Permit CITY OF TIGARD MECHANICAL PERMIT
• a . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00680
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 1 S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68 PKWY
Project: OR Med Assn Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Adding two (2) inline duct exhaust fans
Contractor: AMERICAN HEATING INC Owner: HEALTH CARE ASSOCIATES LLC
1339 SE GIDEON ST 11740 SW 68TH PKWY
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/26/2012 $99.76
Class of Work: ALT Type of Const: Plan Review 12/26/2012 $24.94
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 12/26/2012 $11.97
Stories:
Project Valuation: $1,450.00
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 $136.67
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
S i Issued By: C Permittee Signature: a 1 /11C /CS P �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE IISEONLY . .
City of Tigard Rece/ived
DateBy: la aLel(.)- 'at Permit NcaeTC got _ o0()
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
11 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
Inspection Line: 503.639.4175
TIGARD Date Ready/By: 111,q1; i i IZI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: i 1 Se.. Supplemental Information
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Mechanical permit fees* are based on the value of the work
O New construction Er7kddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
O Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
'-, ..-.5:-.: -- - ,,- - 1 -.' .1.- 1:,.'.; 7:',!..,,•:.$:••..-•-:.;,..-,•-•:.-•.;:Y---:-:-.,=:••-•.-..;,:$' value: S /4/5
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. itisifitnim ;,..
El I- and 2-family dwelling M Commercial/industrial 0 Accessory building
For special information use checklist.
El Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. 1 Total
';'•.:::;,4'..:;:0:':-7Z-:.;:ial•-.":;•Tf:•.';004::'''§0:f110tg!0i8TI014'L#19):..,4 iEgPAII....0N•c.': . .! . ,,z .::-.-i,......:;:..&••,' Heating/cooling
Job site address: // 7"2 5j/ b e , /7,f-// Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: 7/ Q.-1:3 A C' 7, Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: OR Med 455a c. Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.:
Other: 23.32
Tax map/parcel no.: Other fuel appliances
, : -•,: :,•:', --: ;.:,:,:=;-• , :.-! ; ev,-;;:.... , •:;,- . .--, - - , - , .-.-- , .... -., !- -,.,- - .,,,,, : Water heater 23.32
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Gas fireplace 33.39
C./C/ /7 7ZVC, is // „ C/12Ca 7 Flue vent for water heater or gas
fireplace 23.32
e. (.1Y 7 -R ,-) 5
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
-,„::,.,..•,•,::.: ,.,-,:-.: Chimney/liner/flue/vent 23.32
, I.R,klg*.V.i.;440ti... s ,W, '-.4: - L '...1 . O t h er: 23.32
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
1 '4 , -s'''' , A 1-i7- ''' : '''-'-'••• • '.• IiCAPIIIekAilr244".,s;•=1",•."4..1i-Patli----;6Nikaf.,:.,itilsvoi;p:.r,7,,,_:,-„f,;,1;,- Attic/crawlspace fans 23.32
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Other: 23.32
Business name: A rrie r j, 0 r7 Heql in, Fuel piping
Contact name: ,re c,1 / r? okeS+ci- $14.15 for first four; $4.03 for each additional
Furnace, etc.
Address: / 33 ., 5E 6 i dcor 7 S - .
Gas heat pump
City/State/ZIP: FO r -I- I a ei d o f? 9 7Z o7_ Wall/suspended/unit heater
Phone: (5 o3 ) 23 1- y61 0 o Fax: : (503)23, Water heater
Fireplace
E-mail: Range
,,..,..,, t.,,•--44 - -.-4.-: ,tnr.... :,--.-...:., -, Barbecue
Clothes dryer (gas)
Business name: A rnc r 1 cm r7 I e'q — I Other:
Address: /33 q 5 67 . 1 cre 0 r-) 5 : • ' ..;:1■4edR0IbAiliitiiiii,iFift ESt.:
City/State/ZIP: /?-1L. laeld C)r c17202 Subtotal
Minimum permit fee ($90.00)
Phone: (503 ) 23.7... y& Fax: (503 )23'7 8 Plan review (25% ci.' permit fee)
CCB lic.: 3S 136 State surcharge (12% of dermit fee)
TOTAL PERMIT FEE •
This permit application expires if a permit is not obtained within 180
Authorized signature: Ize /4 C Ls -I--
i t days after it has been accepted as complete.
Print name: gr;rci nancA es it- C." . Date: * Fee methodology set by Tri-County Building Industry Service Board
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I ABuildinrAPermits \ MEC-PermitAvo.doc 10/01/09 440-461 7T (11/02/COM/WEB)