Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2014-00040
13125 SW Hall Blvd.,Ti Date Issued: 02/04/2014
Ttt; 1R0 and OR 97223 503.718.2439 Tigard 2S 102AA00905
Jurisdiction: Tigard
Site address: 12000 SW MAIN ST
Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5
Project Description: Adding(1)supply duct and(1)return air duct
Contractor: SALEM HEATING&SHEET METAL INC Owner: HAAGEN,GARY L&CANDACE C TRS
PO BOX 12005 2514 SE 112TH AVE
SALEM, OR 97309 VANCOUVER,WA 98664
PHONE: 503-581-1536 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/04/2014 $75.20
Class of Work: ALT Type of Const: Plan Review 02/04/2014 $18.80
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 02/04/2014 $9.02
Stories:
Project Valuation: $700.00
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 $103.02
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 2
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notif - '. .-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct• estions to O• C by calling 503.232.1987 or 1.800.332.2344.
Issued ;y: 4 APi/ Permittee Signature: At
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City Tigard �� l /6 ,. ^ x
Cit of Ti and Permit No.: �! (Q� V
'� 'EIVED Date/By:
13125 SW Hall Blvd.,Tigard,OR Plan Review I Phone: 503.718.2439 Fax: 503. Date/By: Other Permit:
Inspection Line: 503.639.4175 y ySee Page 2 for
T I G A R D Date Read/B : Juris: ®
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
FEB
rt 4 2014
p COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE
}�'TIGARD Mechanical permit fees*are based on the value of the work
❑ New construction Ac(Add itttp�rgpGatNgpt*r performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: vv DDII VV I���lll(lJl, mechanical materials,equipment,labor,overhead,and profit.
Value:$ ?0h,bb
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
rl-and 2-family dwelling )4,Commercial/industrial ❑Accessory building For special information use checklist
❑ Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
C Air conditioning 46.75 _
Job site address: ,a000 6u) rv1aly� o , Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: --7--- Furnace 100,000+BTU(ducts/vents) 54.91
�CU-r�1 �� aa3
Suite/bldg./apt.no.: Project name: Heat pump 61.06
_Duct work 23.32 ,
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
(AO TOI-A-4—F( c, _ �W G 1-e-e-4 hydronic) 23.32
`� C -� Unit heaters(fuel-type,not electric),
ll �� 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
Q Flue vent for water heater or gas
U,C.I.iF1� — 4 do 1 - SeAp{�icA_ / '(," d(,(.C/�• fireplace 23.32
(_ •_k iYi ',44.1-, J Log Wood/pellet tgas) 23.32
C.l Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ 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: /ti_r, c r,&) � � � � Fuel piping:
v►r-(r�J" $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: 0�,P 1 _44n rLh /Y1_,. � Other:
`S rim ]�CF.I /,►� 1 MECHANICAL PERMIT FEES*
Address: Po •—10 /
Subtotal
City/State/ZIP: 6((T 0r 9730/ Minimum permit fee($90.00) ,
Plan review(25%of permit fee)— _
Phone:(S��)��r— /S Fax:(g3) 370 JZ 7 O State surcharge(12%of permit fee) �rp� _
1 5 Ke) 0,
CCB lic.: /8-0 s".--- 5/ 001/ TOTAL PERMIT FEE lo
This permit application expires if a permit is not obtaineu within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: ��() �'d son Date: y3,/,4 f_1 ‹ (,, A v i I-\Building\Permits\MEC_PermitApp_040113.doc 4 617T(11/02/COM/WEB) '-f)rCVO Ct 6.0
L