Permit
HANICAL PERMIT
CITY OF TIGAR®
COMMUNITY DEVELOPMENT Permit#: MEC2010-00083
M%i MEC
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/24/2010
Parcel: 2S 101 AD02800
Jurisdiction: Tigard
Site address: 12665 SW 69TH AVE 100
Subdivision: WEST PORTLAND HEIGHTS Lot: 31
Project: Amedisys
Project Description: Install (2) return air transfers and (1) exhaust fan in server room.
Owner: FEES
CEDAR ENTERPRISES LLC Description Date Amount
12665 SW 69TH AVE STE 200 Permit Fee 02/24/2010 $81.34
TIGARD, OR 97223 12% State Surcharge - Mechanical 02/24/2010 $9.76
PHONE: 503-636-6657
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115
PHONE: 503-691-9699
FAX: 503-691-8556
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: 1 Vent Systems: Total $91.10
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
oodstoves: Gas Fireplaces:
W
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, uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility tification Center. ose rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or d' ct questions to OUNC b 3.246.6699 or 1.800.332.2344.
Is ed By: Permittee Sign ure:
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 Application , 'FOii3OEFICE`USE O1NL. t "a ,' .:,c,' :'
t Phone: 503.639.4171 Cl ig Hall � Fax 503.598.1960 RECEIVED
E� Received y: /O �� VJS �/�e �vo __
+�o g3
Plan
ill
13125 SW Hall Blvd. Tigard, OR 97223
' `` Plan Review Pe rmit N o.:
2 4 zoio Date /By: Other Permit: ' .6,p i-I ,�
,I I G A RD Inspection Line: 503.639.4175 FEB Date Ready /By: Juris: ® See Page 2 for - •
. t Inte wwwaigard or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF An ;OI'�G DI
,,, . �-
• COMMER F.EE* 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 Other: mechanical, materials equipment, labor, 9verhead, and profit.
CAT GORY" OF CONSTRUCT ION - - _ . Value; C
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 INFORMATION4AND LOCATION . _ Heating/cooling.
Job site address: / f ,X ) & 9 f ' Air conditioning Tes l
! ✓ �' f (requires site plan showing placement) 46.75
City /State /ZIP: ) Furnace 100 BTU (ducts/vents) 46.75
/ �✓ 4 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Proje t name: ✓�p't 52 I / r Heat pump 61.06,
Cross street/directions to job site: 1 / Duct,work 23.32
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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other 23.32
Tax map /parcel no.: Other fuel'appliances
DESCRIPTION OF WORK Water heater 23.32
•
/ : , ., Gas fireplace 33.39
// ) Krk 1/l 4 /" 1 iy / I t 4/ / Flue vent for water heater or gas
C1—. - �� 0 y--7,n �� y - C fireplace 23.32
�7 Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
n y /flue t
- Chime /1" iner /ven 23.32
0 PROPERTY OWNER , 111 -TENANT': . ,
Other: 23.32
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
]' °:APPLICANT• .. • _ , CONTACT PERSON,. t er crawlspace fans 23.32
A ttic/
z l
Business name: ,Q O h 23.32
A CVl Fuel piping
Contact name; C $14.15 for first four; $4.03 for each additional
Address: ` Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ((v/,) Li 1 ir/&.2 '2.-- Fax: : ( ) Water heater
/� 1 /�C� / J �y� Fireplace
E-mail: / r'/,' 7 (.. " a✓, " � `�a , 6/ ' ),, Range
1014/TRACTOR �° Barbecue
Business name: - .4�' �/ Clothes dryer (gas)
C Other:
Address: [�7 ... -
[ :MECHANICALiPERMIT EES '
E*= %.
City /State /ZIP: „9,,,,�'� ,,,,.. L 7/ 1 c Subtotal p ?/
/ / !! Minimum perm f ee ($90.00) D t ".J
Phone: ( ) Fax: ( ) •
Plan review (25% of permit fee)
CCB lic.: /'7 2_,/ 7/C , State surcharge (12% of permit fee) . -(;,
TOTAL PERMIT FEE Q / +t to
/ This permit application expires if a permit is not obtainell arithin
days after Authorized signature: /�� d f it has been accepted as complete.
[[[ /�! n / / / s Fee methodology set by Tri-County Building Indust Service Board
Print name: 7 _/ + 71 '4_ Date: •� / l _ 8Y Y Y B rY
I1 Building \Permits\MEC- PermitApp.doc 10/01/09 440 -4617T (11 02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi Family Fee Schedule:
`TotalnValuation 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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