Permit ` �, ! CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT . Permit #: MEC2009 -00574
air a ti - t� Date Issued: 10/30/2009
TiGAt.D, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
ilrar, }, ,, Parcel: 2S101DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: HealthNet
Project Description: Add 6 supply ducts and relocate existing grills.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
PO BOX 2096 Permit Fee 10/30/2009 $226.88
WARREN, MI 48090 12% State Surcharge - Mechanical 10/30/2009 $27.23
PHONE
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE : 503 - 239 -4600
FAX 503 - 239 -7038
Type of Use:
Class of Work: 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 $254.11
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
UtilityNotifcat nter. Those rules are set forth in OAR 952 001 - 0010 through OAR 952 - 001 - 0100. You may obtain a copy of the rules
or dire questions to 0 C by calling 503.246.6699 or 1.800.332.2344. `
Issue By: Permittee Signature: Ra c 1 /44.+ c ht S ‘...
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 FOR OFFICE USE ONLY
Cl of Ti and Rece B �� Permit No.: Q
`J g Date/By: i Q i/
• 13125 SW Hall Blvd., Tigard, OR 97223 Man Review
� C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
/ �' Q S7
Date/By:
T I G A R D Inspection Line: 503.639 Date Ready/By: lur' 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 7/6, Supplemental Information
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction . Klddition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ S &� /
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling , ommercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty.
Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 5 -t h Gr 1\10i)1 Air conditioning or heat pump
/ f �f P (requires site plan showing placement) 14.00
City /State /ZIP: T pt i r cj Q R /7223 Furnace 100,000 BTU (ducts /vents) 14.00
J H H 1 -� h Ne t Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project nam
Gas heat pump 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
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
. DESCRIPTION OF WORK Water heater 10.00
/ ) Gas fireplace 10.00
(C/.!1 & 5 U p p/ 1 d (> c,-/ 5 Flue vent for water heater or gas
rc /oc 4 -/ e £ e x 15-f 1. rt / / 5 fireplace 10.00
9 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
• ' ❑ PROPERTY OWNER ‘ ' ❑ TENANT Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT - ❑ CONTACT PERSON _ Attic /crawlspace fans 10.00
Other: 10.00
Business name: Am er' /C a/1 / l e4 Il n rj T r, C Fuel piping
g in
V
Contact name: D4 /t / .1 gM/11 el - + $5.40 for first four; 51.00 for each additional
Address: /33 9 5 6') J e Un S t Furnace, etc.
Gas heat pump
City/State /ZIP: J'Or--/- 1 an tJ OR 77202 Wall /suspended/unit heater
Phone: (503 239- yQo Fax: : (5o! )239-703 Water h
8j reer heater e
E -mail: Range
CONTRACTOR ' . . Barbecue
Business name: Am er/ C4,1 H 1 ;2 Clothes dryer (gas) ,
Other
/33 /,, 9 55 w / `// l ebb 5 .' MECHANICAL PERMIT FEES* .
City /State /ZIP: Mr/14 d Q/ 'T72 0 2 Subtotal
( Phone: ) 2.3q- y/ F (5o3) 231_ 3 g Minimum permit fee ($72.50) a( - , 88
Phone:
Plan review (25% of permit fee) -r-,^
CCB lic.: 33 / 3 . 5 State surcharge (12% of permit fee) %3
TOTAL PERMIT FEE as 1/
Authorized si ature: 7/4i,--7 G This p ermit application expires if a permit is not obtained within 180
J � days after it has been accepted as complete.
Print name: 7:3 7/4 ,4 65 -I' e .,-. Date: /0 -2(7-047 * Fee methodology set by Tri -County Building Industry Service Board
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