Permit CITY OF TIGARD MECHANICAL PERMIT
`• COMMUNITY DEVELOPMENT Permit #: MEC2009 -00399
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 08/05/2009
Parcel: 25101 DCO3900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Subdivision: Lot: 0
Project: Progressive Insurance
Project Description: Modify existing return and supply grills. No plan review required
Owner: FEES
PROGRESSIVE CASUALTY Description Date Amount
INSURANCE COMPANY, REAL ESTATE Permit Fee 08/05/2009 $72 50
NOTIFICATIONS, PO BOX 89429 12% State Surcharge - Mechanical 08/05/2009 $8.70
PHONE
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015
PHONE: 503 - 656 -1184
FAX: 503 - 656 -4650
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types' Units < 10000 cfm.
Gas Pressue. 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 $81.20
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, o • or is s p nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Ore. •n
Utility N 'cation Center. Th s • - - e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the •les
or dire questions to OUNC .y ,Ilmg i •.246.6699 or 1 800.332.2344.
Issued y: ` I, ' Permittee Signature: ,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
I ``I' OF TIGARD PERMIT #:
• `BUILDING DIVISION DATE ISSUED:
• 13125 5`W HaII Blvd., Tigard, OR 97223 -- --
A y h
Phone: 503 639 -4171 p I G ,' l
: S „�
Inspection Requests (24 Hrs.): (503) 639 -4175 ? °�� I ` kx acs. /
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 115 (),) SCU a 190 Y Q CLASS OF WORK:
SUBDIVISION: -'LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
ZyV2 - 1 - 1- 1 1 V&VV and Gva 11 Sbr _
OWNER: DD VS Qj _a/A. 4 I4,GL_ PHONE #: 6Z55-?-2--Z- -5 100
CONTRACTOR: p PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
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Ct*SrYtUrflEritICRTY9.6* ---"—)
124 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR REINSPECTION ❑ ADDITIONAL FEES ASSESSED I
Inspector: �Q i. 0061. Date: 2'5' W Phone #: (503) 718- 2`{qi,
i :\Building\IVRUVR- InspWorksheet- BlankForm.doc 03/02/2005
er Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Date/By - BEM Permit No.: �j/I 0 00 q"
IN ° 13125 S W Hall Blvd , Tigard, OR 97223 vv /
t! Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy Other Permit
5
TIC A R D Inspection Line: 503 639 A i G 0 5 2009 Date Ready/By ®See Page 2 for
Internet' www.tigard or.gov Notified/Method BM Supplemental Information
CITY OF TIGARD
TYPE 4416%ti DIVISION COMMERCIAL 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 ❑ Other. mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION - Value $ . j j
. 'RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling 'Commercial /industrial ❑ Accessory building
For special Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty I Ea I Total
- JOB SITE INFORMATION AND LOCATION Heating/cooling
� ' Air conditioning or heat pump
Job site address:
�/ ,f�✓ (requires site plan showing placement) 14.00
City /State/ZIP: - -/ ` �lei _ Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg. /apt. no.: Project name:�2g�,j 7b2tI Gas heat pump 14.00
Cross street/directions to job site: // Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14 00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK : Water heater 10.00
l Gas fireplace 10.00
') 1 0jj(,�jy -yt ,S) 'S.10:1 6Z2f7 lA4� Flue vent for water heater or gas
1 y fireplace 10.00
j) 3 n�0— Log lighter (gas) 10 00
11 Wood /pellet stove 10 00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER " . ' - ❑ TENANT
Chimney/liner/flue/vent 10 00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10 00
City /State /ZIP: Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
PLICANT - ❑ CONTACT. PERSON Attic/crawlspace fans 10.00
Other 10.00
Business name:
d� -A'71• ` Fuel piping
Contact name: 46 -L � e -g- $5.40 for first four; $1.00 for each additional
Address: P Furnace, etc.
I� ° ��� Gas heat pump
City /State /ZIP: �� / �/ s � � 5CZ O7 J Wall /suspended/unit heater
Phone: ( ) b;e5t, � Fax: : ( ) hG-� ab Water heater
�� ll N R a n g
E -mail: e
� �-erdf� Range
CONTRACTOR ' . Barbecue
�/f�y Clothes dryer (gas)
Business name: ,4172/4,. ' j -'" 0- ') ) � Other:
Address: ' MECHANICAL PERMIT FEES* • _ • , •
City /State /ZIP: Subtotal `�
( )
Minimum permit fee ($72.50) (A �l �7�.J
Phone: ( ) Fax:
Plan review (25 %of permit fee) -�—
CCB Iic.: 44 1 State surcharge (12% of permit fee) g. 70
TOTAL PERMIT FEE g /. aQ
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete. .447
Print name: s Jj
p... yam Date: / -hl * Fee methodology set by Tn -County Building Industry Service Board
I.\ Building \Permits�MEC•PermitApp.doc 01/19/07 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
=Total Valuation: Permit- Fee:,
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I•\ Building \PermitsMEC -PermitAppdoc 01/19/07 2