Permit CITY OF TIGARD MECHANICAL PERMIT
•'�1 COMMUNITY DEVELOPMENT Permit#: MEC2015-00620
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2015
Parcel: 1S 134AA01800
Jurisdiction: Tigard
Site address: 10130 SW NIMBUS AVE D5
Project: Scholls Business Center Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 2
Project Description: Replacing sections of(5)different gas lines due to fire damage.
Contractor: RAYBORN'S PLUMBING INC Owner: HANSON, RONALD D
PO BOX 69 ROBINSON, CONSTANCE A
19990 SW CIPOLE RD ROBINSON,CHESTER TRUST ET AL
TUALATIN, OR 97062 203604 EAST FINLEY RD
KENNEWICK,WA 99331
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/17/2015 $115.11
Class of Work: ALT Type of Const: IIIB Plan Review 09/17/2015 $54.31
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 09/17/2015 $26.07
Stories: 1 Info Process/Archiving-Lg$2.00(over 09/17/2015 $4.00
Project Valuation: $2,000.00 Fuel Piping 09/17/2015 $30.27
12%State Surcharge-Mechanical 09/17/2015 $26.07
Fuel Air Handlers Minimum Fee Adjustment-Mechanical 09/17/2015 $71.85
Fuel Types: Natural Gas Units< 10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers 8 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 $327.68
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 foil t e rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 95 01-0090. ou ay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / %Me _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec on 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.
FOR OFFICE ESE ONLI•-0V,Mechanical Permit Appl ation -� Received J' v
City of Tigard Received r
` � � Other Permit: �I�r S- �
^ Plan Revi �� i.�r1�
• 13125 SW Hall Blvd.,Tigard,OR 97223 6o,J Daterl3y: 'S�)(���f
s. 0 See ; 2 for
Phone: 5n Line:.503 Fax: 503.598.1960 Qate Ready ty: //. Supplemental Information•
Ti G A R D
Inspection n Line: 503.639.4175 '�-� 'I•• . o fcd'Method:9 I7 45 •�/� —�
Internet: www.tigard-or.gov ` �� •
t\ 1� • :V
�l 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
TYPE OF WORK 1 1
permit fets*are based on the value of the work
per
■ ' • .
Addition/alteration/ Mechanical pen
Addition a ,cemeperformed.Indicate the value(rounded to the nearest dollar)of all
❑New construction mechanical materials. •ui.ment,labor,overhead,and •rofit.
❑ Demolition Other:
CATEGORY OF CONSTRUCTION -
EQUIPME /SYSTEMS FEES*
Accessory building For special information use checklist.
C .-and 2-family dwelling = Commercial/industrial ❑ Qty Ea. Total
❑Multi-family 0 Master builder
❑Other: Description
Heatin. coolin: -
30B SITE INFORMATION AND LOCATION Air conditioning or heat pump 14.00
(re•uires site•Ian showin•.lacement) _ 14.00 _
Job site address: ( � •� S� 1 u /-- Furnace 100,000 BTU(ducis`�'ents)
• 'Z(,�� _ 17.90
City/StatelZlP: 'bet-wee-tall �E� Furnace 100.000+BTU(ducts'vena) 14.00
Project name: `Y 1, 115 P�„t ,.)ess C el e., Gas heat.um. _ 10 4.00
Suite/bldg./apt.no.: J Duct work _
14.00 _
Cross street/directions to job site: Hvdronic hot waters stem 1111 14.00
Residential boiler(radiator or
h dronic)
Unit heaters(fuel-type,not electric). 14.00
in-wall,in-duct,sus.ended.etc. 80 _
Flue/vent for an of above 6.6.00
Lot no.: Other.
Subdivision:
Other fuel a• liances 10.00
Tax map/parcel no.:
DESCRIPTION OF WORK elarr 10.00
t `u Flue vent for water heater or gas 10.00•, • ' fire•lace ini
LJct I�i.i I' . ., !N
` IL.. �� I U.00
Wood/.ellet stove
. a a � di_. � L-- Wood ti �.lacr`insert 10.00
-�• } `-
•, L y�i �2.i(alC P/1 �f T 10.00 r -t LI _, re i f 10.00
❑ PROPERTY OWNER tg TENANT Other.
Environmental exhaust and ventilation
Address:
Range hood/other kitchen 10.00
•ui.ment
Clothes d er exhaust 10.00
Phone: Single-duct exhaust(bathrooms.
toilet con artments,utili rooms) 6.80
Phone:( ) Fax:( )
❑ APPLICANT ❑ CONTACT PERSON Attic/ctawls.acc fans 10.00
Business name: uel •i,in:
711M -•'� or first four;$1.00 for each
Contact name: -
Address:
City/State/ZIP: Wall/sus. nded/unit heater
Water heater
Phone:( ) Fax::( ) rePill
E-mail: Ran'e
CONTRACTOR Barbecue
Clothes d er(•as)
• I_` Other. _
Address!cqq CI 0 6 MECHANICAL PER IT FEES*
City/State/ZIP: . Subtotal —
I�3...1 � Ot•2 �6Z Minimum permit Subtotal
Phone:( j)CU.00 Fax:(Qj�) 1. 3� Plan rcview(25%of permit fee)
CCB IIC.: ? Suite surcharge(12%of permit fee)
• TOTAL PERMIT FEE -1-80_
�� This permit application expires if a permit is not obtained within
Authorized signature: dal s after it has been accepted as complete.
wnt name: Date:y�///�� F�n.eth°d<'I..Sy set by Tri-County Building Industry Service Board
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10130 SW NIMBUS AVE D5, TIGARD, OR, 97223
Commercial - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00620
Jeff Grove
Violation Summary:
Inspector Contractor