Permit (101) CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit#: MEC2017-00066
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 01/30/2017
TlC \IZC� 9
Parcel: 1S 136DA02600
Jurisdiction: Tigard
Site address: 11140 SW 68TH PKWY
Project: Cascade Veterinary Clinic Subdivision: 2000-025 PARTITION PLAT Lot: 2
Project Description: Replace mini split
Contractor: ROTH HEATING&COOLING Owner: CASCADE VETERINARY HOLDINGS LLC
PO BOX 1265 11140 SW 68TH PKWY
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/30/2017 $164.23
Class of Work: ALT Type of Const: Plan Review 01/30/2017 $41.06
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 01/30/2017 $19.71
Stories: Info Process/Archiving-Sm$0.50(up to 01/30/2017 $2.00
11x17)
Project Valuation: $3,595.00
Fuel Air Handlers
Fuel Types: Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Fumaces<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 $227.00
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ad..ed by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. .0 ay obta. copy of the rules
or direct o OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ed By: I. Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection •=te.
This permit card shall be kept in a conspicuous place on the job site until comp tion : the project.
Approved plans are required on the job site at the time of each inspec ion.
Mechanical Permit Application FORROOFFTCE I<SE ONI,N.
Cityof Tigard � Received I(f) /7�S_ j -1__°,004,0
g i 9...i Date/By: �/ Permit No.: �!
11.
' 13125 SW Hall Blvd.,Tigard,G' ' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready By Juris: ® See Page 2 for
Internet www.tigard-or.gov JAN 3 0 2(11^ Notified/Method: Supplemental Information
7YP , . _.
11 I'��°E A11. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
ow er DI VI Mechanical permit fees*are based on the value of the work
❑New construction /]Ad iera ton/rep aceme performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:$ 0)5 e4 s .
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling la Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11/Li 6g7-4 r , Furnace 100,000 BTU(ducts/vents) 46.75
.--.1
,, �V 0 f 97 -Zu Furnace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: l� I
) Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
''�� 1 t ��1 Flue vent for water heater or gas
_.e Ic- C-e vvl i h) 1. /t T 3//4 11°wN, fireplace 23.32
I Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
IP PROPERTY OWNER' ❑ TENANT
Environmental exhaust and ventilation:
•Name: C ca cc,d C/p. )• Range hood/other kitchen
�' vl equipment 33.39
Address: 1 I - g A 1c,/kwe.. Clothes dryer exhaust 33.39
City/State/ZIP: `j't c. r.1 0 f 97 _7_1.-I Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(_5j3) 6'Lt pg.00 Fax:( ) Attic/crawlspace fans 23.32
E] APPLICANT 0 CONTACT PERSON Other: 23.32
r Fuel piping:
Business name. O J'1€c �i C`�,C( CA-,i, r-,. $14.15 for first four;$4.03 for each additional
Contact name: ,,..) Furnace,etc.
Gas heat pump
Address: Q C�j� Wall/suspended/unit heater
City/State/ZIP: (c ,\_,4 )w-, 1_7_0z3 Water heater
Phone:(6-0y ...6G,ii Li q Fax: :( ) FireplaceRange
I..-mail: R0+1, 6i) ' 41,_JJ, , (.01M Barbecue
CONTRACTOR' Clothes dryer(gas)
Other:
Business name:
MECHANICAL PERMIT FEES*
Address: 2 t Subtotal
City/State/ZIP: Minimum permitofee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) �/
CCB lic.:
/400 4 TOTAL PERMIT FEE 102e27'
t` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
ij
Authorized signature: , ��// `� 11/7://),1
I ` ' Fee methodology set by Tri-County Building Industry Service Board
Print name: 4" r P Yl'+1'et (�-�-, ijc ✓JDt-1 Date: / 7 / 7
1.\Building Permits\MEC_PermitApp_040113.doe 440-4617T(I 1/02/COM/WEB)