Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2014-00414
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2014
T[
GA R.� 9 Parcel: 2S112AD00301
Jurisdiction: Tigard
Site address: 14610 SW SEQUOIA PKWY
Project: John Barleycorns Subdivision: BONITA GARDENS Lot: 4
Project Description: Replacing existing condensing unit.
Contractor: HVAC INC Owner: SMETS,JOHN E&MARIETTA D TRS
5188 SE INTERNATIONAL WAY PO BOX 560
MILWAUKIE, OR 97222 AURORA, OR 97002
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/06/2014 $130.46
Class of Work: ALT Type of Const: Plan Review 08/06/2014 $32.62
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 08/06/2014 $15.66
Stories: Info Process/Archiving-Sm$0.50(up to 08/06/2014 $6.50
11x17)
Project Valuation: $2,500.00
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 $185.24
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / // /■
Cal4175 by 7:00 a.m.for the next available inspect ••n ate.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application toll 1)1 II( I I SF ()MA
11114 City of Tigard j�w�j Received e , - Permit No.: �t� '-, — •
• 13125 SW Hall Blvd.,Tigard,OR 9
g Phone: 503.718.2439 Fax: 503.598. Plan Review e- Other Permit imi Inspection Line: 503.639.4175 DateBe. V
1 I,, ,r:1 201 Date Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov n4� 6 r Notified/Method: /�' ill if Supplemental Information
TYPE OF W N t �.��V`i ON COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�`,' l� Mechanical permit fees°are based on the value of the work
❑New construction ®Addition/altertipl{+'( t�m t performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: �Ul►*�' mechanical materials,equipment,labor,overhead,and profit.
Value:$2,500.
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address:14610 SW Sequoia Parkway (requires site plan showing placement) 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:McMen.John Barleycorn Heat pump
(requires site plan showing placement) _ 61.06
Cross street/directions to job site:SW Sequoia Parkway &Bonita Rd. 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
Push/pull outdoor Condensing unit-Replace 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 I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name:McMenamins Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name:HVAC,Inc. Other: 23.32
Fuel piping:
Contact name:Jody DePew $14.15 for first four;$4.03 for each additional
Address:5188 SE Internaitonal Way Furnace,etc.
Gas heat pump
City/State/ZIP:Milwaukie,OR 97222 Wall/suspended/unit heater
Phone:(503)462-4822 Fax::(503)462-6555 Water heater
Fireplace
E-mail:jodyd @hvacincorp.com Range
CONTRACTOR Barbecue
Business name:HVAC,Inc.1 Clothes dryer(gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
CCB lic.:50897 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: Rig .11 /ti 0 2, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: `IriIrri ' 5' Date:8-6—/[f • Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Pnmits\MEC•PermitApp.doc 03/I 2 440-46I7T(I1/02/COM/WEB)
ErBuilding Division
Over-The-Counter (OTC) Mechanical Permit
T I G A R D Check List
Project Description: A ----
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>= 100K BTU
Gas Pressure: Roof Top Unit(RTU) i 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
Woodstove Duct Work _ Gas Fireplace
Fire/Smoke Dampers Other Mechanical Units—Describe:
Total Project Valuation: $ 2,c0 I FEES DUE
$ j '?d.k(/ Mechanical Permit Fee
$ 2. 6 a Plan Review
$ / ->'": (04/ 12%State Surcharge
$ Info Proc/Arch,Lg(over 11x17 $2.00)
$ 6,.50 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: $ /-say 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 wa11s,signs,awnings or canopies);
REP=repair.
I:1Building\Forms\OTC-MEC.docx 01/13/2011