Permit CITY OF TIGARD MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit#: MEC2013-00499
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2013
Parcel: 1 S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 100
Project: Spec Space Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Mechanical for TI.
Contractor: WILLAMETTE HVAC LLC Owner: BELANICH, ROGER M
3075 SW 234TH AVE.#206 22020 17TH AVE SE#200
HILLSBORO,OR 97123 BOTHELL,WA 98021
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
. FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/29/2013 $398.51
Class of Work: ALT Type of Const: Plan Review 08/29/2013 $99.63
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 08/29/2013 $47.82
Stories: Info Process/Archiving-Lg$2.00(over 08/29/2013 $8.00
11x17)
Project Valuation: $12,000.00 Info Process/Archiving-Sm$0.50(up to 08/29/2013 $8.00
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 $561.96
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 2
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 obtai a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ••• a Signature: _ Cr
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 Received
Date/By: • LrI Permit No.: — 4. • .
III
° 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review �p
C Phone: 503.718.2439 Fax: 503.598..1 Date/By: Other Permit: �/� rL/7'oodoil,cAl TI G A R D Inspection Line: 503.639.4175 % rQ\rr Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov `\V Notified/Method: Supplemental Information
WORK v \� COMMERCIAL FEE*cSoCHEDULE – USE CHECKLIST
TYPE OF WO O�
Ir I G Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration�n[ performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$12,000.00
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. Ea. Total
J B SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: W Greenburg RD (requires site plan showing placement) 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR
Furnace 100,000+BTU(ducts/vents) 54.91 _
Suite/bldg./apt.no.: ion Project name. S Heat pump
�C Y 1't (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/insert 33.39
Install one new 4 ton RTU and complete duct system.Install duct system off Flue vent for water heater or gas
existing 4 ton RTU.Extend gas piping to new RTU. fireplace 23.32
log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER ❑ 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:same as below Other: 23.32
Fuel piping: –
Contact name: S14.15 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
dryer ryer(gas)
Business name:Willamette HVAC,LLC Clothes –
Other:
Address:3075 SW 234'h Ave Suite 206 MECHANICAL PERMIT FEES*
City/State/ZIP: Hillsboro,OR 97123 Subtotal
Phone:(503)259.3200 Fax:(503)848.2597 Minimum permit fee($90.00)
Plan review(25%of permit fee)
CCB lie.:56951 State surcharge(12%of permit fee)
n _ TOTAL PERMIT FEE I,This permit application expires if a permit is not obtained within 180
Authorized signature: r days after it has been accepted as complete.
Print name: michael malstrom Date:8/27/13 • Fee methodology set by Tri-County Building Industry S
I:\Building\Permits\MEC-PermitApp.doc 03/07/12 440-4617T(I1/02/COM/WEB) 45& t'5--