Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit A: MEC2012 -00202
T F G A R ]? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2012
Parcel: 2S102AA04100
Jurisdiction: Tigard
Site address: 12230 SW MAIN ST 120
Project: Live Laugh Love Glass Subdivision: TIGARD HIGHWAY TRACTS Lot: 2
Project Description: New dedicated gas line to northwest space.
Contractor: ELITE MECHANICAL LLC Owner: 3DM HOLDINGS INC
580 SW 12TH 12230 SW MAIN ST STE C
TROUTDALE, OR 97060 TIGARD, OR 97223
PHONE: 503 - 312 -1684 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/24/2012 $130.46
Class of Work: ALT Type of Const: Plan Review 04 /24/2012 $32.62
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 04 /24/2012 $15.66
Stories:
Project Valuation: $2,500.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers 8 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 $178.74
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 O k by calling 503.232.1987 or 1.800.332.2344.
Issued B / / /�
'LL �I���
y i / � =nn ttee Signature�I, //
Call 50. T e 7:00 a.m. for the next available i pec on . • te.
This permit card shall be kept in a conspicuous place on the job site until completion of the oject.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application W \ c� i i child: usl•: ()Nix
City of Tigard � o Received b P No.:
° 13125 SW Hall Blvd., Tigard,0 •e .,\',, Date/By: % AIWA, p� �r 1 _. a a ,r. .111 I
Phone: 503.718.2439 Fax: 503. .i - ' Plan Review Date/By: Other Permit:
_EM
1' i C. n It D Inspection Line: 503.639 Q ( k �® Date Ready/By: ®See Page 2 for
Internet: www.tigard-or.gov q`� � � Notified/Method: Supplemental Information
ci ® I- `d \
TYPE OF WORT \t \ hJ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteratibn / replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, lab• overhead, and profit
Value: $ ��
CATEGORY �OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS , EES*
❑ 1- and 2- family dwelling ylCommercialJindustrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: i 2113. S 1 , 1 ) M Ai 0 (requires site plan showing placement) 46.75
/ 0 n Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP:
J / �� Q'�Z3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: /, _ 1 Project name: `a / �� A / ' ,� / Heat pump
" CJ C 4/ ` ` (requires site plan showing placement) _ 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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
/4-440 /4-440 �&D)C��� ( Gas fireplace/insert ant or water 33.39
[J 0
�� Flue vent for water heater or gas
-
1 (_A it L iniFt 60%-- fireplace 23.32
hP t>ti Wrl/ Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
OPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
/- Other: 23.32
Name: `: 1) `M tr6tvwhs Environmental exhaust and ventilation: •
Address: 1 'Lizo 60 sr Range hood/other kitchen
I l/wt) equipment 33.39
City/State/ZIP: V / / o t o e _ q � ' Clothes dryer exhaust 33.39
• l 6 / Single -duct exhaust (bathrooms,
Phone: (5b (,,,f . lei e Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: 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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: # , rti� t e. z.- Clothes dryer (gas)
7� Other:
Address: S V e s : . W 4 - 1 \ � , MECHANICAL PERMIT FEES*
City /State /ZIP. o Q C '7 fr v Subtotal
I Minimum permit fee ($90.00) /30. 4 Co
Phone: ([ _ . Fax: ( ) Plan review (25% of permit fee)
CCB lic.:v 1 i ?J tl Z %' '12 3 /3/j 1 State surcharge (12% of permit 3 62
fee)
TOTAL PERMIT FEE� '7$. 7y
Authorized signa This permit application expires if a permit is not ob ned within 180
da ys after it has been accepted as complete.
Print name: �'n� � Date: • Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Permits\MEC- PermiWpp.doc 09/09/10 440-4617T (I1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: 'Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
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fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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