Permit CITY OF TIGARD MECHANICAL PERMIT
'; COMMUNITY DEVELOPMENT • Permit #: MEC2009 -00661
T ( GARb' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/11/2009
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 300 •
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Health Net
Project Description: HVAC modifications for TI. This work on 3rd floor only.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096
WARREN, MI 48090 Permit Fee 12/11/2009 $167.30
12% State Surcharge - Mechanical 12/11/2009 $20.08
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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 $187.38
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
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 Noti i .: .n - = . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire questions to OU .y callin. 503.246.6699 or 1.800.332.2344. �4
Issue. By: 1 / Cr Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 ApplicatioIRECF FOR OFFICE USE ONLY
City Q permit No.: (h�
�J of Tigard Received g Date/By: /W. // 07 /
li • 13125 SW Hall Blvd., Tigard, OR 97223 DEC 112009 Plan Resew
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R I� Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Not ifred/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 3 6 S 2
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ ter builder ❑ Other: Description 1 Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /3221 5W & 81 h F r k'v' \/ Air conditioning or heat pump
J (requires site plan showing placement) 14.00
City/State /ZIP: -7 DR '172 23 Fumace 100,000 BTU ( ducts/vents) 14.00
N ea I ti N e - f- Fumace 100,000+ BTU (ducts/vents) 11.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
r I as fireplace 10.00
li VA C m f -} I c q � O/] s' 'D Ti Tr se =ice Flue vent for water heater or gas
/// fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER ❑ TENANT Other: 10.00
•
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans • 10.00
Business name:
A mer IC ,,, fie ''f )n in G Other: 10.00
Fuel piping
Contact name: 0 16 1J qmm c -/- $5.40 for first four; $1.00 for each additional
Address: 1 33 SE 6 U on s . Furnace, etc.
Gas heat pump
City/State /ZIP: O (_/- / and DQ 9 72 02. Wall /suspended/unit heater
Phone: (5Q3) 231- 1.1600 ` Fax: : (503) 239-7038 Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: ��' C a n H e q f � � Clothes dryer (gas)
Other:
Address: / 33 / 5E 6r dep, .i' MECHANICAL PERMIT FEES*
City/State/ZIP: / (� 1 Subtotal 30
ty t� �n �� �2 Minimum permit fee ($72.50) /
6 7
Phone: (503) 2 3 / _ / &0 O Fax: (503) 23i-703 Pl an review (25% of permit fee) —t-
CCB lic.: 33 I3 5 State surcharge (12% of permit fee) ` � 3 R
TOTAL PERMIT FEE . 7
Authorized signature: This permit application expires if a permit is not obtained within 180
! � �� days after it has been accepted as complete.
! Print name: grad MGIn .4 e5 f C/' Date: /2_1/-07 * Fee methodology set by Tri- County Building Industry Service Board
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