Permit CITY OF TIGARD MECHANICAL PERMIT
ACOMMUNITY DEVELOPMENT Permit#: MEC2013-00660
T t G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2013
Parcel: 2S102AA00905
Jurisdiction: Tigard
Site address: 12000 SW MAIN ST
Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5
Project Description: Installing new spiral duct to existing RTU,grills,and exhaust fans.
Contractor: ARJAE SHEET METAL CO, INC. Owner: HAAGEN,GARY L&CANDACE C TRS
5510 SE MCLOUGHLIN BLVD. 2514 SE 112TH AVE
PORTLAND,OR 97202 VANCOUVER,WA 98664
PHONE: 503-231-7717 PHONE:
FAX: 503-230-4888
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/05/2013 $151.95
Class of Work: ALT Type of Const: Plan Review 11/05/2013 $37.99
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/05/2013 $18.23
Stories:
Project Valuation: $3,200.00
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 $208.17
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 les adopted by the Oregon
Utility Notification Center. Those rules are set forth in (BAR 952-001-0010 through OAR 952-001-0090. •y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or • :00.332.2344.
Issued By: � _ 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 OFFICE USE-ONLY .
City of Tigard
...:,a 13125 SW Hall Blvd.,Tigard,OR ,,i3 I Pfau Review
Phone: 503.718.2439 Fax: 503.1;:"*.- Date/ vt3y: Other Permit: kAPAO i3--(70,7.64'
TIGARD Inspection Line: 503.639.4175 Date Ready/By: hots: ® ?See Page for
Internet: www.tigard-or.gov NOV 5 20 hots:13 Notified/Method: f—7 • Supplemental Information
•
TYPE OFe W TIGARD COMMERCIAL FEE* SCHEDULE - USE CIIECKLIST
11 1''' aQ//�'�A1 Mechanical permit Ices*are based on the value of the work
❑ New construction Addition�IJ 1XO � 11d�N performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S 32LC9,CA)
' CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYS'1'P.MSFEES*
❑ I-and 2-family dwelling ®Commercial/industrial ❑ Accessory building For speciaiinJormation use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description ' Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION I Air
( Air conditioning 46.75 —
Job site address: 120 00 Svc MA-ti ST Furnace 100,000 BTU(duels/vents) _ 46.75
City/State/ZIP: T(CA4A,O Of- Furnace 100,000+BTU(ducts/vents) 54.91
—
c Heat pump 61.06
Suite/bldg./apt.no.: Project name: S■&x .> Udr C`
��/ Duct work 3.32_
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.: Oder: 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
V 3 Sio e.4 - / N1-.,. ) OttLI,GS / fireplace 23.32
• V NJ�,-( E x ( f Ar N s( Log lighter(gas) 23.32
W 1 Wood/pellet stove 33.39
Wood fireplace/inser 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
❑ PROPERTY OWNER TENANT Environmental exhaust and ventilation:
Name: D(Z-. S 1 E.l¢.4C Range hood/other kitchen
Address: 12.000 SvJ MM T
equipment 33.39
4 Clothes dryer exhaust 33.39
City/State/ZIP: •tl,k14_) o 49..- Single-duct exhaust(bathrooms.
toilet compartments,utility rooms)• 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
cif APPLICANT IS CONTACT PERSON Other: 23.32
�P,1kEET M Fuel piping:
Business name: L-TkL
$14.15 for first four;$4.03 for each additional
Contact name: _-F-A'(H n u X291 1 - 1 Furnace,etc.
Address: Ca 54s SE, M I,oU V�`(0 a WO Gas heat pump _
Wall/suspended/unit heater •
City/State/ZIP: MUM l`lr Me- 91222 Water heater •
( '� ) q 7�\ - ii li ( ) l.�(�(!i(�5 Fireplace
Phone: �� l� Fax: 03 30,- V v
Range
E-mail:
Barbecue _
CONTRACTOR ' Clothes dryer(gas)
Business name: -14 SWF T r '-rkL Other:
/ , n r An MECHANICAL PERMIT FEES*
Addres: 6s4 s- SE MCLoo t�tk-G N Subtotal
nA11 t p j\ o l�71X-1, Minimum permit fee(S90.00)
City/State/ZIP: IVI l�� I�t Mc _I lN�
Plan review(25%of permit fee)
Phone:(SJ ) 2,31 _I/(7 Fax:( S03 ) 230 -tie 60
State surcharge(I2%of permit fee)
CCB tic.: Y 3g TOTAL PERMIT FEE At. 17•
This permit application expires if a permit is not obtai ed within ISO
days after it has been accepted as complete.
Authorized signature: = Fee methodology set by Tri-County Building Industry Service Board
• Print name: l S 110 M"f SJ,P Date: if/3 1i
1:ABuilding1 PermitsV NI EC'_PcrinitApp 040113.doc 440-46171(1 1/02/COAVVv[n1