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Permit CITY OF TIGARD MECHANICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00117 Date Issued: 04/08/2009 T I G A R ID 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136CCO2100 Jurisdiction: Tigard Site address: 11744 SW PACIFIC HWY Subdivision: Lot: 0 Project: Dutch Bros Project Description: Install HVAC. Owner: FEES GRUNBAUM FAMILY TRUST Description Date Amount BY HANS H /MARILYN K GRUNBAUM TRS, 21390 Permit Fee 04/08/2009 $168.50 SW EDY RD Plan Review 04/08/2009 $42.13 PHONE: 12% State Surcharge 04/08/2009 $20.22 Contractor: SANTIAM HEATING & SHEET METAL INC PO BOX 591 STAYTON, OR 97383 PHONE: 503- 769 -8483 FAX: 503- 769 -8554 Type of Use: COM Class of Work: NEW Type of Const: VB Occupancy Grp: M Occupancy Load: Stories: 1 Fuel Air Handlers Fuel Types: Natural Gas 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: 1 Vent Systems: Total $230.85 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 -0100. You may obtain a copy of the rules Issued By: ''1 S i 1 , 1 1 y. , Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that ulf siness 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. Mechanical Permit Application RECEIVE 01 ro R o FF I c c l' SE ()MN City of Tigard Received e ? � . 2 C) O q 4 Permit No.: la_ c 04 7 11111 • 13125 SW Hall Blvd., Tigard, OR 97223 MAR • 2 0 2009 Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 p ` 4-© Other Permit: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: to See Page 2 for Internet: www.tigard- or.gov BUILDINGDNISIO . -L = Q 2 '. � Supplemental Information 1. TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST New construction ❑ Addition /alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ G S RES ❑ 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building �ENTIAL EQUIPMENT / SYSTEMS FEES* ?l ID Multi-family ( ❑ Master builder El Other: For special information use checklist. Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: 1 t1 V W �Ca T ` g t Air conditioning or heat pump t S (requires site plan showing placement) 14.00 City/State/ZIP: 'T r (� re_ q Z Z3 Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg /apt. no.: I I'm Furnace 100,000+ BTU (ducts/vents) 17.90 Project name: �V ` rt �� 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 Subdivision: I Lot no.: Flue/vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 N tw NU ^ C_ Gas fireplace 10.00 J� Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 PROPERTY OWNER l ❑ TENANT Chimney/I iner /flue/vent 10.00 Other: 10.00 Name: le iZ ^ ti aLu k tyks Environmental exhaust and ventilation i GB sw (V l L4- Range hood/other kitchen t Address: equipment 10.00 City/ State/ZIP: siterwoe 4, Q 77/c/0 Clothes dryer exhaust 10.00 Phone: ( ) Fax: Single -duct exhaust (bathrooms, ( ) toilet compartments, utility moms) 6.80 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 G Business name: .t)S 4`•klam 1.654 n5 „. Steel-maid � Fuel piping Contact name: % (arr. I $5.40 for first four; $1.00 for each additional Address: 6 Sc ' Furnace, etc. Gas heat pump City/State/ZIP: 1 ' , i _ ' 4. re _ 1 75 8 3 Wall/suspended/unit heater Phone: (b3) 7 EN 3 Fax: : (s85) 7 t ass' Water heater y Fireplace E -mail: Range CONTRACTOR Barbecue � T /� ( /` + 5L l /_ / `T ` Clothes dryer (gas) ) Business name: ( Tl I�QT Ta ( rJ--1l Other. Address: aw�!_ �5 e�U !_ 7 MECHANICAL PE FEES* City/ State/ZIP: . ROx c \� V v� Subtotal Phone: ( ) �� F : ( ) Minimum permit fee ($72.50) Plan review (25% o permit fee) CCB lic.: 16 (0 So ' 2 I ` ` State surcharge (12% of permit fee) try TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. L Print name t 1 0 4 4... (Eit I Date: 3/2%" • Fee methodology set by Tri -County Building Industry Service Board I:\ Building \PermitsVMEC- PermitApp.doc 01 /19/07 440- 4617T(II/02/COM/WEB) CITY OF TIGARD TLC Zd ©S d // BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ii p " Phone: (503) 639 -4171 Ato. +t , Inspection Requests (24 Hrs.): (503) 639 -4175 A it °% INSPECTION WORKSHEET FOR DATE: WI 0 /09 TIME: PAGE: SITE ADDRESS: / / 7 7 7 /f� ci�� CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: �j 3 C c OWNER: PHONE #: `' > Z— l 3 CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message (P /.-- ilS a". , GGA,. A 60 it 6 3 0 / Corrections /Com ( 9) ents /Instructions: /7 _■g///c...J .i--j.--e-g-/tit S7 1--- 7-----y.t. C �.....a% c2t / ,- 7L/LA - keiL-) 1 L / - 4,1t Ct % - li` - e- SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED c� Inspector: ` /" �--- qA C� Date: / Phone #: (503) 718 - ?)43'q