Permit City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Mechanical Permit
r I G A R D Appointment Checklist
Permit Record#: 12/t/ e20/q— ljd .j 93G - 2 70o
Contact Name: j/yt7 /41t 4 /2&-L[L_ Phone #: - 319 -39 7/ •
Business Name: ZW/4-NS `f-T,/?_ Appointment Date: / /7 / 1p �l)►
Site Address: /j5 q0 SC,c) 1Q�-�ffG 7 Bldg/Suite #:
Project Name: k -y /f ,�
Project Description: .61%.(7:7-4. --A S,L/'
Related Record #: Aui0 /g --ea.)
GENERAL INFORMATION
ix
*Class of Work: Occupancy Group: Type of Construction:
v .�
*Type of Use: Oregon Specialty Code:
Number of Stories:
FUEL FURNACES
Type: Furnace< 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit(RTU) Tons 3
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump 1
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler(BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes D ers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire/Smoke Dampers Other Mechanical Units—Describe:
Total Project Valuation: $ d 0 .x-
FOO, 00 514./1 Mechanical Permit Fee
714-0$ 4.1.13' Plan Review
3 7.b F$ , 4 d• 12% State Surcharge
Z.OD $ �. O Info Proc/Arch,Lg(over 11x11 $2.00)
z,cO$ 2 00 Info Proc/Arch,Sm(up to 11x17 $0.50)
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
Building Staff:
Date/Time: $ 03.37 TOTAL FEES DUE
sit 41341 k
I:ABuilding\Forms\OTC MEC_021116.docx