Permit (61) CITY OF TIGARD MECHANICAL PERMIT
III'� Permit#: MEC2016-00395
COMMUNITY DEVELOPMENT
T[G'\RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/07/2016
Parcel: 1S136CD01601
Jurisdiction: Tigard
Site address: 11670 SW PACIFIC HWY
Project: Pizza Caboose Subdivision: None Lot: None
Project Description: Replace existing RTU unit.
Contractor: CALIBER PLUMBING&MECHANICAL INC Owner: DOUGHTY FAMILY TRUST
10940 SW BARNES RD#114 BY DAVIS, C THOMAS TR
PORTLAND, OR 97225 12220 SW FIRST ST
BEAVERTON, OR 97005
PHONE: 971-563-1672 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/07/2016 $243.74
Class of Work: ALT Type of Const: Plan Review 06/07/2016 $60.94
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 06/07/2016 $29.25
Stories: Info Process/Archiving-Sm$0.50(up to 06/07/2016 $9.00
11x17)
Project Valuation: $6,250.00
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 $342.93
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 50 87_ or . 2.2344.2Q �
Issued By: Permittee Signature: ��
3.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r
Mechanical Permit Application
Received Q
City of Tigard REC ivp � 7 / PermitNo.: �I6_L1 pn1Zj b037S
Date/By: !��'
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19JU Date/By: � A� yi‘
Other
r Permit:
Inspection Line: 503.639.4175 1 2016 Jeris:
See Page 2 for yy
Internet: azd-or. Notife, ethod: Supplemental
Information
Cl i Y Lir
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TYPE F'„:IRRQ DIVISIONa (f,, COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead and profit.
de
Value:$ ( Z6-0,
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE`INFORMATION AND LOCATION
Heating/cooling:
Air conditioning 1 46.75 4-I�.P -'5
Job site address: \1�-( "Q(lkt.0_, �� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �'t ��� ) o ._ ,Q,� Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump _ 61.06
Suite/bldg./apt.no.: Project name: P1 7-P '(- p5-lt._ 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
Other: 23.32
Subdivision: Lot no.:
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
.---Va)`1 AC- C 1 M:tC6A (- cik- c6_(tQP1{�('i t�11�(lD V fireplace 23.32
V_n C 1 ,^, r p ( `' Log lighter(gas) 23.32
laS \ .\`1 12 Q 'ec.'k i l COLA VC onnic 'C r E C1e rn c Y Wood/pellet stove 33.39
\jlai CYF Q .x\ 1(\)L Li ` , Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 0 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 _
0 APPLICANT 0 CONTACT PERSON Other: 23.32
\ Fuel piping:
Business name: '( ,A IACD RG e \ \ec tane ai
J $14.15 for first four;$4.03 for each additional
Contact name: �(�a�00 i Furnace,etc.
Address: u_ Ni l ex�\rCl� Si e n�Q0 Gas heat pump
P� Wall/suspended/unit heater
City/State/ZIP: �` � `J� CC-I-a n- Water heater
Phone:( 0 FID- �C� ' n D Fax: :(�(c--
,)03)n2 _5'� ` Fireplace
Range
E-mail:( I�nC Ca 11t(r `CC V)(ti\ CGJ .C CSM Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:Cat Lc( , k \\` eco n(C MECHANICAL PERMIT FEES*
u.
Address: V � w C 1e_ St- 9iO0 Subtotal _
City/State/ZIP Xkll;\ci Oa_ C,l an Minimum permit fee($90.00)
PC pap-q_� 1 1 Fax: J(rte-3)2,a)*-- J e su review(25%of permit fee)
Phone:
( (,; G
State surcharge(12%of permit fee) _
CCB lic.: ac�ati s- TOTAL PERMIT FEE :1.
This permit application expires if a permit is not obtained within 180
CXdays after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: 04,fL ilA,1/4..NAR Date:S'Si- t LO
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)