Permit CITY OF TIGARD MECHANICAL PERMIT
2 - COMMUNITY DEVELOPMENT Permit#: MEC2013-00488
Date Issued: 09/17/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 1S1356C00202
Jurisdiction: Tigard
Site address: 10763 SW GREENBURG RD 120
Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: New ducting for existing root top unit and(1)new duct-free mini-split.
Contractor: TRI COUNTY HVAC INC Owner: BELANICH, ROGER M
571 NW WADE ST 22020 17TH AVE SE#200
ESTACADA, OR 97023 BOTHELL,WA 98021
PHONE: 503-849-9207 PHONE:
FAX: 503-630-4369
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/17/2013 $176.51
Class of Work: ALT Type of Const: VB Plan Review 09/17/2013 $44.13
Occupancy Grp: A-2 Occupancy Load: 12%State Surcharge-Mechanical 09/17/2013 $21 18
Stories: 1 Info Process/Archiving-Lg$2 00(over 09/17/2013 $2 00
11x17)
Project Valuation: $4,000.00 Info Process/Archiving-Sm$0 50(up to 09/17/2013 $1 00
11x17)
Fuel Air Handlers
Fuel Types Units<10000 cfm' 1
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 $244 82
Hoods Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers Other Mech Units.
Gas Outlets: Other Desc
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O . Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if .rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION. Oregon law requires you to •Ilo the rul- adopted by the Oregon
Utility Notif Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009'. ou m•'obtain a copy of the rules
or direct estions t OUNC by calling 503 232.1987 or 1.800 332.2344.
Issued By. C ���,� Permittee Signature: `--
Call 503.639.4175 by 7:00 a.m.for the next available inspecti•,i .ate.
This permit card shall be kept in a conspicuous place on the Job site until I pletion of the project.
Approved plans are required on the job site at the time of ea sf inspection.
Mechanical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard AUG Z 1 2013 Datee/vea�� /I` Permit No i ��(/�3�� Lt�'�'
Ili
q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi 1�
Phone: 503.718.2439 Fax: 503.598.1960 cr t1, (3 Other Perm t�. uPo2a/3-00/2 a
Date/By _
I I G n K D Inspection Line: 503.639.4175 CITY(*TIGARD Date Ready/By loos 13 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method "�7/i9 �76--- Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement I performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value.$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSVTEMS FEES*
❑ I-and 2-family dwelling 1Lry 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 46.75
Job site address: /D 7‘.3 See....- re ent,,J C e ID. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ;6A r 1D J 0 JZ Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: 02 Project name:
SU Ig t/OLy Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23 32
Subdivision: Lot no.: Other 23 32
Other fuel appliances:
Tax map/parcel no.: Water heater 23 32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
_ Flue vent for water heater or gas
Nenv D uc I/1 nc JO SCI e S]'1 n:1 RQ' •1 e 1 fireplace 23.32
J Log lighter(gas) 23.32
on; j e O n e_ 1VeGV D u67 /'r a e_ Wood/pellet stove 33.39
0'fi4 0 I - S ?1;7 Wood fireplace/insert 23 32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33 39
Address: Clothes dryer exhaust 33 39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23 32
❑ APPLICANT ❑ CONTACT PERSON Other 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
•
Business name: r; _4,U 47�l /-AM PIG- Other.
MECHANICAL PERMIT FEES*
Address: 5 7 / mw WADe. 57: Subtotal
City/State/ZIP: Ec74C/FDA o? q 70.23 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(50.;) 8 vq_ (role/7 / Fax:(OS) 620- '���q State surcharge(12%of permit fee)
CCB lic.: «tp S a� i /74 7 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tn-County Building Industry Service Board
Print name: C, 6 - 196 3a ? Date:64 OS
I\Building\PermnsU�C_PermitApp_040113 doc 440-4617 /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_040113.doc 2