Permit a CITY OF TIGARD MECHANICAL PERMIT
° : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00371
T I G AR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2012
Parcel: 2S 110DC01000
Jurisdiction: Tigard
Site address: 11240 SW MEADOWBROOK DR 4
Project: Brookside Condominiums Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Installation of in -wall a /c.
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Contractor: J BEALS CONSTRUCTION LLC Owner: SUMMERFIELD ASSOCIATES, LLC
1635 NE 53RD AVE BY HSC REAL ESTATE
PORTLAND, OR 97213 1500 SW FIRST AVE STE 1020
PORTLAND, OR 97201
PHONE: 503 - 206 -7035 PHONE: 503 - 684 -1891
FAX: 503 - 288 -9023
FEES
Specifics: Description Date Amount
Type of Use: MF Permit Fee 07/19/2012 $93.62 -
Class of Work: ALT Type of Const: VB Plan Review 07/19/2012 $23.41
Occupancy Grp: R -2 Occupancy Load: 12% State Surcharge - Mechanical 07/19/2012 $11.23
Stories: Info Process /Archiving - Sm $0.50 (up to 07/19/2012 $1.00
Project Valuation: $1,285.00 11x17)
Fuel Air Handlers
Fuel Types: 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: 1
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $129.26
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:
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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 Noti .n —ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc • uestions to O C • calling 503.232.1987 or 1.800.332.2344.
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Issued =y: / '//', A O t PermitteeSignature: 1,/
Call 503.639.4175 by 7:00 a.m. for the next available inspection e.
This permit card shall be kept in a conspicuous place on the Job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
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• Mechanical Permit Application FOR 01 I-I( i. I Sl- 0) "x.1
City of Tigard Received B,y:: "] l t .7 dirt ll
• 13125 S50 Hall Blvd., Fax: 503.598.1960 Plan Review 1�� ®�
N.
Phone: 503.718.2439 Fax: 5013.598.1960 �eB : • �� ��� '' ' " _ ""
i i ,„ h i 1 Inspection Line: 503.639.4175 JUL 1. 7 2012 Date Ready/By: 0 See Page 2 for
Internet: www.tigard Notified/Method 7/ /g/ /y- , NMI Supplemental Information
1 a TIGARD _Jon,.::.
T�lq� IR DI I ' o co , 1 « FEE* SCHEDULE - USE f
.19rc�rs echanical permit fees' are based on the value of the work
❑ New construction crAddition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $ /9 $S -°a
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spedal Information use checklist
[✓Multi- famil ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
/ r Air conditioning
Job site address: ,// 7 J 2 0 5W 040�4,d1�(/ L ?d1C L c . ' , / fi y (requ site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/ State/ZIP: T Ore 7 p7 22 V Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: 7 1 Project name: - Heat pump 61.06
(requires site plan showing placement)
Cross street/directions to job site: Duct work 23.32
I ^ Hydronic hot water system 23.32
Al f7, Pvr Jio.n i 5c/nn m e 4 d.'4' pi Residential boiler (radiator or
�QdO� Lf/ ra Ji P2 , hydronic) 23.32
Unit heaters (fuel -type, not electric),
CfAd9'I 6-C-5 / / et-7) in -wall, in- duct, suspended, etc. 46.75
Flue/vent for an of above 23.32
Subdivision: I Lot no.:
Other 23.32
r:
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
(!)PEN Gbroil Fr,,ne h,/- lea, Ja/n skeee Jw d►/ //- Flue vent for water heater or gas _
Akin/ . Ate/A, JD Art/ Per t lie it Dv //' >L Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER 1 ❑ TENANT Chimney/liner /flue/vent 23.32
�'� Other. 23.32
Name: S(JI'11!/?f/1 /Y�i !13100 s ( 1/_41 Environmental exhaust and ventilation:
Address: /// 75 Sit/ 02eac(Ow .4-oak )r/ /r-Q equipment �l d/other kitchen 33.39
City/ State/ZIP: Ti -/2,,, d,-e - 9V 21( Clothes dryer exhaust 33.39
Phone: 3 +' /i9/ Fax 68y_ 996 Single-duct comp exhaust (bathrooms,
(50 ) (503) toilet t compartments, utility lity ro rooms)
APPLICANT ❑ CONTACT PERSON Attic 23.32 fans 23.32
Other. 23.32
Business name: J•- Beds. ea o ldrte / , Ile Fuel piping:
Contact name: J4,7 f 49 / $14.15 for first four; $4.03 for each additional
Address: /‘ 35- NGr . 0 Furnace , etc.
Gas heat pump
City/State/ZIP: I / , owe 17.2d Wall/suspended/unit heater
Phone: (h3) )60 - 7035 Fax: : (5 ) . 2 kg' f0 Water heater
Fireplace •
E -mail: 7 8C4i/S 11,xS•Iia e /1754/ - 110/,1 Range
CONTRACTOR Barbecue
L /� Clothes dryer (gas)
Business name: � ° "'�r -'� , 45 h�/�0V e Peelie.oi/ A O ther:
Address: � MECHANICAL PERMIT FEF,S'
City/ State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB Iic.: /7 fly 2 , //,07//3 _ State surcharge (12% of permit fee)
I / TOTAL PERMIT FEE
This permit application expires if a permit is not obtained 180
Authorized signature: //� d ays after it has been accepted as complete
I Print name: , p fry V Ben( Date: 7 -13 --/ 2 • Fee methodology set by Tri-County Building Industry Service Board
1:\ Building\PermitAMEC- PermitApp.da 03/07 /12 440 -4617T (I1/02/COM/WFB)