Permit CITY OF TIGARD MECHANICAL PERMIT
t COMMUNITY DEVELOPMENT Permit #: MEC2012 -00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Pacific Medical Group Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: 4 -ton RTU replacement.
Contractor: ARROW MECHANICAL Owner: TIGARD MEDICAL CENTER
10330 SW TUALATIN RD 13200 SW PACIFIC HWY
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/28/2012 $218.45
Class of Work: ALT Type of Const: Plan Review 02/28/2012 $54.61
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 02/28/2012 $26.21
Stories: Info Process /Archiving - Sm $0.50 (up to 02/28/2012 $3.50
Project Valuation: $5,360.00 11x17)
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 $302.77
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
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.
Issued By _ rmittee Signature:
_C • �9.4175_by 7:00 a.m. for the_next_available insp • n 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 OFFICE USE oil
City of Tigard Received , PermitNo.:
Date,By: 2. 1312 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503.7182439 Fax: 503.598.19 � rL�11' pate/By Other Permit
TI G A R D Inspection Line: 503.639.4175 �� , Date Ready/By. Juris: B See Page 2 for
Internet: www.tigardor.gov � �� 1 0' oti6ed/Method Supplemental Information
0 4 0 .
TYPE OF WORK ♦' \,..\C) COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
C Mechanical permit fees* are based on the value of the work
El New construction @ Addition/alteration/reent performed. Indicate the value (rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Vice $ S 340, o 0
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling Igi Cotnmercial/industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 13 2 N O 6 PA G I P i L (requires site plan showing placement) . 46.75
Y Furnace 100,000 BTU (ducts/vents) 46.75
City/StatefZlP: T 0 Alto O IQ 6 1'1223 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgfapt no.: I P r o j e c t name: P A GI c I . M E M CAI Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 2332
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 2332
Gas fireplace 3339
K EPItr t.a H TohJ bra, PALe_ - krub r c_or2,8 P w x Flue vent for water heater or gas
fireplace 23.32
Amp T- STS Log lighter (gas) 23.32
Wood/pellet stove 3339
Wood fireplacermsert 2332
•.• PROPERTY OWNER .I ❑ TENANT - - Chimney/liner /flue/vent 2332
o
Other: 23.32
Name: 1/4C. Ft L teurvit,^ I Environmental exhaust and ventilation:
Range Address: 13 20 6 4 ?Ad-rflt- vtv- y equipment ood/othalt9tchen
equipment 3339
City/State/ZIP: T18Ai2o 0it_ q 't'Z3 S Clothes
dexha athrooms, 3339
Phone: ( 503) 6 Z N •' 1 eI b 1 Fax: ( ) toilet compartments, utility rooms) 2332
•; tg ,APPLICANT _ , • . :. g • CONTACT 'PERSON Attic/aawlspace fans 2332
Other: 23.32
Business name: A K1ttybJ 'tn. I!=LtiAs.tPG/01 Fuel piping:
Contact name: 0-e F p I1t.4 IA o y $14.15 for first four, $4.03 for each additional
Furnace, etc.
Address: 1 033a 6 Tu w IATtI. . Gas heat pump
City/State/ZIP: T LATi" 012 9106 WaWsuspended/unit heater ,
Phone: ( ) Lea, t5 36 I Fax:: b3 ) &I I, 15 71 Water heater
Fireplace
��:
Range
. .. - CONTRACTOR Barbecue •
Clothes dryer (gas)
Business name: Atttov.4 IFU4Am4, M I '
O ther
Address: 10330 5 1 IATLM Ad. . MEC :; PERA l 1 T F EE S ' ,= ;' , - ,..' `' . -
City/State/ZIP: "r A I wTin/ O 176,62 mum Subtotal
L Mini permit fee ($90.00)
Phone: ( $ 0 3 ) e"l 2 - 6S6 5' I_Fax :_Wel 3.)- 6e1-1 -1$ 79 • Plan review (25% of permit fee)
CCB lic.: 61 443 State surcharge (12% of permit fee)
TOTAL PERMIT FEE r 77
Authorized signattu e . � This permit application expires if a permit is not obtalhed i 180
days after it has been accepted as complete.
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