Permit •
CITY OF TIGARD MECHANICAL PERMIT
r `+
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00584
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
T f GARI) Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: HVAC modifications for TI
Contractor: GENERAL SHEET METAL WORKS INC Owner: PROVIDENCE HEALTH SYSTEM
11235 SE HWY 212 4400 NE HALSEY BLDG 1 SUITE 160
CLACKAMAS, OR 97015 PORTLAND, OR 97213
PHONE: 503 - 650 -0405
PHONE: 503 - 215 -6282
FAX: 503 - 650 -1058
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/16/2010 $677.91
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/16/2010 $81.35
Occupancy Grp: Occupancy Load:
Stories:
Project Valuation: $22,975.00
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 $759.26
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 Notifica ton - er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir ct questions to OU s . -lin• :3.232.1987 or 1.800.332.2344.
Iss ed By: /� - Permittee Signature: Af` d ///'
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 Applic i FOR OFFICE USE LY
Received
111 City of Tigard Date/By: /( �� Permit No.ON: �e �Olf'-C7 •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 501598.1 ° f V 1 2 2 010 Date/By: Other Permit
T 1 G A R D Inspection Line: 503.639.4175 U Date Ready /By: Juris, 0 See Page 2 for
_ Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
.
_ , , _
1 'a� a .: . , N' ® 0 ?T�x � 11 # � . w 'f t e11 J11 t . - , zit (1 "":48/ 8 / ..
❑ New construction CO Addition/alteration/replacement Mechanical permit fees* are base alue of the work
performed. Indicate the valu rounded to the - . rest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overheat. and profit.
J" r t ,yq a >i ®4-'111 t ..„ A m ,. value: $ 2 2. 9
.« e,.., .tg .. 1... �.6`°'k.... «'-w Nye&v�,,.2, -`.. .: x.. -,T4-7:- - l: , - , . . .ems ry .,,. ,, - :tom °
.. �1 4 a `T 1Vl a :l a ,
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi -family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
1 .:: ` a p "' "� ►' g €ice . Heating/cooling
Air conditioning
Job site address:-1 SW Scholls Ferry Road (requires site plan showing placement) 46.75
City/State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: 202 Project name: Providence Rehab Remodel Heat pump 61.06
Cross street/directions to job site: Scholls Ferry Road and SW N. Dakota Stre Duct work I 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
Flue/vent for any of above 23.32
Subdivision: 1 Lot no.:
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
_ r�� i g , :x.air . N . a Water heater 23.32
Gas fireplace 33.39
To f h\ S L e^9e ok ',O. .4 t ,, y A to Flue vent for water heater or gas
u_Q_T ' O2 L / (O 1 r 1 e /-n0 U (V fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
,> -T. : e. - ,- - , J . Chimney /liner /flue/vent 23.32
"' Other: 23.32
Name: Providence Health System - OR Environmental exhaust and ventilation
Range hood/other kitchen
Address: 4400 NE Halsey, Bldg 1 Suite 160 equipment 33.39
City/State /ZIP: Portland, OR 97213 Clothes dryer exhaust 33.39
Single - duct exhaust (bathrooms,
Phone: (503)215 - 6282 Fax: (503) toilet compartments, utility rooms) 23.32
' Attic /crawls ace fans 23.32
s a5 �e �� s 51 P
+ � �� t ;,. Other: 23.32
1l usin met General Sheetmetal ,/
���r1 5 /00 Fuel piping
Contact name: ✓(.I"° ,I. e \ e n -1 L 0 v ,„ n $14.15 for first four; $4.03 for each additional
Address: 112 3S < Gas h ea t p
k.1%.,,,..3 � I �"' Gas heat pump
City/State /ZIP: c \ 4. 4 ke„.nn e1/44. U g 4i.10/4-* Wall/suspended/unit heater
1 Fax: Water heater
Phone:
( v 3 6,s - 6 y t l 4' cr sa a) d S v- 1 Os. es" Fireplace
E -mail: (• e- Q S 1Yl W, c 0oft Range
,,,� , �s :. .„ f - ;;s _ ' r z . «sri
.-, I z a ' . Barbecue 4. _ _ t
Business name: A , dersen Co t truction Clothes dryer (gas)
Other:
Address: 6712 Nor 'I Cu -r Circle ' °"
ity/State /ZIP: Portl i d, OR 97217 Subtotal r 0 ,/
Minimum permit fee ($90.00) -----
Phone: (503) 283. 1712 Fax: (503) 283 -3607
/ Plan review (25% of permit fee) _
CCB lic.:: i v0 „ , � 4 . State surcharge (12% of permit fee) ., ,5 [[[ TOTAL PERMIT FEE "`•f"
� , r , This permit application expires if a permit is not obtain td wit in 180
Authorized Signature: / O fir"° r - v / days after it has been accepted as complete.
Print name: 1
G re f K e A'� H I y y� Date: J l y if / / O * Fee methodology set by Tri-County Building Industry Service Board
t:\ Building \Permits \MEC- PermitApp.doc 10/01/09 440- 4617T(11 /02 /COM/WEB)