Permit CITY OF TIGARD MECHANICAL PERMIT
° 11 . COMMUNITY DEVELOPMENT Permit#: MEC2016 00758
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/01/2016
G k" g Parcel: 1 S 135 BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE AVE
Project: Rose City Futsal Subdivision: None Lot: None
Project Description: 160 ft.of fuel piping for(3)gas appliances in kitchen.
Contractor: JH KELLY LLC Owner: ICON IPC PROPERTY OWNER POOL 2 L
2311 E 1ST STREET BY INDCOR PROPERTIES
VANCOUVER, WA 98661 2 NORTH RIVERSIDE PLAZA, STE 235
CHICAGO, IL 60606
PHONE: 360-423-5510 PHONE:
FAX: 503-285-0812
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/01/2016 $115.11
Class of Work: ALT Type of Const: Plan Review 11/01/2016 $28.78
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/01/2016 $13.81
Stories: Info Process/Archiving-Sm$0.50(up to 11/01/2016 $0.50
11x17)
Project Valuation: $2,000.00
Fuel Air Handlers
Fuel Types: Gasoline 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 $158.20
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
.i‘:72: ...
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application t / FOR OFFICE I.SE ONE)'
City of Tigard Received
w Date/By: /!limnPermit No.: --- 1 t - -.,) r
13125 SW Hall Blvd.,Tigard,OVW' ,' Plan Review
Phone: 503.718.2439 Fax: 503. 1 ,Ark) Date/By: Other Permit:
T 1 G A K D Inspection Line: 503.639.4175 ,' Date Ready/By: rim ® See Page 2 for
Internet: www.tigard-or.gov �� r' "�
- '` 'I 'Notified/Method: Supplemental Information
TYPE OF W016 x\ COMMERCIAL FEE* SCHEDULE–USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction , Addition/alterati cement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and pr it.
Value:$ 22)t a
CATEGORY OF CONSTRUCTION I
RESIDENTIAL EQUIPMENT I 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 46.75
Job site address: J €5 ?( so l�/ucA /4P't Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: rl b ifie66 V e--4 / Q7 2 G-"� 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: ?OSTE (_/i9' tg,47f4f Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residentialboiler(radiator orS, `(: 4 U6ea /e-p 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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
k DESCRIPTION OF WORK Gas fireplace/insert 33.39
A7:0.0 / ,� L r Flue vent for water heater or gas
Me / i' C�7� f/9/ fireplace 23.32
i j_ / IC41d> Log (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
0 PROPERTY OWNER I. ❑'TENANT
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 .,.,, 0 CONTACT PERSON= Other: 23.32
Fuel
Business name: L k& C piping:
!y
$14.15 for first four;$4.03 for each additional
Contact name: el c�N ie I TO LA Furnace,etc.
Address: Z 3 i 11. iv- cr Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: I/A- Cou4/5*. 67A G)Q 66
/ Water heater
Phone:(36o) 41Z 3 a/D Fax::( ZJS Q S ,Z Fireplace
Range
E-mail: rr. i -taijlea 1.4k...60.54 , t 9y,. Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: S.
.E As /IPPL I* er
MECHANICAL PERMIT FEES*
Address: Subtotal I/5":-/i �.5?
City/State/ZIP: Minimum permit fee($90.00) --'
Plan review(25%of permit fee) ?V. J"
Phone:( ) Fax:( )
State surcharge(12%of permit fee) /3,`e(
CCB lic.: ® / / -7 C Y Li TOTAL PERMIT FEE /ST,
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
t1<r ..._........2
Authorized signature: /Z. * Fee methodology set by Tri-County Building Industry Service Board
Print name: tCt(J4 k 1 ra&t Date: //— /.— 20/6
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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