Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00405
T t GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 140
Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Relocate grills and t- stats; add (1) new cooling only VAV for TI
Contractor: AMERICAN HEATING INC Owner: PNWP LLC #2
1339 SE GIDEON ST PNWP LLC
PORTLAND, OR 97202 6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/01/2012 $357.87
Class of Work: ALT Type of Const: IIB Plan Review 08/01/2012 $89.47
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 08/01/2012 $42.94
Stories: Info Process /Archiving - Lg $2.00 (over 08/01/2012 $2.00
1 $10,400.00 11x17)
Project Valuation:
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 $492.28
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 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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • I / - Permittee Signature: / 40C/ NCO G Q s e
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 OFH( t 1 : ()\L1
City of Tigard Rec o p / rum' . ermitNo.: /A E d, do I a` -DD p.:
III • 13125 SW Hall Blvd., Tigard, OR 97223
C Phone: 503.639.4171 Fax Plan Review 503.598.1960 Date/By: 4 ' j 0' AM
er PermeattO 1 Z - D0/31
TI G A R D Inspection Line: 503.639 Date Ready/By: run B See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction 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
CATEGORY OF CONSTRUCTION Value. $ ( il
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling [S 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 Healing/cooling
t<Q 5 p S ( +
Air conditioning
Job site address: 1
L (.,J ✓�Ue (requires site plan showing placement) 46.75
City/ State/ZIP: -1; gi-a. 0V. 9-7 Z7_3 Furnace 100,000 BTU ( ducts/vents) 46.75
* Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt no.: NO Project name: a
1��QC.� �xp Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
#4%. `, Hydronic hot water system 23.32
1 Vr & ■•_Yf) LL Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I 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
�'G� [ ° "` - AC a\ �� 1 T- S Gas fireplace 33.39
17 � 4- 1 Flue vent for water heater or gas
fireplace 23.32
Log Ik i A .e.A. j [_[7D�. r:vAi UA A J L
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 moms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawispace fans 23.32
��J�� Other: 23.32
�`
Business name: �'CY l it i ( Al Ak... a .a ' ' l 1 T - (1 , ( - , Fuel piping
Contact name: A� $14.15 for first four; $4.03 for each additional
Address: ,133 E t j S Furnace, etc.
Gas heat pump
City/ State/ZIP: C ,4kand ( � ch a. Wall/suspended/unit heater
Phone: (5�) a3ct U, V O Fax :: () a3c1 -1 o3 $ Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: ^ • l p /r r. t��2C/'t!n r I(t[
Clothes dryer (gas) Other:
Address: l'5 CA � C, 611'64.-4M- 1 MECHANICAL PERMIT FEES*
City/State/ZIP: 1 0 e Cfl Subtotal
�[� Minimum permit fee ($90.00)
Phone: ( ate- " L�0 0 0 Fax: (ca f ) 301 -77 03 S Plan review (25% of permit fee)
CCB tic.: ✓ � ( 3 State surcharge (12% of permit fee)
���� `+ r )(:6•64015Y1 TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: YL(Y�ti �-t' all ,� 6V\ Date: i i `).__! • Fee methodology set by Tri -County Building Industry Service Board
Meuitding \Permits\MEGPermitApp.doc 10/01/09 440.4617T (I rrovCOMV WEB)
' PI
0 Building Division
Over - The - Counter (OTC) Mechanical Permit .
TIGARD
Check List ,, per
Project Description: Gff1 T /Lkc -- kg - G �to2'd 0q"
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION � },l �
*Class of Work: I Z Occupancy Group: Type of Construction: 2
*Type of Use: 0,711. Oregon Specialty Code: ZO(®
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) 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 1 Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe: ( KW
Total Project Valuation: $ t() 140 FEES DUE
$ --.. j `77, 67 Mechanical Permit Fee
$ %ij/X Plan Review
$ 2 7 ' 12% State Surcharge
$ Z ,co Info Proc /Arch, Lg (over 11x17 $2.00)
$ 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: $ 42'Z 15 02j2e3 TOTAL FEES DUE
*OP'T'IONS:
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:\BuildingWorms \OTC- MEC.docx 01/13/2011