Permit 1
IN 4 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00021
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/23/2009
PARCEL: 2S 101 AC -01300
SITE ADDRESS: 07105 SW HAMPTON ST ZONING: MUE
SUBDIVISION: BEVELAND NO. 2 LOT: 018 JURISDICTION: TIG
PROJECT: KAISER DENTAL
Project Description: (1) new RTU. Modify existing ducts. Project Value: $31,365
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: 1 COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
KAISER PERMANENTE Description Date Amount
500 NE MULTNOMAH SUITE 100
PORTLAND, OR 97232 [MECH] Permit Fee 1/23/200, $520.40
[MECPLN] Plan Rev l/23/200K $130.10
[TAX] 12% State Surch 1/23/200 $62.45
Phone: Total $712.95
Contractor:
JOHNSON CONTROLS INC
4011 SE INTERNATIONAL WAY #605
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 305 -2000
FAX 503- 654 -1158
Reg #: LIC 65320
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ►� � Permittee Signature: r' rt.
Call 503.639.4175 by 7:00 a.m. for inspections t - 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.
O 44
1VjechanicaliPermit Application . eived . /
, FOR OFFICE USE ONLY
C13i12ty5 S W Hall Blvd. Tigard RECEIVED Rec
Date/By: , 0 ,.. Permit No.: aczn . 0 eoz (
. . W Tigard, OR 97223
MI Phone: 503.639.4171 Fax: 503.598.1960 JAN • 1 2, 2009 D Pl a an Reyiem
te/3 irrffm
f Other Permit:
Inspection Line: 503.639.4175
TIGARD Date Read /By: , 4? ,,.., A NI Juris: 10 See Page 2 for
Internet: www.tigard-or.gov
CITY OF TIGARD Notified/Method: i i f K 0 7 O i I el Supplemental Information
BUILDING DIVISION, froile-
KINtr304161 fO Ad v.i*florte 'ts,..4:4;f*wir:a4 4f
0 New construction Addition/alteration/replacement
Mechanical permit fees* are based on the value of the work
El
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
15,: i i - 4 - 0*60 , 43 , - 0,176,-,,* ; ki j e l ooNmr. :: :: - , , ,,,; , ,,0,7:, : In ,,, , ,, , ,,, , , , ,, , ,, _y Valu $ $31,365.00 _
' '''''"'"' "" ' ' — ""-- — ""''" — ---- ' ' '''' ' ' l: R )i l :Ci j kg'700i I' M E * ' i ' l:AqtY: 1 :k4•OWt;,'
El 1- and 2-family dwelling El Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family El Master builder 0 Other:
Description Qty. Ea. Total
41 it4:1310WOOf2.71 atig4 Heating/cooling
Air conditioning or heat pump
Job site address: 7105 SW HAMPTON ST
(requires site plan showing placement) 1 14.00
City/State/ZIP: TIGARD, OR 97223-8314 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: KAISER TIGARD DENTAL RTU
Gas heat pump 14.00
Cross street/directions to job site: Duct work 1 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.: 2S101AC01300 Other fuel appliances
pl:c,*Ttf5rOp Water heater 10.00
Gas fireplace 10.00
ADD ONE (1) NEW 5-TON ROOFTOP HVAC UNIT TO THE EXISTING FACILITY. Flue vent for water heater or gas
MODIFICATION OF DUCTWORK PER PLANS. fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
vw----o„.',, Chimney/liner/flue/vent 10.00
eitittP P4!4144 3: : Other, 10.00
Name: KAISER PERMANENTE Environmental exhaust and ventilation
Address: 500 NE MULTNOMAH, SUITE 100 Range hood/other kitchen
equipment 10.00
City/State/ZIP:'PORTLAND, OR 97232 Clothes dryer exhaust' 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
....
At,OR:,:f ,:**JfIV'''',N':C(ri1:,`9:AfRsON4:j?:::;:at Attic/crawlspace fans 10.00
Other: 10.00
Business name: JOHNSON CONTROLS, INC.
Fuel piping
Contact name: TONY HUNT $5.40 for first four; $1.00 for each additiona
Furnace, etc.
Address: 4011 SE INTERNATIONAL WAY, SUITE 605
Gas heat pump
City/State/ZIP: INITLWAUKIE, OR 97222 Wall/suspended/unit heater 1
V
Phone: (503) 305-2016 Fax: : (503) 654-1158 Water heater
Fireplace
E-mail: TONY.M.HUNT@JCLCOM Range •
41 irwtt:::'::E4f Barbecue
Clothes dryer (gas)
Business name: JOHNSON CONTROLS, INC. ..
Other:
Address: 4011 SE INTENATIONAL WAY, SUITE 605 4•Z.17:7!ci#*4".f*0#LL
City/State/ZIP: MILWAUKIE, OR 97222 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 305-2000 Fax: (503) 654-1158
Plan review (25% of permit fee)
CCB lie.: 65320 dA7/1/ State surcharge (12% of permit fee)
TOTAL PERMIT FEE
-- ..r - o giii Fs l
This permit application expires if a permit is not obtained within 180
Authorized signature: T
days after it has been accepted as complete.
Print name: TONY H Date: 01/12/2009 * Fee methodology set by Tri-County Building Industry Service Board
IABtolding \ PermitsWIEC-PermitApp doc 01/19/07 440-4617T (11/02/COM/WEB)
f
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation:
$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:\BuildingWermits\MEC-PermitApp.doc 01/19/07 2
ity of Tigard, Oregon Page 1 of 1
City of Tigard, Oregon �' C
S 13 SW ffall B[e %d , 7igo,rl, OR 97223 1 1 , ( J
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CONTACT US
City of Tigard, 13125 SW Hall Blvd, Tigard, OR 97223, 503- 639 -4171 I Map and Directions
AFTER -HOURS CONTACT
Public Works/Water: 503- 639 -1554 I Police Non - Emergency: 503 -629 -0111
Questions, comments, suggestions? Fill out the feedback form.
http:// www .tigardmaps.com/mox52_multimap/ index. cfin ?fuseaction= aerial.photo_2007 &scale= 1:5... 1/12/2009
CITY OF TIGARD
BUILDING DIVISION / PERMIT #: MEC2009-00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10312009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/5.1/2009 - TIME: 7:00AM PAGE: 13
SITE ADDRESS: 87105 SW HAMPTON ST CLASS OF WORK:
'
SUBDIVISION: BEVELAND NO. 2 LOT #: 018 TYPE OF USE:
PROJECT NAME: KAISER DENTAL
DESCRIPTION: CO now RTU. Modify existing ducts. Project Value: $31,365
OWNER: KAISER PERM ANENTE, PHONE #:
CONTRACTOR: JOHNSON CONTROLS INC PHONE #: 603
Inspection Request Scheduled For: Date: 2/8/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 080411-01 503-21-9819 N
Corrections /Comments/ Instructions:
(•.' /4-SLf it) C-. &31 1 tc -----
Ass n PARTIAL APPROVAL { CANCEL
/
i 0 NO ACCESS
FAIL II] CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: , A_ 41111111. Date: til Phone #: (503) 718-
lab.
, . _