Permit•
q CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: MEC2013-00525
Date Issued: 09/17/2013
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718 2439 1 Parcel: 1 S135BC00202
Jurisdiction: Tigard
Site address: 10763 SW GREENBURG RD 120
Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Installation of Type II hood and anchorage of walk-in cooler and freezer units.
Contractor: JUSTIN L BALDWIN CONSTRUCTION Owner: BELANICH, ROGER M
PO BOX 1688 22020 17TH AVE SE#200
TUALATIN, OR 97062 BOTHELL,WA 98021
PHONE: 503-805-0150 PHONE:
FAX:
FEES
- — Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/17/2013 $360.41
Class of Work: ALT Type of Const: VB Plan Review 09/17/2013 $90.10
Occupancy Grp: A-2 Occupancy Load: 12%State Surcharge-Mechanical 09/17/2013 $43 25
Stories: 1 Info Process/Archiving-Sm$0 50(up to 09/17/2013 $1 50
11x17)
Project Valuation: $10,500.00
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' 3-15 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 $495.26
Hoods. Comm Incinerators:
Woodstoves. Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets. Other Desc. walk in
Duct Work. cooler
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if wo• is not started within 180 days of
. issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to f. • the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009. You , obtain a copy of the rules
or direct qu-- • to OUNC by calling 503.232.1987 or 1.800.332 2344.
` Issued By � Permittee Signature: X-.
//�
Call 503.639.4175 by 7:00 a.m.for the next available inspecti•� ate.
• This permit card shall be kept in a conspicuous place on the job site until c pletion of the project.
Approved plans are required on the job site at the time of ea.inspection.
Mechanical Permit Applicatio Foli OFFICE USE.ONLY
City of Tigard CEIVED Received
Date/By /4,A C/E�'o/a/3— V52 5
Permit No
II
n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
2, Phone 503.718.2439 Fax: 503.598.19605�� 1 6 2013 Date/By: •,/' • Other Permit o* f�
T I G A R D Inspection Line: 503.639.4175 Date Ready/By. ///3 ^ _ Juns ® See Page T2�for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method / /7 / CIO Supplemental Information
TYPE OF WORK DING DIVISION
COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees*are based on the value of the work
New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: - mechanical materials,equipment,labor,overhead,and profit.
Value:$ ltd,)to ,pv
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling .Commercial/industrial ❑Accessory building For special information use check list.
❑Multi-family ❑Master builder ❑Other: Description I Qty I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
n Air conditioning 46 75
H
Job site address: /0763 3 u) G/tc r4 OCr4 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tr y,, c ,( Furnace 100,000+BTU(ducts/vents) 54 91
Heat pump 61 06
Suite/bldg./apt.no.: /w Project name: .50 Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23 32
Subdivision: Lot no.: Other: 23 32
Other fuel appliances:
Tax map/parcel no.: Water heater 23 32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
''// /� Flue vent for water heater or gas
I•11�l4l I e/r,S c 1I MM cue'/ 6iec t)./e,.., fireplace 23 32
lid 6d14- Co-die r t F-,,r7 i1 Q 4.0 2 Log lighter(gas) 23.32
Wood pellet stove 33.39
Wood fireplace/insert 23 32
Chimney/liner/flue/vent 23 32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23 32
Phone:( ) Fax:( ) Attic/crawlspace fans 23 32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc
Address: Gas heat pump
. Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)-T 1 Other.
Business name: ao53 . L (3,Idw,' CO3��,/„ ,,. MECHANICAL PERMIT FEES*
Address: p�d �a'( /688 Iy Subtotal
City/State/ZIP: U 'Q. r q 7 a(7 Z Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(5j2,) go S —0 Fax:( ) State surcharge(12%of permit fee)
_
CCB tic.: y38 3 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: h Date:
r\Building\Permits\MEC_PermitApp_0401 I3 doc 440-4617T(I I/o2/COM/WEB)
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.
•
1•Building\Permits\MEC_PermitApp_040I13.doc 2