Permit CITY OF TIGARD MECHANICAL PERMIT
! , ' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00368
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/18/2011
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Adding new RTU, exhaust fans, duct work, grilles and gas piping for TI.
Contractor: HVAC INC Owner: TRC MM LLC
5188 SE INTERNATIONAL WAY 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 462 -4822 PHONE:
FAX: 503 - 462 -6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/18/2011 $515.35
Class of Work: ALT Type of Const: IIB Plan Review 08/18/2011 $128.84
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 08/18/2011 $61.84
Stories: 1 Info Process /Archiving - Lg Sheet (over 08/18/2011 $4.00
11x17)
Project Valuation: $16,589.00 Info Process /Archiving - Sm Sheet (up to 08/18/2011 $18.50
11x17)
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 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 $728.53
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
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 •btain copy of the rules
or direct qu- •. . ,UNC by ing 3.232.1987 or 1.800.332.2344.
Issued B :- Permittee Signature: -
fV
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until co •letion of the project.
Approved plans are required on the job site at the time of each ins. - •.n.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.: f
IN
- ° 13125 SW Hall Blvd., Tigard, OR n3y / ` ° 6l ✓, • Phone: 503.639.4171 Fax: 503.5 >i-+ I 1 I Plan Review of��//�, �t
: .. i Date/By: rM S2I � Other Permit: / "/ � �G01 j F e
TI G A RD Inspection Line: 503.639.4175 Date Ready iy: J nis: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
AUi) --.0 „ ! i� it 176
. te Z e_ U>1.../in .
' TYPE . Otti1''TIGAf COMMER FEE* SCHEDULE = USE CHECKLIST
❑ New construction M, AdditiolaMiNtiOWNWN 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: $/4.6
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES * ".
❑ 1- and 2- family dwelling ►. Commercial /industrial ❑ Accessory building
El .Multi-family CI Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. 1 Total
'r i JOB SITE INFORMATION. AND LOCATION Heating /cooling
Air conditioning or heat pump
Job site address: /5570 to.) / �,� ' `/ C.-
f'�/ /INl . (requires site plan showing placement) 14.00
City /State /ZIP: 7764,40 02 97 4/ Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 8> Y 4)/ 0 178 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: 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
//JJ � ,'/ �� Gas fireplace 10.00
!`tO,p /(/ELt� /27Z?, , �i j /. / /�M �. L1/J/ 6J/1/I/ s l Flue vent for water heater or gas
64- Ja/Pk_ fireplace 10.00
Log lighter(gas) 10.00
Wood/pellet stove . 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWN 1=1 TENANT • Ot yflinerlflue/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
APPLICANT ❑ CONTACT PERSON, Attic /crawlspace fans 10.00
Other: _ 10.00 __
Business name: ViclLl 41/e , Fuel piping
Contact name: A41� �Q $5.40 for first four; $1.00 for each additional
Address: G Furnace, etc.
1�6 S� �������� Gas heat pump
City/State /ZIP: // /e/6 972.2-2- Wall /suspended/unit heater
Fax: A� Water heater
Phone:
�,3 �6,3 . �,��� O3 142 ' 64-6- Fireplace
E -mail: / Gi l01 /n 0 . ,4uu Cfnc.aep Co /h Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: A r >2 Other:
Address: MECHANICAL PERMIT FEES* •
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) - P, •
Plan review (25% of permit fee) _ ..,•
CCB lie.: 5/)r 9 7 State surcharge (12% of permit fee) 7
�/" TOTAL PERMIT FEE '
Authorized signature: This permit application expires if n pen nit is not obtain wi bin 1.0
� p / days after it has been accepted as complete.
,, 1liz:%c
Print name: ,� , Date: //s-k * Fee methodology set by Tri- County Building Industry Service Board
1:\Building\Permits\MEC- PermitApp.doc 01/19/07 440- 461177T (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. 3 (Pc
$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.
L\ Buildin \Permits\MEC- PermitApp:doc 01/19/07 rf - °� 2