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite /bldg. /apt. no.: Project name: Dr. David Wilson Dentist Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: 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
Replace 2 existing RTUs with new. Like for like change outs. Flue vent for water heater or gas
fireplace 23.32
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: Dr. David Wilson Environmental exhaust and ventilation:
Address: 14300 SW Pacific Hwy. Range hood/other kitchen
equipment 33.39
City /State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)639 -4330 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: _
Business name: Roth Heating & Cooling
Fuel piping:
Contact name: Jesse Manselle $14.15 for first four; $4.03 for each additional
Address: PO Box 1265 Furnace, etc.
Gas heat pump
City /State /ZIP: Canby, OR 97013 Wall /suspended/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater
Fireplace
E -mail: jessem @roth- heat.com Range
CONTRACTOR Barbecue
Business name: Roth Heating & Cooling Clothes dryer (gas)
Other:
Address: PO Box 1265 MECHANICAL PERMIT FEES*
City /State /ZIP: Canby, OR 97013 Subtotal
Phone: (503) 266 -1249 Fax: (503) 266 -3478 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 14008 ' State surcharge (12% of permit fee)
— TOTAL PERMIT FEE /Ayr). (o 5'
Authorized signature: Jai we Th is perm application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print name: Jesse Manse, Date: 12/12/12 * Fee methodology set by Tri- County Building Industry Service Board
I :\ Building \Permits'MEC- PermitAp..doc 03/07/12 440- 4617T(I1/02 /COM/WEB)
;' , ' Building Division
I WARD
Over - The - Counter (OTC) Mechanical Permit
Check List
Project Description: jM. E � ( 1 c_A-L_- A . /a- (JDlo7(7
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: Oregon Specialty Code:
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= IOOK BTU
Gas Pressure: Roof Top Unit (RTU) 'Z Tons Z
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
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $ I FEES DUE
$ ( Mechanical Permit Fee
$ / Plan Review
$ / 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ 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: $ TOTAL 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:\Bui lding\Forms \OTC - MEC.docx 01/13/2011