Permit CITY OF TIGARD MECHANICAL PERMIT
Permit#: MEC2022-00231
COMMUNITY DEVELOPMENT Date Issued: 4/12/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68TH PKWY 200
Project: Mindful Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Demo split system, relocate(5)existing thermostats,relocate(10)existing supply ducts, add(1)supply diffuser
and(7)return grilles.
Contractor: AMERICAN HEATING INC Owner: 11740 SW 68TH PARKWAY LLC
5035 SE 24TH AVE 111 SW COLUMBIA ST STE 1380
PORTLAND, OR 97202-4765 PORTLAND,OR 97201
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 03/31/2022 $428.99
Class of Work: ALT Type of Const: Plan Review 03/31/2022 $107.25
12%State Surcharge-Mechanical 03/31/2022 $51.48
Occupancy Grp: Occupancy Load:
Info Process/Archiving-Lg$2.00(over 03/31/2022 $4.00
Stories: 11x17)
Project Valuation: $13,115.00
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 $591.72
Hoods: Comm Incinerators: Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
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 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 may obtain a copy of the rules
Issued By: Permittee Signature:
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 Applicati4ECElVE 9 FOR OFFICE USE ONLY
ReceivedBy - .I/�,.r/n .r 2.3,/
City of Tigard Date / Permit No..( (�✓ C ll
13125 SW Hall Blvd.,Tigard,OR 97223 MAR 1 6 2022 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 3-3 0 -217 Other Permit:
i 1 t A 32 1 t Inspection Line: 503.639.4175 , I Y OF TIUHKL Date Ready/By: / Jurirs�: El See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISI Notified/Method- �f/,/7( + I pr. Supplemental Information
TYPE OF WORK Rib(
E*MSCHEDULE - 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:$13,115
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11740 SW 68th Pkwy 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.: 200 I Project name: Mindful Therapy Suite 200 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
Other: 23.32
Subdivision:
Lot no.:
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
Demo split system,Relocate(5)existing thermostats,Relocate(10)existing supply ducts, fireplace 23.32
Add(1)supply diffuser and(7)return air grilles 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 , 0 TENANT 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 moms) 23.32
Phone:( ) I Fax:( ) Attic/crawlspace fans 23.32
'4 APPLICANT ® CONTACT PERSON Other: 23.32
Fuel piping:
Business name: American Heating
$14.15 for first four;$4.03 for each additional
Contact name: Melina Swalko(Vaca) Furnace,etc.
Address: 5035 SE 24th Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Portland,OR 97202 Water heater
Phone: 503-239-4600 ext.258 Fax:: Fireplace
Range
E-mail: m.swalko@americanheating.net Barbecue .
CONTRACTOR Clothes dryer(gas)
Business name: American HeatingOther:
MECHANICAL PERMIT FEES*
Address: 5035 SE 24th Ave Subtotal
City/State/ZIP: Portland,OR 97202 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone: 503-239-4600 Fax: State surcharge(12%of permit fee)
CCB lie.: 33135 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Digitally s5nd by Melina swam days after it has been accepted as complete.
Melina Swalko °�s-b .a. swe� a,,n,n.ama rem caw —s.a
Authorized signature: Da:,202aoo.ls,4 4a 1 oroo * Fee methodology set by Td-County Building Industry Service Board
Print name: Melina Swalko(Vaca) Date: 03/15/22
I:13uilding\Permits\MEC_PerznrtApp_040113.doc 440-4617T(11/02/COMrwt.B)
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.
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