Permit CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: MEC2015-00669
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2015
Parcel: 2S101 DC03700
Jurisdiction: Tigard
Site address: 7095 SW SANDBURG ST
Project: UFCW Local 555 Subdivision: ROLLING HILLS NO.2 Lot: 44
Project Description: Installation of Mitsubishi heat pump split system.
Contractor: ALLIANT SYSTEMS LLC Owner: UNITED FOOD&COMMERICAL WORKERS
1600 NW 167TH PL#330 UNION LOCAL#555
BEAVERTON, OR 97006 PO BOX 23555
TIGARD, OR 97281
PHONE: 503-619-4066 PHONE:
FAX: 503-230-9238
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/30/2015 $344.90
Class of Work: ALT Type of Const: Plan Review 09/30/2015 $86.23
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 09/30/2015 $41.39
Stories: Info Process/Archiving-Sm$0.50(up to 09/30/2015 $1.00
11x17)
Project Valuation: $9,851.00
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: 1
Appliances
Vent Fans: Vent Systems: Total $473.52
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 rules adopted by the Oregon
Utility Notific. • - • er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire •uestions to OU • by - ' g 503.232.1987 or 1.800.332.2344.
I sued By: / / ` Permittee Signature: X
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
CEIVEJ) Date/By: �//k//� (x...� Permit No.:Htedi"---001,c69
r 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T WARD Inspection Line: 503.639.4175 S E P 3 0 2015 Date Ready/By: kris fa See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
M
TYPE
lr���/i��n�. Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement !vv performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$9851
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 1 Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:7095 SW Sandburg St 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:UFCW Printing Room HP 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
Install a Mitsubishi heat pump split system. 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/crawispace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Alliant Systems $14.15 for first four;$4.03 for each additional
Contact name: Dave Russell Furnace,etc.
Address: 1600 NW 167th Place,Suite 330 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Beaverton,OR 97006 Water heater
Phone:(503)572-2761 Fax: :(503)230-9238 Fireplace
Range
E-mail:d.russellQalliant-systems.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:Alliant Systems MECHANICAL PERMIT FEES*
Address: 1600 NW 167th Place,Suite 330 Subtotal
City/State/ZIP:Beaverton,OR 97006 Minimum permit fee($90.00)
Plan review(12%of permit fee)
Phone:(503)572-2761 Fax:(503)230-9238
State surcharge(12/o of permit fee)
CCB lic.: 153420 TOTAL PERMIT FEE f973
This permit application expires if a permit is not obtained within 180
�j days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Dave Russell Date: et/30/(Jr
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