Permit Y„
.`�;.� a CITY OF TIGARD MECHANICAL PERMIT
Y��l COMMUNITY DEVELOPMENT Permit #: MEC2009-00333
13125 SW Hall B lvd., Tigard OR 97223 503.639.4171 Date Issued: 07/08/2009
T . ? Parcel: 1S135AA01400
Jurisdiction: Tigard
Site address: 10215 SW HALL BLVD
Subdivision: Lot: 0
Project: Dermatology Associates
Project Description: Move existing mini -split duct system to new location. No plan review required per Dan Nelson.
Owner: FEES
INTEGUMEND LLC Description Date Amount
BY SCOTT COLLINS, MD &, MARLA ROSS, MD,
Permit Fee 07/08/2009 $72.50
10215 SW HALL BLVD 12% State Surcharge - Mechanical 07/08/2009 $8.70
PHONE:
Contractor:
OHAC INC
PO BOX 241
DUNDEE, OR 97115
PHONE: 503 - 538 -2953
FAX: 503- 691 -8556
Type of Use: SF
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 $81.20
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 Notificatio • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct que ons to OU C : • c.11inngg5503. A( 2446..669 orrr 1.8 /
Issued By: ? 0 ^ 1 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 Application 0 FOR OFFICE USE ONLY
Received 65
�
VI
City of Tigard Date/By: � ��✓ jQ
J
13125 SW Hall Blvd., Tigard, OR 'V? Plan Review
Phone: 503.639.4171 Fax: 503.5'(.. ':' 4 5 0 3 . 5 ' ' . ' ‘ ` ' , I C Date/By: Permit No.: y: Other Permit:
Inspection Line: 503.639.4175 09 Date Ready/By:
® See Page 2 for
Internet: w
ww.tigazd- or.gov JUL O s V3 Notified/Method: Supplemental Information
TYPE OF 1100 OF 1 `G AP® A , COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
IVISIJ�1 Mechanical permit fees* are based on the value of the work
El New construction XI,Addition/altellaWeirient performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, ov rhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ Gf(2
RESIDENTIAL EQUIPME / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
v
Job site address: Air conditioning or heat pump
C 0 � (" l C l/ �j ee , /// (requires site plan showing placement) 14.00
City /State /ZIP: _Jl / .47/j J ✓ E ? 7 7 z 3 Furnace 100,000 BTU (ducts /vents) 14.00
// // J // Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: La./ 4 SS')� i pump Gas heat 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
/li 2/&.-- ✓f' /J✓/ — S0/J _1 abi --(- 15 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
t iif PROPERTY OWNER TENANT Chimney /liner /flue /vent 10.00
i Other: 10.00
/
Name: ' /714 a 5 z 0 �/ Environmental exhaust and ventilation
Address: C
/ /� ✓ Range hood/other kitchen
/ 4 4 equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:.( ) 2;--15 2 < Fax: ( ) toilet compartments, utility rooms) 6.80
[y APPLICANT / ❑ CONTACT PERSON Attic /crawlspace fans 10.00
J' Other: 10.00
Business name: (3- I / , (� Fuel piping
Contact name: r _ � t 1 r /1 L $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
0/7)V1 / _ Fireplace
A—/
E -mail: G / / 1� Range
CONTRACT Barbecue
Clothes dryer (gas)
0
Business name: t � Other:
Address: () {��- / ,51"-- PERMIT FEES*
City/State /ZIP: 1/ 4, 0 _ c3 f 9 7/) 5 Subtotal
Phone: CS as. ( ) Minimum permit fee ($72.50)
�r�h� Fax: review (25% of permit fee)
CCB lic.: //7 7 —/ 7i 3 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: n - L - / Date: --- 6 79 * Fee methodology set by Tri- County Building Industry Service Board
I.\ Building \ Permits \MEC- PermitApp.doc 01/19/07 440 -461 (11 /0 COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building \Permits \MEC- PermitApp.doc 01/19/07 2