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Permit k1 " CITY OF TIGARD MECHANICAL PERMIT a COMMUNITY DEVELOPMENT Permit #: MEC2009 -00612 T [ G.ARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/17/2009 ,.„ Parcel: 2S110AA00300 Jurisdiction: Tigard Site address: 14145 SW 105TH AVE Subdivision: Lot: 0 Project: Pacific Health & Rehabilitation Center Project Description: Push /Pull gas furnace. (Not a RTU - No plan review required per Mark V) Owner: FEES TIGARD INVESTMENT GROUP LLC Description Date Amount BY EYRING REALTY INC, 1777 N CALIFORNIA Permit Fee 11/17/2009 $167.30 BLVD #300 12% State Surcharge - Mechanical 11/17/2009 $20.08 PHONE: Contractor: HEINZ MECHANICAL INC 2615 NW ST HELENS RD PORTLAND, OR 97210 PHONE: 503 - 220 -0855 FAX: 503 - 220 -0260 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Occupancy Load: Stories: Fuel Air Handlers Fuel Types: Natural Gas 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 $187.38 Hoods: Comm Incinerators: Required Items and Reports (Conditions) Woodstoves: Gas Fireplaces: 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 issuanc- : • • ' uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon tit • Notification Center. • - - es are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 •u may obtain a copy of the rules direct questions to OU s calli ;. .246.6699 or 1.800.332.2344. Issued By: ' k Permittee Si nature: :fihi �(-11—••■—___, Call 503.639.4175 by 7:00 a.m. for an inspection that busines 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 or• Elul': I. SF, S )N1 1. g RECEIVE P Q ecivcd 111 Ci of Tigard .ateBy: Permit No. 2 0(�� • �,��o 12 _ 4 13125 SW Hall Blvd., Tigard• OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 NOV 16 2009 Date/By: Other Permit: T I i i A R fJ Inspection Linc: 503.639,4175 Dace Ready/13y: Joie: la See Page 2 for Internet; vvww,tigard Or,QOV CITY OF TIIG 1 N Notificd/Method: Snpptementnl Infnrrnotien 1 1 j �' it () + 1 j 4 ' 1 +i1 Y1 tu 'Ar`�+ JI �:. i; r 9 A��,,©©+ q li f f 9. N, .� i r,!. , �t ,ii 1 i { , , ..��i�!�,iG;yf r, , y(Ii 1. i, ,. + r, l' ,,r"1 1I ,(, i � ,, > U,,B, ?{;∎,'i ■ ,,. r r],,1'n) o , i,' ,'', , A r ,,,,, /0 {c r '� ` ` , if� 4, ru ,.,u 4,Vi .PjLr ` , y> ` i , Mechanical permit fees* are based on the value of the work ❑ New construction /- Addition /alteration . plaeemen performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead. and profit, r r 1 r �) 1 I '1 1 r„ ' r ,,, r . ` , . 1 1 Bf u r � .I�� ��(1'r li'�'t1 y { i i ; 11 i „ 11 V a l ue: $ • • t-n i ,,,, i { { li I j� i1 1'if idol ' li#li ietftliii rlifig IS { " Y, { '� 1 'i 1 �J'':,;!:� I,lf'TIl {, � 1,''1 I r .,( rGi'P {, ._. � ,,., I- and 2-family dwelling ' �,d ❑ y g Commercial /industrial ❑Accessory building For special information use cheekilsr, ❑ Muht family 0 Master builder ❑ Other ' 1 � 4 C r1 t i c ( 1 r { Description I Qty. 1 Ea J Total Cr+ l ,lf l l h {lr Otil �`i tits /� � Y� t011 lick iN:W ''�ibC1l�.