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Permit CITY OF TIGARD MECHANICAL PERMIT 111 a I : COMMUNITY DEVELOPMENT Permit#: MEC2013-00535 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2013 Parcel: 1 S136AD04000 Jurisdiction: Tigard Site address: 11513 SW PACIFIC HWY Project: Vine Gogh,LLC Subdivision: VILLA RIDGE Lot: 7 Project Description: TI Contractor: OREGON HEATING&AIR CONDITIONING Owner: PACIFIC TERRACE COMMERCIAL LLC 19300 SW 118TH AVE BY SMITH, EDITA M TUALATIN,OR 97062 833 NW 170TH DR BEAVERTON,OR 97006 PHONE: 503-691-9699 PHONE: FAX: 503-691-8556 FEES Specifics: Description Date Amount Type of Use: Permit Fee 09/23/2013 $93.62 Class of Work: Type of Const: Plan Review 09/23/2013 $23.41 Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 09/23/2013 $11.23 Stories: Project Valuation: $1,300.00 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 $128.26 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: Fire/Smoke Dampers: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work i not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow t e r es adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 Yo m 'n a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Call 503.6 9.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard 0 Date a• A - Permit No.: C ` l — S- lim q 13125 SW Hall Blvd.,Tigard,OR 9722, - Plan Review 12: Phone: 503.718.2439 Fax: 503.59:41 ' t• kj� rl Date/By: Other Permit: / T IG n lz a Inspection Line: 503.639.4175 3 rj \ Date ReadyBy: Juris: See Page 2 for Internet: www.tigard-or.gov CO �j r YY�A►►((''��rr�-QQl Notified/Method: Supplemental Information TYPE OF WO ` ®V `v �a O� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST reme Mechanical permit fees*are based on the value of the work 12 New construction Addition/alterat ement performed.Indicate the value(rounded to the nearest dollar)of all ID Demolition Other: D" mechanical materials,equipment,labor,overhead,and profit. Value:$ /3e,PP CA EGORY 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 Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: / Air conditioning 46.75 Job site address: �/9 5.0) n it y ttiAiii Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: l / i1�•� P1 " Furnace 100,000+BTU(ducts/vents) 54.91 1 / Y J� Heat pump 61.06 Suite/bldg./apt.no.: Project name: V i xi 6 o il k- 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 � M Flue vent for water heater or gas , j,i `, ,�friV i/h, fireplace , 23.32 / 1A fr i fa6nS Log d/pellet sto 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:( A Fax:( ) _Attic/crawlspace fans 23.32 APPLICANT CONTACT PERSON _ Other: 23.32 Fuel piping: Business name: ©tieQe $14.15 for first four;$4.03 for each additional Contact name: l'/r, / 1Q-11 -- Furnace,etc. Address: V 1^ Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:¶, j) )pi g762 Fax: :( ) Fireplace 11'"'�� [ire ��/ l �) �l Range E-mail: (_b4f f(.� ( Q�7(�`/I�.Y,,/7 fit') s(ejt.� Barbecue CONTRA OR �� ✓/ • Clothes dryer(gas) Business name: �%//aij� Other: �� 1�/t�t� n '�/ MECHANICAL PERMIT FEES" Address: !� Subtotal City/State/ZIP: �� 711� Minimum permit fee($90.00) d�� Plan review(25%of permit fee) Phone:(5U3) 65/ e(J ll Fax:( ) State surcharge(12%of permit fee) CCB lic.: /7?-/Z.4, TOTAL PERMIT FEE This permit application expires if a permit is not obtain within 180 days after it has been accepted as complete. Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board Print name: ai my). (.reji,et Date: / ,05 1:\Building PermitsMEC_PennitApp_0401 13.doc 440-44617T(I 102/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 1 $5,000.00. $5,000.01 to$10,00.0:00 $207.21 for the first$5;000.00 and $2.81 for:each additional$100.00 or fraction there of,to and including $10,000.00. . $10,000.01 to$50,000:00 $347.711for the first$10,000.00 and $2.54 for each additional$100.00 or 1 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 1 a- $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$10.0,000.00 and $2:92 for each additional$100.00 or fraction thereof. • r. Note: All new commercial buildings require 2 sets of plans. .7. • • i I L • • • • I:\Building\Permits\MEC_PermitApp_040113.doc 2