Permit (66) CITY OF TIGARD MECHANICAL PERMIT
1 • ' COMMUNITY DEVELOPMENTIN
Permit#: MEC2019-00365
Date Issued: 06/11/2019
T-I( A R.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: None Lot: None
Project Description: Replacing(2)15-ton roof top units with curb adapters,economizers and return air smoke detectors.
Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH&SERVICES-ORE
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 06/11/2019 $1,861.71
Class of Work: ALT Type of Const: VB Plan Review 06/11/2019 $465.43
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 06/11/2019 $223.41
Stories: Info Process/Archiving-Lg$2.00(over 06/11/2019 $2.00
11x17)
Project Valuation: $69,942.00 Info Process/Archiving-Sm$0.50(up to 06/11/2019 $12.50
11x17)
Fuel Air Handlers
Fuel Types: Natural Gas 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: 1
Appliances
Vent Fans: Vent Systems: Total $2,565.05
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
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 cop of the rules
or direct questions to OUNC by calling/.03.232.1987 or 1.800.332. 344.
Issued By: 7,1/ �i Permittee Signature: 7/72;"�� ivi
,
,ti tS �/
i
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 Application
Received
City of Tigard J y: ( G�//� 11°. � ��h 3G S�
III13125 SW Hall Blvd.,Tigard,OR 97223 DateB
Phone: 503.718.2439 Fax: 503.598.1960 i �� _ 2019 Plan By ewC ;'1 Other Permit:
DateB C
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: kris: H See Page 2 for
Internet: www.tigard-or.gov GI 1 a" .,✓ - I G A D No"ed/Method: , f , Supplemental Information
ia '
S% �i0 IP'. r= � / to ` t s-,y yei. ! t #P 1 ,6 Ya` ami ce., '4'
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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,overhead,and profit.
Value:$$69,942.00
' A,FP)HL" W 1 ' T / I1fP ,10 ✓
„i,,/„iii r, /.. t VYo ::',‘"&'-'-
❑0
1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
-Pa ,rW gfg Heating/cooling:
Air conditioning 46.75
Job site address:12442 SW Scholls Ferry Road Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:1.S8 /00 Project name:Providence Scholls Ferry Duct work 23.32
Cross street/directions to job site: 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
Other: 23.32
Subdivision: 1 Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
f' J Gas fireplace/insert 33.39
,,, a/i /c, 3 - Flue vent for water heater or gas
replace 2 15 ton roof top units with curb adapters,economizers and return air fireplace 23.32
smoke detectors Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
4/� %: PROP Q f*.A IT f, and ventilation:
���'�� Environmental exhaust
Name: Range hood/other kitchen
equipment 33.39
Address: 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
w; i f*III.G ! /� , ,,.� = coNA,..fi, Other: 23.32
Fuel piping:
Business name:American Heating Inc.
$14.15 for first four;$4.03 for each additional
Contact name:Brad Manchester Furnace,etc.
Address:5035 SE 24th Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR.,97202 Water heater
Phone:(503)239-4600 Fax::(503)239-7038 Fireplace
Range
E-mail:brad@americanheating.net Barbecue
�� 1'
;i/ /A rl . i,, , j/ " `�� y Clothes dryer(gas)
Other:
Business name:American Heating Inc.
iti )., C,7..1( l(2 v111')*$
Address:5035 SE 24th Ave Subtotal
City/State/ZIP:Portland,OR.,97202 Minimum permit fee($90.00)
Phone:(503)239-4600 Fax:(503)239-7038 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.:33135 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: /4,4,_s---, ., * Fee methodology set by Tri-County Building Industry Service Board
Print name:Brad Manchester Date:6-3-19
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
City of Tigard
IIIa COMMUNITY DEVELOPMENT DEPARTMENT
T1cARD Building Permit Review — Commercial - No Land Use
Building Permit #: ,/h' 6--o9o(, --o ) 3‘..5-------
,
Site Address: 12'-1 U-2 STI . J l tS 1-t_.'"rrvl Suite/Bldg#:
Project Name: Prpv fCtIZACI
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Repl PY eL.GVt - ce .P 010 * bre - -{
Existing Business Activity: lJ AA
Proposed Business Activity: r\)/1A-
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ❑ Yes No
Zoning: C -P
NikPermitted Use: ❑ Yes ❑ No ❑ Spec Space
1- Confirm no land use required.
Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes: no V(v-vii. requ 11-ed . V 1 H 1 VI,* 1 -C 14,>1 -F t �t.k1 St,' iiA,U1L.
Approved by Planning: v) Date: I [ t ci
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: I3 J
Site Plans: #
Building Plans: #
Building Permit#: , tenter building permit#above.
Workflow Routing: Planning ____U—P-effnits-C—ovrcl ngtoruilding
Workflow Sign-off: ign-off for Planning(include notes from planning review)
Route Application Documents: wilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,Ar....—(..... id //;«i� Date: /‘17/y
/
I:\Building\Forms\BldgPermitRvwCOM NoLandUse 060116.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applican •
❑ SDC Fees Entered: Wash Co Trans ►ev Tax: 0 Yes 0 N/A
Tigard Tra ,- DC: ❑ Yes ❑ N/A
Parks , C: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit,`oordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse 07091 5.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2019-00365
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor