Permit CITY OF TIGARD MECHANICAL PERMIT III • COMMUNITY DEVELOPMENT MECHANICAL
MEC2015-00121
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2015
Parcel: 2510 2 DA00100
Jurisdiction: Tigard
Site address: 12970 SW HALL BLVD 110
Project: MAGNO-HUMPHRIES Subdivision: BARNUM PARK Lot: 9
Project Description: Replacing(1)5 ton RTU and(1)4 ton RTU.
Contractor: JACOBS HEATING&AIR CONDITIONING Owner: MAGNO, LLC
4474 SE MILWAUKIE 8800 SW COMMERICAL ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-234-7331 PHONE:
FAX: 503-296-5351
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 03/09/2015 $454.39
Class of Work: ALT Type of Const: Vg Plan Review 03/09/2015 $113.60
Occupancy Grp: F-1 Occupancy Load: 12%State Surcharge-Mechanical 03/09/2015 $54.53
Stories: Info Process/Archiving-Sm$0.50(up to 03/09/2015 $6.50
11x17)
Project Valuation: $14,190.00
Fuel Air Handlers
Fuel Types: Natural Gas 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 $629.02
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or RLa'1:37 344.
Issued By: ,..,1 •ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. —401011"
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard C^rI`,CD Dateivya
GV C V Ir Date/B
" 1 hone S50 Hall Blvd., Fax: OR 972 plan Ry' VN IIIMMIMMffili
Phone: 503.718.2439 Fax: 503.598.1 b Date/By: A`/ et 4 Other Permit:
Inspection Line: 503.639.4175 �1^p 9 205
T I GARD Internet: www.tigard-or.gov M ° Date R� ho ® See Page 2 for
Notitied/Methad: 3 :' ra Supplemental Information
OF TIGARD
- t
TYPE OF „rr ti:, i j DWISI9$ , .3 ` . FEE*SC�IEDBEE USE CIIECKLIB
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:$$14,189.60
CATEGORY OF co IS11ti.- . RESIDENTIAL EQUIPMENT I 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 46.75
Job site address: 12970 SW Hall Blvd
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: r to Project name:Magno-Humphries 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
Replace(1)5 ton gas pack and(1)4 ton gas pack on the roof fireplace 23.32
Log lighter(gas) _ 23.32
Wood/pellet stove 33.39 _
Wood fireplace/insert _ 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
0
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name:Magno-Humphries 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:(503)684-5464 x122 Fax:( ) Attic/crawispace fans 23.32
❑ APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Jacobs Heating and A/C
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Bob Kozel! Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(50350)853-0018 Fax::( ) Fireplace
Range
E-mail:bobk @jacobsheating.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Jacobs HEating and A/C Other:
MECHANICAL PERMIT FEES''
Address:4474 SE Milwaukie Ave Subtotal
City/State/ZIP:Portland,OR 97202 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)234-7331 Fax:(503)808-9108 State surcharge(12%of permit fee)
CCB lic.:1441 TOTAL PERMIT FEE
ed . Q02,This permit application expires if a permit is not obta within 180
�- days after it has been accepted as complete.Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Peter Richey Date:2-26-2015
I:\Building\Permits\MEC_PermitApp_040113 doc 440-46170(11/02/COM/WEB)
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