Permit CITY OF TIGARD MECHANICAL PERMIT
* COMMUNITY DEVELOPMENT Permit#: MEC2014-00529
T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2014
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Relocation of duct work,grilles and diffusers.
Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
5035 SE 24TH AVE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND,OR 97202-4765 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Specifics:, Description Date Amount
Type of Use: COM Permit Fee 10/01/2014 $378.19
Class of Work: ALT Type of Const: Plan Review 10/01/2014 $94.55
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 10/01/2014 $45.38
Stories:
Project Valuation: $11,200.00
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 $518.12
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. - 1
Issued By: Permittee Signature:
Call 3.639.4175 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 Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By:
Cf 251/1,1 0, l Permit No.:I/v.1 L L- >]
L 1 II- e" 13125 SW Hall Blvd.,Tigard,0 Plan Rcvicw 1 g Phone: 503.718.2439 Fax 503 iNistl Date/By: Other Permit:
Inspection Line: 503.639.4175 Iuno. ® Sec Page 2(or Date Ready/13y:Internet: www.tigard-or.gov 2.0k Notified/Method: Supplemental Information
rmation p J I i(?
SU- :-- -
_ �4 `s 1;�b s fs\' Q11C4i >!`8£ D1>1LE USECTSi.7ST
�1V Mechanical permit fees'are based on the value of the work
❑New construction U Additional jai 1 it performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other, �}�b. mechanical materials,equipment,laboriencead,and.rofit
Value $ IA 1 -�-�
>iJSm ,
.- . .,YO--:4..;----,.---
...... .,._-L._:- . .._ :_ ._ ---: . ..- .. _ .. tJI14ME1!1'>`/�3YST1�S� _.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. 1 Ea. I Total
�: _= Heating/cooling
:..-:•.��'..=•cam•."
sYOB:::s1TE._INi ORMATION AND T:O 1 01,.-s..- ..= .
; . `- t rail° ....:.,........ _•...c Air conditioning 46.75
Job site address: tia44 as r5 4 e Flaw V1 Furnace 100,000 BTU(ducts/vents) 46.75
City/State(LIP: 71 kills() cit.. Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 0Q( Project name: ti D 5.�.{y�ry i Heat p � 23.32
r ��/` Duct work 23.32
Cross street/directions to job site: Ilydronic 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 Lot no.:
Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
- _...-- . .. _ =_�kSCI�P!I91L� ��Q)t�= ,. .. Gas fir e la
cclinsctt 3339
t Flue vent for water heater or gas
R r, 0 i r 1+444C, DVt. 1(�1,� Ki QaIF L �i fireplace _ 23.32
t\41.4) V(: , Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood tireplace/insert 2332 _
Chimney/liner/llue/vent 23.32
_fl PROPER''Y OWNER ': 7 Q TENANT _ = d ventilation: 23.32
Other
• _.. _ .. -- - Environmental exhaust an
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
.,•.::.-��::.:-�_._;_ _ p1 .. - --------n- _�.:_:._.. _ _ .4 --= 2332
-._�,.;-_--= = ..... �__;_.. -. .- ---- - `� �I±11' L�=) _ -_ Other -
!._..........:.:... Fuel piping:
Business name: ALAI fltly Imo,
524.15 for first four,54.03 for each additional
Contact name: >k `-..10 11,, Furnace,etc.
Gas heat um
Wall/suspended/unit heater
Address: ,.:,.. .t a. L7� P AL1. pump
l/
City/State/ZIP: 1. p ) t Cr4`00A,. Water heater
Phone:(M) a ..t ° Fax::(5) ,, ' Fireplace
Range
E-mail: Barbecue
=- LL -_? ,� ,= _ }: `". 2. .- .-_�. ; _ . Clothes dryer(gas)
Business name: L:4, P7-G y�1(,.t1 t Other:
Address: " �( A.:C`(� - ..-^ q1ANXf 1;.PtR11 '1`ubtot
r[• Subtotal`
City/State/ZIP: cpr,, � a ( .f _ c ,. Minimum permit fee($90.00)
�"+'�` ■ Plan review(25%of permit fee)
Phone:(tk3 Q�G71 t 0 Fax ( ) ,._" _ State surcharge(12%of permit fee)
CCB lie.: `T 0 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:
• Pce methodology set by 1'ri-County Building Industry Service Board
n r
[Print name: Ili r r l f.L Dated I I
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11 COM/WEB)