Permit (50) IIIICITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00020
13125 SW Hall Blvd.,Ti Date Issued: 01/10/2017
T[t t k�.Dand OR 97223 503.718.2439 9
Parcel: 1 S135BC00300
Jurisdiction: Tigard
Site address: 10840 SW CASCADE AVE
Project: Franz Bakery Subdivision: None Lot: None
Project Description: Replacing(4)unit heaters in warehouse.
Contractor: HVAC INC Owner: UNITED STATES BAKERY
5188 SE INTERNATIONAL WAY PO BOX 14769
MILWAUKIE, OR 97222 PORTLAND, OR 97214
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/10/2017 $411.21
Class of Work: ALT Type of Const: Plan Review 01/10/2017 $102.80
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 01/10/2017 $49.35
Stories: Info Process/Archiving-Sm$0.50(up to 01/10/2017 $2.50
11x17)
Project Valuation: $12,500.00
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: 4 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $565.86
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow th= ules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You a obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `� (G Permittee Signature:
•
Call 503.639.4175 by 7:00 a.m.for the next available inspectio date
This permit card shall be kept in a conspicuous place on the job site until corn,leti'n of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1.OR 01.11( F.. ISI:Oyl.l
City of Tigard Received
-t Date/By: �� �lE Y" Permit No.: — y�,)
13125 SW Hall Blvd.,Tigard,OR 972 y t r / wLJ
Phone: 503.718.2439 Fax: 503.598.1 �J �t- PPllaante/vlti .. ...
Inspection Line: 503.639.4175 y ay �� Other Permit:
l I( A K[) p Date Ready/By. H See Page 2 for
Internet: www.tigard-or.gov j� i Notified/Method: Supplemental Information
f,;.,. 14 2011J ir) Fi i
TYPE OF WORK 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
New constructionF T x Mechanical permit fees*are based on the value of the work
❑ 0 Addition/alteraddition/altera41)
l e lace i
t k performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: tlii- .;lr�t + 3ti mechanical materials,equipment,labor,overhead,and profit.
Value:$ 1 1 .t
CATEGORY OF,CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 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:
c a Air conditioning
Job site address: i U I.1 ClL C, Lc1 Q (i v� (requires site plan showing placement) 46.75
City/State/ZIP: j Cl '� S-, /� Furnace 100,000 BTU(duets/vents) 46.75
� � (A-I�" - t Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt.no.: Project name: 5r(,v it' ."1-'1 1 0,1( 1 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: 0 f1/ Duct work 23.32
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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORKWater heater 23.32
p(ucsv,j 11_,,\ {/1 , 1 — 1,/^�0 ) Gas fireplace/insert 33.39
L/1 Flue vent for water heater or gas
'c i l`u -s 0 0 q, fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0
PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 23.32
Name: Other: 23.32
Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 3339
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( )
toilet compartments,utility rooms) 23.32
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Business name:HVAC,Inc. Other 23.32
Fuel piping:
Contact name:Jody DePew $14.15 for first four;$4.03 for each additional
Address:5188 SE Internaitonal Way Furnace,etc.
Gas heat pump
City/State/ZIP:Milwaukie,OR 97222 Wall/suspended/unit heater
Phone:(503)462-4822 Fax::(503)462-6555 _Water heater
Fireplace
E-mail:jodyd @hvacincorp.com Range
CONTRACTOR Barbecue
Business name:HVAC,Inc. Clothes dryer(gas)
Address: ? rr " Other:
(it4 i 1'Q MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone: Minimum permit fee($90.00)
( ) Fax:( ) Plan review(25%of permit fee)
CCB lie.:50897 State surcharge(12%of permit fee)
1 jj TOTAL PERMIT FEE
Authorized signature: /// This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name:Jody DePew U Date: 1 f t D j '� * Fee methodology set by Tri-County Building Industry Service Board
I:\Buulding\Petntits\MEC-PermitApp.doc 03/07/12 440-461TT(Il(/02/COM/WEB)
It City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Mechanical Permit
L Appointment Checklist
Permit Record#: Air--;-,6-219/, .10
Contact Name: 7 C4 Phone #: • 02- II; ,
Business Name: //1A 1.1-Nr.„ Appointment Date: 1 0 /7 10,'00
Site Address: /6?"1-10 Sc.,) Bldg/ uite #:
Project Name: fca .Z .fir of
Project Description: /c,c, by) ,- iVeri
Related Record#:
GENERAL INFORMATION JT
*Class of Work: Occupancy Group: I Type of Construction: _
`'
*Type of Use: -SIS --C--b AAl Oregon Specialty Code:
Number of Stories: I
FUEL FURNACES
Type: 0 6" Furnace< 100K BTU Furnaces>= 100K BTU
Gas Pressure: 2 u6 Roof Top Unit(RTU) Tons
Floor Furnaces Unit Heaters Ac --
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units> 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler(BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes D ers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire/Smoke Dampers Other Mechanical Units—Describe:
Total Project Valuation: $ (2-)!`
$ Mechanical Permit Fee
$ l , '`'j Plan Review
$ '� . ,'j T 12%State Surcharge
$ Info Proc/Arch,Lg(over 11x17 $2.00)
$ " -t' Info Proc/Arch,Sm(up to 11x17$0.50)
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
Building Staff:
Date/Time: $ 5i (, TOTAL EES DUE
I:\Building\Forms\OTC_MEC_021116.docx
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
10840 SW CASCADE AVE, TIGARD, OR, 97223
Record Type:
Commercial - Mechanical
Inspection Type:
699 Mechanical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MEC2017-00020
Inspector:
Jeff Grove
Contractor