Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00018
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04
PARCEL: 1S126DB-02800
SITE ADDRESS: 09370 SW GREENBURG RD 205
SUBDIVISION: PP1991 -018 ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical TI, new register and new bathroom vent fan. Project Value: $800.00
Owner: FEES
FRANKLIN COMMONS ASSOCIATES Description Date Amount
BY NORRIS + STEVENS
520 SW 6TH STE 400 [MECH] Permit Fee 1/15/04 $72.50
PORTLAND, OR 97204 [TAX] 8% State Surchart 1/15/04 $5.80
Phone: Total $78.30
Contractor:
WILLAMETTE HVAC SERVICE
PO BOX 23334
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone: 628 Mechanical Insp
Final Inspection
Reg #: LIC 56951
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• •regon law
requir- ou • . ow rules adopted in the Oregon Utility Notification Center. Those rules are set fort' i• OAR 952 - 001 -00
Iss• -d By: `l � Permittee Signature, /
Call (5.3 • . -4175 by 7:00 P.M. for inspections needed the next business day
MPC 113I11Cal Permit Application FOR OFFICE USE ONLY' ed
City of Tigard Date/By: / / a iffiltMl Penult No.: Me �/ e „L00/0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 //tptlll' f � Date/
By Permit:
Inspection Line: 503.639.4175 l � ry p , j j i y
.� e, Date Ready /By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us r Notified/Method: Supplemental Information mam
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CI New construction CI 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.
st`v :t , ;t,.: 41;1 ,xl� .;lr. 's " „vW, :€,ev tv . _ iii r «x v ; ! ,�'d" 51y. �' u'.ri• ., x'r Value: $ WOO ,e
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RESH) ENTIAL `` <EQUIEMEN /'SYSTENIS.FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
^.�;a.;,�„�.. -: ��;a.::fuf •e�:: 3r. �t, *:..�rt:�x e:°� °:?s:�ut.��;.�xo . � n �,
m t JOB= STfEINFOR LOCATI , a Heating/cooling
«�v- �sEl�t, th�:� «�.- s,> x;��.�:?t:�F,.�.�. �; . -., ...,..,x.�'r,,,:�' + r e- „�,� nu. �.�� :...�.: �. s.: x . Q., �. - ” a .:,�.a
Air conditioning or heat pump
Job site address: 't 3 2 sw .V. e,,t t,� v.... (requires site plan showing placement) 14.00
City/State /ZIP:
77. ' tj Furnace 100,000 BTU (ducts /vents) 14,00
n, � Furnace 100,000+ BTU (ducts /vents) 17.90
' Suite/bldg. /apt. no.: `v`� Project name: ,mow 03� e Gas heat pump 14.00
Cross street/directions to job site: ij' <v, tS ��. /- /l Duct work 14.00
Hydronic hot water system 14.00
, Go 1.--..t. 1.41 pan. .3 - S cat P Iut l a/0 e, Residential boiler (radiator or
hydron 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
,.., ,fr.. ,..: u" :,.,,,, ,t$;;, .,o "3� . _,:F' :rt ; r wt. VIM; ; :'k fir. 1 Water heater 10.00
ri kik .-1r t.. t :: DES UR� 4ia� , . ° , - ?1... ..
•, v �� .t.. f t a i � , o
/ Gas fireplace 10.00
,7V ' `t_Lc_.) i R e - 4JStet/ c"�vt., �� e 3 -tvc.„ „,, -.✓., 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
r , tt r Ravi , . '.X Chimney /liner /flue /vent 10.00
. r' , `... ® PROPERTY .. agc• "..' ._. "?' . TENANT 3 1 Other: 10.00
Name: Environmental exhaust and ventilation
Range hood /other kitchen
Address: . equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) • toilet compartments, utility rooms) 6.80
ti„ 1 ,, , PPLI . M ,,: .. rt _. , T „ : #,,�_ ,: , p .,- .# 4. Attic/crawlspace fans 10.00
� f I'APPI; . N r t . , t. �v,, ,, ,0 CON PERSOPI , ` u,: P
/ 7 / Other: 1 0.00
Business name: l/a y„t t., /Y/fiC Fuel tin
P g
Contact name: ,JC"t a l - tit SI/cal,.p. $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: J •() J 3c� i1 0� 3' ! Gas heat pump
City/State/ZIP: e... ��� 1 2 Wall /suspended /unit heater
Phone: (sG 3) 4' „a- C e <{ ( Fax:: (So 3) 8e../ &,--. c ,.? - > Water heater
Fireplace
E -mail: Range
� 1 ., f<f ,, „ , ,,;? x3, „ „ '$,` -... �t ,, n ,grt ,., Barbecue
�», diet �.�1 „ x,: ig.4F.''4 : ',',ARVAU.t ^. �I , , ,' txxSry. zai r�. F3,.., .;?1,`? x -,r .ARE&i,'7 A AMA A:
Clothes dryer (gas)
Business name:
Other:
Address: E,( L:MEGHAIVICAL,;PERMITFEES* '
City/State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: 3-41 5 1 /i I j 0 `) State surcharge (8% of permit fee)
uthorized signature:.
TOTAL PERMIT FEE
his permit application expires if a permit is not obtained within 180
d after it has been accepted as complete.
Print name: /4 ■t I - ( e. - Sx oe..,.w Date: y/ s70 �{ * Fee methodology set by Tr- County Building Industry Service Board
i:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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Commercial Fee Schedule:
'AT�otalyalu'aton v
$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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