Permit r q CITY OF TIGARD MECHANICAL PERMIT
`"' 2 '' C OMMUNITY DEVELOPMENT Pe rmit #: MEC201000003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/12/2010
Parcel: 1 S135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD
Subdivision: Lot: 0
Project: Columbia Dental Arts
Project Description: Replace rooftop unit.
Owner: FEES
PANG, KEIKO TR Description Date Amount
46-442 HOLOLIO ST Permit Fee 01/12/2010 $243.74
KANEOHE, HI 96744
Plan Review 01/12/2010 $60.94
PHONE: 12% State Surcharge - Mechanical 01/12/2010 $29.25
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
Type of Use: COM
Class of Work: ALT Type of Const: VB
Occupancy Grp: B 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: Vent Systems: Total $333.93
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. r-
Issued By: ,__ QM, (ti, ( n (, ) Q d o (� Permittee Signature: le
osie
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Call 503.639.4175 n l ,jl 4 ` by7::0 + 0 a.m. for an inspection that business 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.
_ e Pg. /7 -.
Mechanical Permit Applicat lS t FOR OFFICE USE ONLY
.F.I City of Tigard ���aaa Received y s �a Permit No.: /7tg ... 3
II ., ,
Date /B �/
13125 SW Hall Blvd Tigard OR 97223 II pp 1,' Plan Review, WA
III 503.639.4171 Fax: 503.598.196P 2010 Date/By: / Iplja a Other Permit:
TIGARD Inspection Line: 503.639 Date Ready :y: �' Ea See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: /t7 /jA Supplemental Information
RUILDIN - . 1 , e ► , . - /
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TYPE OF WORK CO MERCIAL E* SCHEDULE — USE CHECKLIST
7 Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition 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: $ $6,300.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder 0 Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: 11565 SW Hall Blvd Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard OR 97223 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: I Project name: Columbia Dental Arts Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: I Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Push /Pull 4 ton RTU Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
Other 23.32
Name: Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Same as below Other: 23.32
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) j Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Willamette HVAC Clothes dryer (gas)
Other:
Address: 3075 SW 234 Ave Suite 206 MECHANICAL PERMIT FEES* /
City /State /ZIP: Hillsboro OR 97123 Subtotal ei?j. V/
Minimum permit fee ($90.00)
Phone: (503) 628.6841 Fax: (503) 848.2597 Plan review (25% of permit fee) • g`f
CCB lie.: 56951 State surcharge (12% of permit fee) a , aZ 5
Il
/ TOTAL PERMIT FEE , ,g, . 93
This permit application expires if a permit is not obtaine within 180
Authorized signature:
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 12/30/09 * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \ Permits \MEC - PermitApp.doc 10/01/09 440 -46t7T (1 I /02 /COM/WEB)