Permit (58) INCITY OF TIGARD MECHANICAL PERMIT
I°' COMMUNITY DEVELOPMENT Permit#: MEC2016-00551
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2016
Parcel: 2S101 BB01500
Jurisdiction: Tigard
Site address: 12250 SW GARDEN PL
Project: MedFocus Subdivision: CROW PARK 217 Lot: 3
Project Description: Install a mini-split system and relocate a few grilles for TI
Contractor: GOHMAN MECHANICAL Owner: ICON OWNER POOL 1 WEST LLC
14505 SE HWY 212 BY RYAN
CLACKAMAS, OR 97015 PO BOX 460169
HOUSTON,TX 77056
PHONE: 503-658-1892 PHONE:
FAX: 503-658-6925
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/02/2016 $191.86
Class of Work: ALT Type of Const: Plan Review 08/02/2016 $47.97
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 08/02/2016 $23.02
Stories: Info Process/Archiving-Lg$2.00(over 08/02/2016 $2.00
11x17)
Project Valuation: $4,500.00 Info Process/Archiving-Sm$0.50(up to 08/02/2016 $2.00
11x17)
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 $266.85
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. the rules -dopt-a ,y the Oregon
Utility Notifi - '.. Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 ou ma -in • copy of the rules
or dire questions to•► , •' ailing 503.232.1987 or 1.800.332.2344.
Permittee Signature:
ssued By: 0 � �/'i, 91 AO
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.
1
Mechanical Permit Application FOR OFFICE USE ONLY
F EIVED Received 3O/( PermitNo.: I-1g 5/
- City of Tigard RRR 999777 Date/By: bD°S
13125 SW Hall Blvd.,Tigard,O 2
Phone: 503.718.2439 Fax: 503.5 0 Plan Review
'i ti 2 2016 DateBy: Other Permit: t`•/6,_,,di/9;
TIGARD Inspection Line: 503.639.4175 U DateReady/By: Juris ® See Page 2(foo!r
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
CITY OF TIGARD
Tau DIVISION COMMERCIAL FEE* SCHEDULE — USE CHEC .IST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$4,500.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12250 SW Garden Place 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:MedFocus
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
Install a Mini Split System and move a few grilles to accommodate new floor plan fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
:4 PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Icon Owner Pool 1 West LLC by Ryan Range hood/other kitchen
equipment 33.39
Address:PO Box 460169 Clothes dryer exhaust ; 33.39
City/State/ZIP:Houston,TX 77056 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:Gohman Mechanical,Inc. Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Jennifer Fulsher Furnace,etc.
Address: 14505 SE Hwy 212 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Clackamas,OR 97015 Water heater
Phone:(503-)658-1892 Fax: :(503)658-6925 Fireplace
Range
E-mail:Jennifer@gohmanmechanical.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Gohman Mechanical,Inc Other:
MECHANICAL PERMIT FEES*
Address: 14505 SE Hwy 212 Subtotal
City/State/ZIP:Clackamas,OR 97015 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)658-1892 Fax:( ) _
State surcharge(12%of permit fee)
CCB lic.: 119952 TOTAL PERMIT FEE �• 85
This permit application expires if a permit is not obtained within 180
Authorized signature, days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:Jennife //� Date:8/2/2016
I:\BuildingWermits\MEC_PermitAp. "�I3.doc ' 440-4617T(11/02/COM/WEB)