Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2020-00052
Date Issued: 01/28/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD 180
Project: Paulson's Floor Coverings Subdivision: None Lot: None
Project Description: Reconnecting(6)exhaust fans.
Contractor: EVERGREEN GAS Owner: TV5 LLC
16385 SW LANGER DR 10855 SW CASCADE BLVD
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-407-9542 PHONE: 503-620-7080
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/28/2020 $118.18
Class of Work: ALT Type of Const: Plan Review 01/28/2020 $29.55
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 01/28/2020 $14.18
Stories: Info Process/Archiving-Sm$0.50(up to 01/28/2020 $6.00
11x17)
Project Valuation: $2,050.00
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: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 6 Vent Systems: Total $167.91
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard ""~ Received
Permit No.:
® 13125 SW Hall Blvd.,Tigard,OR 97223 y I �t ' �� �'
Phone: 503.718.2439 Fax: 503.598.1960. Q )) (�}y Plan Review
�. 1j 8 L O Z UIII Date/By: Other Permit: / 41001t41._it
T 1 G A RD Inspection Line: 503.639.4175 Date Ready/By: Juris: r®J See Page✓2 for
Internet: www.tigard-or.gov ,TI,r ,(,,, ?g' )*y r,t"z Notified/Method: ;"" Supplemental Information
& -v" COMMERCIAL FEE*SCHEDULE-=USE CHECKLIST
''` `" 'a"''' - Mechanical permit fees*are based on the value of the work
O New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
,,,i o :� Value:$ 0 50"
CATEGORY OF CONSTRUCTION ` 11� i,,,, , ES ENTL4LEQUiPME YSTEMSFEES*
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION A 'I t CAn , Heating/cooling:
•, __ Air conditioning 46.75
Job site address: /'S b5- .$(,,,) ¢(( 6 t M Furnace 100,000 BTU(ducts vents) 46.75
City/State/ZIP: / r it ref b.a, / l 22 S Furnace 100,000+BTU(ducts/vents) 54.91
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: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
•ail Gas fireplace/insert 33.39
RIPTION OF WORK ,.
°' Flue vent for water heater or gas
RLL0.^Y1L(.f 6" ✓..`S W/ yIt )acf fireplace 23.32
Log
b G"POK .i # 1 1I r Wood/pellet(gas) 23.32
stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
IA PROPERTY OWNER 4 — 9' ,
�� Environmental exhaust andventilation:
Name: 1/401s J, &a r- co Range hood/other kitchen
equipment 33.39
Address: w 2 ZX 2 5 4/Z 1 Clothes dryer exhaust 33.39
City/State/ZIP: 'D r ' 7 ei 7 2 e/ Single-duct exhaust(bathrooms,
r.�• `(, �k 9' toilet compartments,utility moms) IF' 23.32
Phone:(5 js )712 g/ .. Fax:( ) Attic/crawlspace fans 23.32
13_J=AIxI"�c / .0 CONTAC t N Other: 23.32
Fuel piping:
Business name: et.) r l: $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
, , CONTRACTOR Clothes dryer(gas)
Business name: meter'
�l)�r(rlteiti G� rTKL MECHANICAL PERMIT FEES*
Address: / / g B s-4 S �y,-t Er b� Subtotal
City/State/ZIP: t L��II d E 6 ( q t /41� Minimum permit fee($90.00)
✓ Plan review(25%of permit fee)
Phone:(t 63) yd 1 C9,5yZ_ Fax:( ) State surcharge(12%of permit fee)
CCB lie,.:/ / 5 5 0� I i Ji /1-1 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: CA.)1 u t Nf/fr./.1/1-0,t Date: 2Z 70
W `
1:\Building\Peimits\MEC_PennitApp_040113.doc 440 617T(11/02/COM/WEB)