Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2022-01066
Ti c;n ItD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/17/2022
Parcel: 2S101AA07600
Jurisdiction: Tigard
Site address: 12540 SW 68TH AVE
Project: Connect Physical Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: Mechanical for TI:(3)new ceiling mount exhaust fans for(2)new restrooms and laundry room.
Contractor: LATIMER HVAC LLC Owner: CONNECT PHYSICAL THERAPY
11230 SW MORGEN CT 12540 SW 68TH AVE
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-290-1085 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/15/2022 $467.09
Class of Work: ALT Type of Const: Plan Review 11/15/2022 $116.77
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/15/2022 $56.05
Stories: Info Process/Archiving-Sm$0.50(up to 11/15/2022 $4.00
11x17)
Project Valuation: $14,700.00
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: 3 Vent Systems: Total $643.91
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 t 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 ain copy of the rules
Issued By: c! / 1 p J/4 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 Application R EC E I V FOR OFFICE USE ONLY
City of Tigard Received
illilr Pcmut No.: /
u 13125 SW Hall Blvd.,Tigard,OR 97223 0 CI 2 .` ZQ) an By: �� /K/ —0/Q6/o
an Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: /{ /� V. y,.y-4
Inspection Line: 503.639.4175 CITY OF TIGA ieBy. �✓ i)�N47"f �i i—1 rR
-1 1 t 1 A It U Oo le���teadyBy runs, ® See Page 2 for
Internet: www.tigard-or.gov UI1.DING nIUIJI tiAed�Merhod-9! i /3P Irr ,. Supplemental Information
TYPE OF WORK / 4COMMERCIAL FEE* SCHEDULE—USE CHECKLIST
/1✓t 1'f 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:$$14,700.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12540 SW 68th Ave 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 bidg./apt.no.: Project name:Connect P ti dt r ! 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
Provide(3)ceiling mount exhuast fans for 2 new restrooms and laundry room fireplace 23.32
ducting and air distribution modifications as drawn Log lighter(gas) 23.32
Wood/pellet stove 33.39
dryer vent to exterior Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
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
2 APPLICANT 0 CONTACT PERSON Other. 23.32
Fuel piping:
Business name: Latimer HVAC LLC
$14.15 for first four;$4.03 for each additional
Contact name:Carrie Latimer Furnace,etc.
Address:11230 SW Morgen Ct Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater
Phone:(503)2901085 Fax::( ) Fireplace
Range
E-mail:carlie@latimerhvac.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Latimer HVAC LLC Other:
MECHANICAL PERMIT FEES*
Address:11230 SW Morgen Ct Subtotal
City/State/ZIP:Tigard,OR 97223 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)2901085 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:220839 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature-` * Fee methodology set by Tri-County Building Industry Service Board
Print name:Carlie Latimer Date:10/25/2022
1:1Buitding\PenuitsMEC_PertnitApp 040113.doe 440-4617T(11/02ICOM/WEB)
1
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.
1\Building\Permits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD RECEIPT
' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: After 5
Site Address: 12995 SW PACIFIC HWY
Receipt Number: 443462 - 11/17/2022
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2022-00241 Permit Fee-Additions,Alterations, 230-0000-43104 $225.80
Demolition
BUP2022-00241 12% State Surcharge-Building 100-0000-24001 $27.10
BUP2022-00241 Info Process/Archiving-Sm$0.50 (up to 230-0000-43135 $2.00
11x17)
Total: $254.90
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 47639 BTAGGART 11/17/2022 $254.90
Payor: Meyer Sign Co. of Oregon, Inc
Total Payments: $254.90
Balance Due: $0.00
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