Permit CITY OF TIGARD MECHANICAL PERMIT
R�! g COMMUNITY DEVELOPMENT Permit #: MEC2011 00387
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/31/2011
Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: Pacific Convenience & Fuel Subdivision: Lot:
Project Description: Installing (2) roof mounted condensing units for an ice maker and refrigerated deli case.
Contractor: HILBERS INC Owner: PCF ACQUISITION CO LLC
1210 STABLER LN 22026 68TH AVE S
YUBA CITY, CA 95993 KENT, WA 98032
PHONE: 530 - 673 -2947 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/31/2011 $207.21
Class of Work: ALT Type of Const: Plan Review 08/31/2011 $51.80
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 08/31/2011 $24.87
Stories:
Project Valuation: $5,000.00
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: Vent Systems: Total $283.88
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.80(1 44. ! /
Issued By: ,Permittee Signature:
Call r .6y 7:00 a.m. for the next available ins. . -cti. n date.
This permit card shall be ept in a conspicuous place on the job site un it .mpletion of the project.
Approved plans are required on the job site at the time of e c inspection.
08/31/2011 WED 14:19 FAX 5306744141 HILBERS 0002/002
C18/ 31 / 2011 14 :01 5035'=19E0 CITY OF TIGARD
PAGE 02/
Mechanical Permit Applicatioi ' - gyp \ xreevea Dell t1• H U E. l 41; ()Nil
14, City of Tigard \ Tcimltrro.: rn }
" 131 SW Hall Blvd., Tigard, , OR 9 ? 223 � D 3 � A ' f // ,a / 1 —t.)" _
_ F. P Phone: 5 0.718.2439 nix: 5C .59$• l 40 P `J G a �9 - o -3 iv' - pc,,..,, g Other Permit ` ) , r _ _ �'
I t t.: A RI) i Lim: 54:0.639.4175 _1 , Date ReedyIBy: MI sa S4e Page 2 for
internal tww,tigard - er.gov S '� + - r Wi ed/Method: Supplemental Inform akin
'flied✓ OF WORK 93`3 , 'COMM MAL " i+ff SCBE iVLE - VS citeo 1; 7'•= `•
Mechanical permit fees' are based on the value of the work
❑ Now construction I] Addition /alteration /replacement performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. a phipmcnt, labor, overhead, and profit
CATEGORY OF CONSTRUCTION valve: $ Jj ,rL
-.) 8Ii1ENfIAL EQBIPMENTISTSTEDIS FEES"
❑ 1 • and 2-family dwelling d Commcroialfindustrial [] Accessory building For specirrlhrftrmrarlon tveo4eckllSt..
Multifamily ❑ Master builder 0 Other: Description ! Qty. j Total
JOB Sf . INFORMATION AND LOCATION ReatiryJconling:
• Air conditioning
Job site address ! 5 ® CD . -7r L. 4 . A (requires site plan showing placement) 46.75
—
l mace 100,000 8TU (duets/vyM) 46.75 _
City /State/LIP: - T - e:.,_ . • - , e7 2. Furnace 100,000 +13 1J(ductslvrnta) 54.91
Suite/bldg.lapt, no.; / Project erne: ipQet C a Ulevl e� , .0 Heat pump
(
Cross suxetfdireaion5to job �4ai:wsitcolaa towing placement) 61,06
1 Duet work --- _ 2332
Hydronic hot water system 23.32
-- Residential boiler (radiator or
hydronic) 2332
Unit heaters (fuel -type, not electric),
inwatl• induct, suspended, eta 46,75
Subdivision: no , F1ie/vent for any of above 23.32
Other: _ 2332 _
Tax a ap(parcel no.: Other fuel appliances:
• T S DESCRIYrION Qi' WORK Water heater 23.32
TN _ Gas fireplace 33.31
( -i a 2 Q V fi t^ s 1 V a-AAA Flue vent for water heather or gas
`C -e■Y' 2 S - •,: - . AA - o 1 — 7 c - - VV A 4. fir lace 13.32
• d - Lo>;1it{htcr (gas) 23.32 • •
�� �'Cr 1 C ° ^r�G - _ 0.0i Wl . Wood/pellet stove 33.39
V Wood frrcjiiacefnserr , 2332
❑ PRC)YEFII Y OWNER I
❑ TENANT himney/liner/flue/vent 23.32
{-� � I Other: _ 23,32
Name: T 0..:t e_ avt_ k) i €,i4 ee 04Aci I-t t.�l Environmental exhaust and ventilation:
Address: Range hood/ether kitchen
f3tatcf7.IP equipment 33.19
Cit
Y Clothes dtzar exhaust 33.39
Single cerheuet (bathrooms,
Phone: ( ) Fax: ( ) toilet so artmcnts, utility rooms) _ 23.32
Q APPLICANT 0 CONTACT PEIUSON Atticterawlapacc fans 23.32 -
'Business name Other' 2332
Fact pl ling:
Contact name. 516.15 for firs t four; 54.03 for nick_ ddldonal
Address: Furnace. etc.
—
City /State/ZiP: • Gas heat pump
Wall /sus •eitdcd/unit heater
fhonc: ( ) Fax:: ( ) Water heater
E�rtlail: Fireplace !
Range •
- CONTRAcrolt Barbecue
Business name: HILBERS INC Clothca dryer (gas)
Address: 1210 STABLER LANE Other: -
haarANICAL PERACI r FECES'
City/StatelZIP: YUBA CITY CA 95993 - Subtotal
Phone: ( 530) 673.2947. Fax: ( 530) 674.4141 .. Minimum permit fee (S40.t:6) ;47.9.
Plan tcview (25ek of permit fcc) J . t/ !
CC$ tic.: (124�e of 1 1 R71 n State surcharge
permit fee) "%Ai,,
/ TOTAL PERMIT FE ,2, 9) , Ve
Authorized signatt 1 _ - r ( - This permit appticstton expires fife permit a sot ohr( within 140
4 ' , . ' l . - . i .A• / % * daps alter it has been accepted ae complete
Print n rime: �rilffi m $, a Fee methodology act by To -county building }Monty Service Board
imuildiner.mitatIEC- ,tnpp.6eo 09/OMa 'I / - 4404461'+7' ir141;1Cl3M/Atti) f ?
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