Permit CITY OF TIGARD MECHANICAL PERMIT
0:- COMMUNITY DEVELOPMENT Permit #: MEC2012 00557
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S 113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 110
Project: Professional Practices Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Relocate ducts and grilles for new TI
Contractor: WILLAMETTE HVAC LLC Owner: OREGON STATE BAR, THE
3075 SW 234TH AVE. #206 16037 SW UPPER BOONES FERRY RD
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503 - 259 -3200 PHONE: 503 - 431 -6313
FAX: 503 - 848 -2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/25/2012 $84.41
Class of Work: ALT Type of Const: Plan Review 10/25/2012 $21.10
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 10/25/2012 $10.13
Stories:
Project Valuation: $1,000.00
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:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $115.64
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 t e rules
or direct qu- : ons to • • C by calling 503.232.1987 or 1.800.332.2344.
Issued By. / O 4 Permittee Signature: 41140",
IA
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 US ONLY ' ' '7 •
R eceiv ed �/ A�..� t 41...0.T /
City of Tigard
Date/By: t Ai Permit Nn.:
r1 e
III
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: / - Other Permit:
T,1 G A R U Inspection Line: 503.639 Date Ready/By: lads: RI See Page 2 for
Internet: www.tigard or.gov Notified/Method /D /42 s/� Supplemental Information
TYPE OF WORK . COMMERCIAL FEE' :CHEDULE - 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, labor, overhead, and profit.
Value: $ $1,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
El 1- and 2- family dwelling Z Commercial/industrial ❑ Accessory building For special infonnadon use checklist.
El Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
/ • Air conditioning
Job site address: `4Q r j (requires site plan showing placement) 46.75
�`� �` � Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard OR
/ • g Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: 4 r . . i , '� t H� t pump
� Fq uires 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: 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
relocate registers or duct work to accommodate new office layout Gas f vent 33.39
Flue veent 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
I' APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
� � Other: 23.32
Business name: , 77 - .�l�t ��p Fuel piping:
/�-- _
Contact name: _ "I _ i $14.15 for first four; $4.03 for each additional
Address: GGG"` � Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ✓� 7S/.... Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: Willamette HVAC, LLC Clothes dryer (gas)
Other:
Address: 3075 SW 234 Ave Suite 206 MECHANICAL PERMIT FEES* /
City/State /ZIP: Hillsboro, OR 97123 Subtotal KC/ yf
Phone: (503) 259.3200 Fax: (503) 848.2597 Minimum permit fee ($90.00) ........----"
Plan review (25% of permit fee) °� to
CCB lie.: 56951 State surcharge (12% of permit fee) /al . /1
' _ , , irf TOTAL PERMIT FEE // 5. Celf
Authorized signature: e P �' "/ ^ - ,f1✓] This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: michael malstrom Date: 8/23/12 ' Fee methodology set by Tri -County Building Industry Service Board
I:03ul1d1nglPertnhsl NEC- PerrnttApp.doc 03/07/12 440 -4617T (11 /02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
lig II - : 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
A ‘ ,..... ‘ j d.„..eidi.a _ 4.46.
BUP2012 -00206 - 16037 SW UPPER BOONES FERRY RD 110, T ARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
DC Provision Review, COM TI - Ping 100-0000-43112 $67.00 $67.00 $67.00
DC Provision Review, COM TI - LRP 100 - 0000 -43117 $10.00 $10.00 $10.00
Permit Fee - Additions, Alterations, 230 - 0000 -43104 $377.90 $377.90 $377.90
Demolition
12% State Surcharge - Building 100 - 0000 -24001 $45.35 $45.35 $45.35
Plan Review 230 - 0000 -43106 $245.64 $245.64 $245.64
Plan Review - Fire Life Safety 230 - 0000 -43108 $151.16 $151.16 $151.16
Info Process /Archiving - Lg $2.00 (over 230 - 0000 -43135 $4.00 $4.00 $4.00
11x17)
Totals for Fees $901.05 $901.05 $0.00 $901.05
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $901.05