` 1iii 1� "" `lil. rl; 1 'I 1 I: r „ lu,� 1 �� .q , r -u -. -.r' ft .;'r ` ..i 11eaNn�C00lining y I p -� Air condition Job site address: i L� t V (requires site plan showing placement) 1 46.75 City/State /Z1P: yi cict, . 9L -? 27 j-•i Furnace 100,000 BTU (ducts/vents) j 46,75 Suite/bldg. /apt. no.: Project name: � (i i , Teat pump 100,000+ BTU (dt'�+s /vente 1 61.06 1 �' i seat um Cros9 strcctIdircctiona to job site: Duct work 23.32 1•lydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), v' 61° / L) Lot no.: in-wall, in -duct suspended, etc. 46.75 Flue /vent for any of above 23.32 S u Sign: Other 23.32 Tax map /parcel no.: I1 p 11, y�� y,yy �y Other fuel appliances Ill llil��(il��l�1111 {tl,lJ�X � ) a v .r,)'; { � ^1 :r�La�llJI1 �41Cr1hW j�.�' 4 .dr r i r l '! 'r :� : ,; Water heater Gas fi .lace 23.32 33.39 Flue vent for water heater or gas 19 � f I _ y . U l J - fireplace 23.32 ` f ► �/�/ Log lighter (gas) 23.32 Wood/pellet stove 33.39 T Wood fireplace /insert 23.32 d ..�yyyy, µ �p ; � p r r 1 s r ��y,�,�. ' Chimney /liner /fluc /vent 23,32 I1 iI L �I' 1 1 1 efi f e# . 0.>r�K, ty, ` Ri r , „i.�, '' 4i�t 1�1 ,40:,,, : i1; rt�ss, {. Other: 23.32 Name: : G g *4 ! i P ` Cu i dui - I21 Environmental exhaust and ventilation IMIIIIIIIIIIIEMI Address: Range hood /other kitchen equipment 33.39 City/State /ZTP: / - )7 Lam' `' 4 De J 7 Clothcs dryer exhaust 33.39 I ' [, 1 ! `T `'C Fax ($ a ) toilet compartments. (util roo ms) 23.32 , Phone: ('�� � utility rooms) II''!lu 7lli'11ki7s ' ., ; ,r: , , h'1:..,.. i `' 1 Attic/cra lspaccfans 23.32 ''i1►11` Jwt)�4'w1C .r4�,, C3 It511�`MCAr�i •li16N i , , +i `ry Other: 23.32 Business name; wow. 4 �� _ I Fuel piping Contact name: S14.15 for first four; 54.03 for each additional �1 i .1 L io�a _IL, Address: b IS N N s4 . 1-- v �.�u Gas hea s r' • . etc. 4 as heat pump City /State/ZIP: - Lc l - 7D4 U Wall /suspended /unit heater Phone: alft i - Fax: ; ( 2 -bite D Water heater - p /; '' 1,� �q I / r, Fireplace E -mail: i' Liwr ti i to i y z -- t f L ccV l L.�:� v ). Range ii 11 i�il Iii 1 1Mf tl 1 ° �{ >i ',' , i'!. lnl„ 1 { r1 -''�{, jl l+ Barbecue 1 rli f(;i' 1 ''���2P f <.; � ,,,;.�. �'C�.te4�`C�R i,r 1 , � lr,ir . 1 Business name; ' Ciothcs dryer ( ,eac) l.L C Other: 1 Address: r •r11 i„ IIS i{ 11 1i11� r'' �� r 1� 11 i 1 1 I , P 1. S W G� �, h 0±! 1 f '' +4 I, i ,ij i <',�;I'( 1 1 i,, Cit /StateIZIP: rt,y-i a - i Subtotal Fax: (i1 ) Minimum permit fee (590.00) Phone: ) S - QbS 2-? 0 0 Plan review (25% of permit fee) CCB lie.: sb b 6, Stale surcharge (12% of permit fee) p.0 , /;r TOTAL PERMIT FEE i SO . f � /� ,(/ This permit ap-plicntioe expires if a permit Is not obtained within : Authorized signature: �� , w J (�V'- days after it has been accrptcd ax complete. " ' • • Fee methodolo�v set by Tn- County Building industry Service B n Print name: " [ p ate: t MI $ •3g I Bull' lfnglPermital;NEC•PcrmitAnpdot 10/01/M 4 40• 4 6I71 (11 /OZ/C'OMM'ER)