Permit v CITY OF TIGARD MECHANICAL PERMIT
rs ' . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2012
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Install (1) 4 -ton RTU, to include ductwork and grilles.
Contractor: GOHMAN MECHANICAL Owner: PACIFIC REALTY ASSOCIATES LP
14505 SE HWY 212 ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 658 -1892 PHONE:
FAX: 503 - 658 -6925
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/15/2012 $319.61
Class of Work: ALT Type of Const: Plan Review 05/15/2012 $79.90
Occupancy Grp: S -1 Occupancy Load: 12% State Surcharge - Mechanical 05/15/2012 $38.35
Stories: 1 Info Process /Archiving - Lg $2.00 (over 05/15/2012 $2.00
11x17)
Project Valuation: $9,000.00 Info Process /Archiving - Sm $0.50 (up to 05/15/2012 $5.00
11x17)
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 $444.86
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
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 Notific- - - -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. u may obtain copy of the rules
or direct • •estions to 0 C by c- ing 503.232.1987 or 1.800.332.2344.
Issued y: i/, Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
•
•
Mechanical Permit Application FoR OFFICE USE ONLY
City of Tigard Date/By I / Permit No.: w /, ...44, Z
11 I . 13125 SW Hall Blvd., Tigard, �]� Plan Revie
Phone: 503.718.2439 Fax: 5 1 V L' Date/By: e ems t '
TI G A R D Inspection Line: 503.639 Date Rea.y : y: Juris: ® See Page 2 for
Internet: www.tigard - or.gov MAY 15 2012 Notified/Method: Supplemental Information
TYP!"ITYGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�1�
Mechanical permit fees* are based on the value of the work
❑ New construction El AdE�i�/ 1 1CDDIM t performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
9
Value: $ 06
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPME ` NT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ 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: 16195 SW 72 Ave (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: Tigard, OR 97224 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Option Care Heat pump
(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
Gas fireplace 33.39
Install (1) 4 -Ton RTU To Include Ductwork and Grilles
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:
Address: Range hood/other kitchen
•
_ 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: Gohman Mechanical, Inc. Other: 23.32
Fuel piping:
Contact name: Jeremy Hunt • $14.15 for first four; $4.03 for each additional
Address: 14505 SE Hwy 212 Furnace, etc.
Gas heat pump
City /State /ZIP: Clackamas, OR 97015 Wall /suspended/unit heater
Phone: (503) 658 -1892 Fax: : (503) 658 -6925 Water heater
Fireplace
E -mail: jeremy @gohmanmechanical.com - Range
CONTRACTOR Barbecue
Business name: Gohman Mechanical, Inc. Clothes dryer (gas)
Other:
Address: 14505 SE Hwy 212 MECHANICAL PERMIT FEES*
City /State /ZIP: Clackamas, OR 97015 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 658 -1892 Fax: (503) 658 -6925 Plan review (25% of permit fee)
CCB lic.: 119952 State surcharge (12% of permit fee) _
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: 4.- days after it has been accepted as complete.
Print name: Jeremy Hun Date: 05/15/2012 • Fee methodology set by Tri- County Building Industry Service Board
1 \Building \Permits \MEC- PermitApp.doc 09/09/10 440-4617T (1 t /07JCOM/WEB)
III Building Division
Over - The - Counter (OTC) Mechanical Permit
T l c n li ° Check List
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Project Description: 1“Eir—ti1 (C-M----'
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: iLL Occupancy Group: !j ‘ Type of Construction:
*Type of Use: &MA Oregon Specialty Code:
Number of Stories: 1
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) I Tons ''"-
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line -�
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work l Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units - Describe:
Total Project Valuation: $ I)- I FEES DUE
$ , . Mechanical Permit Fee
$ .6 Plan Review
$ f' r 12% State Surcharge
$ 2,0O Info Proc /Arch, Lg (over 11x17 $2.00)
$ '5cc) Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ ,g‘., TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
1:\Building\Forms \OTC - MEC.docx 01/13/2011