Permit p CITY OF TIGARD MECHANICAL PERMIT
1,1 8 COMMUNITY DEVELOPMENT Permit#: MEC201500204
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2015
Parcel: 25101 BCO2800
Jurisdiction: Tigard
Site address: 8250 SW HUNZIKER RD
Project: Centrex Subdivision: 1990-082 PARTITION PLAT Lot: 1
Project Description: Installing a 4 ton split system with duct work and diffusers. Scope of work also includes gas line for new furnace.
Contractor: ROTH HEATING&COOLING Owner: SEVERSON, JAMES A&ROBIN 0
PO BOX 1265 29404 SW HEATER RD
CANBY,OR 97013 SHERWOOD, OR 97140
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/23/2015 $627.11
Class of Work: ALT Type of Const: VB 12%State Surcharge-Mechanical 04/23/2015 $75.25
Occupancy Grp: B Occupancy Load: Plan Review 04/23/2015 $156.78
Stories: Info Process/Archiving-Sm$0.50(up to 04/23/2015 $7.50
11x17)
Project Valuation: $21,000.00
Fuel Air Handlers
Fuel Types: Natural Gas Units< 10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 1 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: 1
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $866.64
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
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 starte. within 180 days of
issua i work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules a,opted by the Oregon
U' y Notification Center: Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. .0 may obt in a copy of the rules
r direct ques'ins to OUNC b -fling 03.232.1987 or 1.800.332.2344.
Issued By: /1/1/ , i Permittee Signature: jf
,
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 pro •ct.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
:I'i 13125 SW Hall Blvd.,Ti Date/By: / �)) i 41._,10 if
gard,OR 97223 Plan Re MI/IMMIX
Phone: 5n Line: Fax: 503.598.196Qr.�r I\ I her Permit: /
Inspection Line: 503.639.4175 KC V • Date/By: ► {�T/J ���t� ari-
1 I ci A RI, Date Ready t y: G Mris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:_71/ L(/1� ,ef77 Supplemental Information
APR 13 2015
TYPE OF WORK OF.=.1^ RD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
4�^ Mechanical permit fees*are based on the value of the work
CI New construction ®Addition/alteraijq ii ,,(jjtDIV ISIO N performed.Indicate the value(rounded to the nearest dollar)of all
ID Demolition 1=1 Other: D mechanical materials,equipment,labor,overhead,and profit.
Value:$$21,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ® Commercial/industrial ❑Accessory building For special information use checklist.
El Multi-family ❑ Master builder El Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:8250 SW Hunziker Rd Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Centrex HQ Remodel 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
Installation of new 4 Ton Split System with duct work and diffusers to fireplace 23.32
accommodate new floor plan. Includes new gas line for new furnace. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Centrex Range hood/other kitchen
equipment 33.39
Address:8250 SW Hunziker Rd. Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32 _
Business name:Roth Heating&Cooling Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Jesse Manselle Furnace,etc.
Address:PO Box 1265 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Canby,OR 97013 Water heater
Phone:(503)266.1249 Fax::(503)266.3478 Fireplace
Range
E-mail:jessem @roth-heat.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Roth Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address:PO Box 1265 Subtotal
City/State/ZIP:Canby,OR 97013 Minimum permit fee($90.00)
Phone:(503)266.1249 Fax:(503)266.3478 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:14008 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:Jesse Mans a Date:4/10/15
I:Building.PermitsMEC_PermitApp_040113.doc 440-46171(11/02/COM/WEB)