Permit (33) IN CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
PeCOMMUNITY
MEC2019-00441
Date Issued: 07/16/2019
T i(;A I+.1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102BD03200
Jurisdiction: Tigard
Site address: 13075 SW PACIFIC HWY
Project: SANCHEZ Subdivision: NORTH TIGARDVILLE ADDITION Lot: 35
Project Description: Gas pipe extension to(2)furnaces.
Contractor: FADI KARAM KARAM Owner: SANCHEZ, J GUADALUPE
21020 SE YAMHILL ST ZAVALA, BLANCA E
GRESHAM, OR 97030 10000 SW MOLLY CT
TIGARD, OR 97223
PHONE: 503-810-9202 PHONE: 503-700-6115
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/16/2019 $145.81
Class of Work: ALT Type of Const: VB Plan Review 07/16/2019 $36.45
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 07/16/2019 $17.50
Stories: Info Process/Archiving-Sm$0.50(up to 07/16/2019 $0.50
11x17)
Project Valuation: $3,000.00
Fuel Air Handlers
Fuel Types: Natural Gas Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Fumaces: 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 $200.26
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
DuctWbftc
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma 'obta - copy of the rules
or direct questions to OUNC by calling 503.232t:87 or 1.80•.332 2 .. ,p
•
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
Mechanical Permit ApplicatioI N 2 b 2019 FOR OFFICE LSE ONE)
Received /
City of Tigard r� Date/By: ! y . Per�,� /: �> yq
lig si 13125 SW Hall Blvd.,Tigard,OR 970OF IGAR e 1 Plan Revie / -�j `
Phone: 503.718.2439 Fax: 503.5 1 I I S 3. Date/By: a.,* j Other Permit:
Inspection Line: 503.639.4175 1 L c
I 1 c,n R l) p Date Ready/By: �f �j� i Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: `a ( Supplemental Information
f a [h t'PE OI+ *owCOMMERCIAL FEE* SCHEDULE 'USE CHECKLIST.-
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY:OF CONSTRUCTION ,::.4,, Value:$ t >
j
ty... R.E . A EQUIPMENT/4 SYSTEMS FEES "n ,e.
❑ 1-and 2-family dwelling q Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. 1 Ea. I Total
JOB SITE 1NFGRMATION AND LOCATION Heating/cooling:
- i (( "„. Air conditioning _ 46.75
Job site address: t 0 '5 r w fol 0 F IC h'l/y Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: .-/%g /) f!!//�l ii�� / Furnace 100,000+BTU(ducts/vents) 54.91
V` 6A 2- p/ 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
Subdivision: l Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
, i l', ION OF'' o �Q Gas fireplace/insert 33.39t f" Flue vent for water heater or gas
,4 f' /2SZ. )0'� .5-121 t 1 fireplace 23.32
i..)U't*N SI-A./.-c.
,/ 'l am T Log lighter(gas) 23.32
A�'" Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
i� �tr � � Other: 23.32
‘/In IyR{3 ' * R` I T Environmental exhaust and ventilation:
Name: y7 6-o4 „kr� „ c,/,,2_.I 1; 1. c._ Range hood/other kitchen
vvequipment 33.39
Address: it--� �' ,Sr„ el,/ 6/, Clothes dryer exhaust 33.39
City/State/ZIP: r C3-","\.C3-","\. il-) 2 2 Single-duct exhaust(bathrooms,
.� , _ 3 toilet compartments,utility rooms) 23.32
Phone:( ) S�3 tru Fax:( ) Attic/crawlspace fans 23.32
`, ❑ APPLICANT a CONTACT PIf-644,'y Other: 23.32
Fuel piping:
r^
Business name: �� t ^/'\ C,J✓l-6( -lrt}L4d 7A.- $14.15 for first four;$4.03 for each additional
Contact name: r4 ( 1` J Furnace,etc.
Gas heat pump
Address: tvt„)4t S tin 6.a 1 . Wall/suspended/unit heater
CityiStateal lam._-- - ,-macer-heater _ _
Phone:6v3) &i . 2-U , Fax: :( ) Fireplace
Range
E-mail: 17/y1 CO t.1 c-i'u'c'j-t YJ 1 :.t ' 4.' 1 C 0 v"-1 Barbecue
CONTRACTOR =� -4 Clothes dryer(gas)
Business name: - er:
��- MECHANICAL PERMIT FEES*
Address: 2L S(11 $( 1,.1/ 811- Subtotal a
City/State/ZIP: �yte�irk... ea/(_ < Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 9- TOTAL PERMIT FEE
mo This permit application expires if a permit is not obtained within 180
L _ days after it has been accepted as complete.
Authorized signature: �- * Fee methodology set by Tri-County Building Industry Service Board
Print name: c-,-.4 a:- 144/-------- Date: 6-i-S -(5
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation:'ry Permit F
$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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2