Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00435
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/20/2012
Parcel: 2S112AD01000
Jurisdiction: TIG
Site address: 7007 SW CARDINAL LN 135
Project: Cundiff Engineering Subdivision: Lot:
Project Description: Installation of (1) mini - split system and move ceiling grilles.
Contractor: GOHMAN MECHANICAL Owner: PACTRUST
14505 SE HWY 212 15350 SW SEQUOIA PKWY
CLACKAMAS, OR 97015 #300
PORTLAND, OR 97224
PHONE: 503 - 658 -1892 PHONE:
FAX: 503 - 658 -6925
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/20/2012 $277.46
Class of Work: ALT Type of Const: Plan Review 08/20/2012 $69.37
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 08/20/2012 $33.30
Stories: Info Process /Archiving - Lg $2.00 (over 08/20/2012 $2.00
11x17)
Project Valuation: $7,500.00 •
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: 1
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $382.13
Hoods: Comm Incinerators: •
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
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, . ' ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to f. the rules .•opted by the Oregon
Utility 'otification Ce = . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -00• s ou may • _ . a .py of the rules
or di ect questions to OUN : ca in. 503.232.1987 or 1.800.332.2344.
"-
Issue • By: A t/ // �1.-v , e / Permittee Signature:
✓�' (
Call 503.639.4175 by 7:00 a.m. for the next available inspecti. 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
Ci}� of Ti and R Received q � G / o ^
City g ] Ll V E+ Date /By: ( /`� / f Permit No.: HLCQ�JIO -� 3
° 13125 SW Hall Blvd., Tigard, OR 972 33
. Phone: 503.718.2439 Fax: 503.598.1960 AUG r Date/gDate/By: ew
C Other Permit: _
Inspection Line: 503.639 +.� 2 0 '. 3 '
TIGARD Date Ready/By: for
� 0,544,„ Y B y : kris: l g
Internet: www.tigard or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPE OF BiatiONGDIVIS ION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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,) or, overhead, and profit.
Value: $ 5-6-8 n
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / 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: 70v 7 5 1,..- c . . 6 e o , ' ' - / , (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP:p..z 0 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Co A.,, +7i Jr, ,G f_/NE1Y /N Heat pump
7 (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
r Gas fireplace/insert 33.39
ni9/Jt 1)//e n- S 5141 / Flue vent for water heater or gas
fireplace 23.32
�Q/G CZ" lG L Log lighter (gas) 23.32
l Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: 1(c. & ci S' 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:
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: (,O4/0MA/ ML I � Clothes dryer (gas)
6 Other:
Address: / O 5 -- AtAi Z/ 2 MECHANICAL PERMIT FEES*
City /State /ZIP:rl „t1+1 ,l- / i Subtotal
, j
) 73 G, —” g 9,p.. Fax: (53 ) Minimum (25% permit fee permit fee
Phone: (51
) C&' - ;" - G9,2 � Plan review (25% of permit fee)
CCB lic.:/ /e �—") State surcharge (12% of permit fee)
0 TOTAL PERMIT FEE
Authorized signatur • This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: '1 �/ . G y 1 - Date: ����. • Fee methodology set by Tri County Building Industry Service Board
I: lBuildingWermiutMEC- PermitApp.da 03/07/12 0-461 7T(II / /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
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.
1:\Building\Permits\MEC- PermitApp.doc 03/07/12 2