Permit (129) CITY OF TIGARD MECHANICAL PERMIT
Iii • COMMUNITY DEVELOPMENT Permit#: MEC2016-00768
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2016
Tic_;A 1:D9 Parcel: 1S135BC00201
Jurisdiction: Tigard
Site address: 10765 SW GREENBURG RD
Project: 7-11 Subdivision: None Lot: None
Project Description: Install barometric relief hood and damper
Contractor: SOURCE REFRIGERATION Owner: GREENBURG ROAD CENTER LLC
5506 SE INTERNATIONAL WAY 22020 17TH AVE SE#200
MILWAUKIE, OR 97222 BOTHELL,WA 98021
PHONE: 800-677-2688 PHONE:
FAX: 503-652-0449
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/22/2016 $167.30
Class of Work: ALT Type of Const: VB Plan Review 11/22/2016 $41.83
Occupancy Grp: M Occupancy Load: 12%State Surcharge-Mechanical 11/22/2016 $20.08
Stories: 1 Info Process/Archiving-Sm$0.50(up to 11/22/2016 $2.50
11x17)
Project Valuation: $3,700.00
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 $231.71
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: barometric
Duct Work: relief hood
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o ' is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification CenteThose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir ct questions to OUN b ling 503.232.1987 or 1.800.332.2344.
Issu d By: `--� Permittee Signature:
'------------5---- II .77:' -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicatio Y FOR OFFICE I_SE ONE)
City of Tigard Received
7 Date/By: // '7 /4? ✓ Permit Npt� �* fal-74,'
u 13125 SW Hall Blvd.,Tigard,OR 97223 N O V 2016 Plan Revte=
• Phone: 503.718.2439 Fax: 503.598.1960 Date/B Y: - �� `Other Permit:
�}
TI G A R p Inspection Line: 503.639.4175 CITY OF TI GA R Date Ready'y. Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: /I )� i„ j Supplemental Information
BUILDING DIvISIO . / �`�/ J
"TYPE OF"WORK t l ro'Jt`COMl1ERCIAL FEE* SCHEDULE - USE CHECKLIST,,
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ /Gfl
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION.AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: '0764 S(,) ( re R Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
J _ Heat pump 61.06
Suite/bldg./apt.no.: i Project name: -7-(I 4--o2 j C, - Duct work 23.32
Cross street/directions to job site: G rte QD 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 t ' ' '2 Gas fireplace/insert 33.39
Flue vent for water heater or gas
.1-1(k �„kik DRct i.&.tkt tK,.._ r \tCL' herr-J (104,c d'xvA r- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER D TENANT Other: 23.32
.. . Environmental exhaust and ventilation:
Name: -1-i` Range hood/other kitchen
equipment 33.39
Address:
01 X05 S G - mitO%C . Clothes dryer exhaust 33.39
City/State/ZIP: \7 Single-duct exhaust(bathrooms,
-T- l O& toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
`' . x Other: 23.32
APPLICANT ❑ CONTA ' PERSON'
name: (� ( Fuel piping:
Business
�O�r(C_. !C moi.. $14.15 for first four;$4.03 for each additional
Contact name: (�iuvv.- ¢-7c..Il Furnace,etc.
C--56(10i Gas heat pump Address: -tti\ c 7Wall/suspended/unit heater
City/State/ZIP: (1 Gl'idu)CQ'i 612- Water heater
Phone:(56 )5-7k- 517 Fax: :( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas) .
Business name: 1 Pc \f.�I• Other:
S MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: ,/.\9'ga) TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatu -: _... ....--........7.... .'
* Fee methodology set by Tri-County Building Industry Service Board
Print name: t_i' "1 V\ fr . f Date://-1-1C
I:\Building\Permits\MEC_PermitApp_0401I3.doc 440-4617T(11/02/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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2