Permit CITY OF TIGARD MECHANICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit#: MEC2015-00584
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2015
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12196 SW SCHOLLS FERRY RD
Project: Mod Pizza Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Gas piping for pizza oven.
Contractor: PMSI LLC Owner: ATLAS GREENWAY LLC
21195 NW EVERGREEN PKWY#204 333 NW NINTH AVE, STE 1009
HILLSBORO, OR 97124 PORTLAND, OR 97209
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Specifics:, Description Date Amount
Type of Use: COM Permit Fee 08/27/2015 $69.06
Class of Work: ALT Type of Const: Plan Review 08/27/2015 $17.27
Occupancy Grp: A-2 Occupancy Load: 12%State Surcharge-Mechanical 08/27/2015 $8.29
Stories: 1 Info Process/Archiving-Lg$2.00(over 08/27/2015 $4.00
11x17)
Project Valuation: $500.00
Fuel Air Handlers
Fuel Types: Natural Gas 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 $98.62
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
issuan - • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut'' Notification Cen_ o rules are set forth in OAR 952-001-0010 through OAR 952-0 -0090. You may obtain a copy of the rules
•r direct questions to OU■ •y callin• 03.232.1987 or 1.800.332.2344.
l i _.
Issued By: � `/ / / Permittee Signature:
. ���+++"' it_ • (AC
Call 503.639.4175 by 7:00 a.m.for the next available inspec••n date.
This permit card shall be kept in a conspicuous place on the job site u it 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
(NAN a Received v 114 City Of Tigard 11��j pateBY: a�` Permit No.: �y ��t�I ��G�
- ^ 13125 SW Hall Blvd.,Tigard,OR 972218 Plan Review►e. J /'I�i'L d
Phone: 503.718.2439 Fax: 503.598.196600 Q,5 Date/By: l '.4 / Other Permit: 4 ,/ ` r`
T 1 G A R D Inspection Line: 503.639.4175 5 Date Read/: iuris
Internet: Line:gard-or.gov ^U Y ' • S See Pagel for
M �k,`A � Notified/Method: , �� f � Supplemental Information
t kyC‘ U� / ri /�v
TYPEsr „'11
5 �."Yr / echanical permit fees*are based on the value of the work
❑ New construction ®Additionialterati•; ent performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$500.00
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. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12196 SW Scholls Ferry 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.: I Project name:MOD Pizza Duct work I 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: I Lot no.: �' 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
Gas piping for restaurant fireplace 23.32
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:PMSI LLC
$14.15 for first four;$4.03 for each additional
Contact name:Laoell Robinson Furnace,etc.
Address:21195 NW Evergreen Pkwy Suite 204 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Hillsboro,OR 97124 Water heater
Phone:(503)466-2222 X Fax::(503)466-2211 Fireplace
Range
E-nlai I:Irohi nson @msi-systems.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:PMSI LLC -
MECHANICAL PERMIT FEES*
Address:21195 NW Evergreen Pkwy Suite 204 Subtotal 69.06
City/State/ZIP:Hillsboro,OR 97124 Minimum permit fee($90.00) - -'
Plan review(25%of permit fee) t 7,J'Z 22.50 -
Phone:(503)466-2222 Fax:(503)466-2211 State surcharge(12%of permit fee) S'Aci.1A80-
CCB lie.:158286 TOTAL PERMIT FEE tt- v -
This permit application expires if a permit is not obtained within 180
ti
f a �� (� days after it has been accepted as complete.
Authorized Signs /�✓IJ�CY o ` • Fee methodology set by Tri-County Building Industry Service Board
Print name:Lanel obinson Date:8/25/15 di�D b
I\Building\Permits\MEC_PamitApp_0401I3.doc 440-4617r(11/02/COM/WEB)