Permit ` CITY O F TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00043
,.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/4/04
PARCEL: 2S112DC -00100
SITE ADDRESS: 15675 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Relocate ducts & grilles for TI. Project Value: $500
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 2/4/04 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 2/4/04 $5.80
Phone: Total $78.30
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202
Mechanical Insp
Phone: 239 - 4600
Final Inspection
Reg #: LIC 33135
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 -00 : I. ou may obtain copies of these rules or direct questions to OUNC by calling
(503 46 -6699.
Issu • d By: , _ I .4 � � � � / Permittee Signature: �j � •
Call (503) 6 9-4175 by 7:00 P.M. for inspections needed - "*�nTxx's usiness day
Mechanical 4. Application FOR OFFICE USE O `` N ,, ,�,,,,i. LY
City of Tigard
Date/By: d t>�t i �r 1 Pemut No.:Tf �� 3
..I '11
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /A � DDate/By: Other Permit:
�1(
Inspection Line: 503.639.4175 • -_ar i� " r.. Date Ready/By: kris: ® See Page 2 for
Internet: www.ci.tigard.or.us . " Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction [ddition/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: S 500
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: 15-6 75--- SK! .7z It, 0 frcV (requires site plan showing placement) 14.00
City/State/ZIP: T L t / A �� / 6g... 2 ZC7L Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: M 1 (E 6dLF p nuner7ocas heat pump 14.00
Cross street/directions to job site: �� /�` y� t • - /? Z iv/ Duct work 14.00
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. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
A 7 2 y/ 1 9i //e/4 1 •1 7u/ejv � Liu-- Flue vent for water heater or gas
�f� fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: ,die_ -nu sr Environmental exhaust and ventilation
Range hood /other kitchen
Address: 15 5 v i 64.- p 1 _ �aQ equipment 10.00
City/ State/ZIP: 47 y 1 7 L Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone: ( 5 , l 6 1 . .. 7 7E 7 Fax: (q9) b 2.....t -175S toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
/ Other: 10.00
Business name: i t i t , 106 - Fuel piping
lv P�P 1;
Contact name: L s..,& -24) $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 1 J viz,. Gas heat pump
City/ State/ZIP: T' /7645- -6 q ¶3. Wall/suspended/unit heater
Phone: (gfj) 6 .7! - 7.$ A L Fax: : (5 ) 5 - Z 7 G 75" Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: �,yv� Clothes dryer (gas)
��� ��� 7 a�� �G Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 3 ( - 2 j $ State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: - 04S� days after it has been accepted as complete.
Print name: 5141 506/ Date: • G f . 4. • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Pamits\MEC- PermitApp.doc 12/03 440.4617T(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.
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