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Permit a I. CITY OF TIGARD : - MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2013 -00171 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/28/2013 TIGARD Parcel: 2S113BA00400 Jurisdiction: Tigard Site address: 7632 SW DURHAM RD 105 Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: 4/4/13, reprinted to correct project description to: Modification of ducts and grilles for TI. 6/24/2013: REPRINTED to correct suite address. Contractor: OREGON HEATING & AIR CONDITIONING Owner: PORTLAND SW CENTER LLC 19300 SW 118TH AVE BY FELTON PROPERTIES INC TUALATIN, OR 97062 ATTN: FELTON, MATT 520 SW 6TH AVE, STE 610 PORTLAND, OR 97204 PHONE: 503 - 691 -9699 PHONE: FAX: 503 -691 -8556 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 03/28/2013 $235.31 Class of Work: ALT Type of Const: Plan Review 03/28/2013 $58.83 Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 03/28/2013 $28.24 Stories: Info Process /Archiving - Sm $0.50 (up to 03/28/2013 $1.00 11x17) Project Valuation: $6,000.00 Fuel Air Handlers Fuel Types: Units < 10000 cfm: Gas Pressure: Units > 10000 cfm: Furnaces Boilers & Compressors Fumaces < 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 $323.38 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 a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: Permlttee Signature: 40,77 611.--,,./0 G /e' -77 , "LJ 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. p CITY OF TIGARD l MECHANICAL PERMIT 1111 COMMUNITY DEVELOPMENT © Permit #: MEC2013 00171 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 ® D ate Issued: 03/28/2013 Parcel: 2S 113BA00400 Jurisdiction: Tigard Site address: 7632 SW DURHAM RD 100 Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: 4/4/13, reprinted to correct project description to: Modification of ducts and grilles for TI. Contractor: OREGON HEATING & AIR CONDITIONING Owner: PORTLAND SW CENTER LLC 19300 SW 118TH AVE BY FELTON PROPERTIES INC TUALATIN, OR 97062 ATTN: FELTON, MATT 520 SW 6TH AVE, STE 610 PORTLAND, OR 97204 PHONE: 503 - 691 -9699 PHONE: FAX: 503 - 691 -8556 FEES Specifics:, Description Date Amount Type of Use: COM Permit Fee 03/28/2013 $235.31 Class of Work: ALT Type of Const: Plan Review 03/28/2013 $58.83 Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 03/28/2013 $28.24 Stories: Info Process /Archiving - Sm $0.50 (up to 03/28/2013 $1.00 11x17) Project Valuation: $6,000.00 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 $323.38 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 N• ' a ion - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or di -ct questions to OUN •y cal ' g 503.232.1987 or 1.800.332.2344. sued By: / ,�� /� , / Permitte- Signature: � , 7 / ice. / �' Call 503.639.4175 by 7:00 a.m. for the next available inspec on 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. CITY OF TIGARD MECHANICAL PERMIT ai Permit MEC2013 00171 COMMUNITY DEVELOPMENT Ti G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/28/2013 Parcel: 2S 113BA00400 Jurisdiction: Tigard Site address: 7632 SW DURHAM RD 100 Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: Remove walls, new walls, doors, relites, cabinetry and plumbing for TI Contractor: OREGON HEATING & AIR CONDITIONING Owner: PORTLAND SW CENTER LLC 19300 SW 118TH AVE BY FELTON PROPERTIES INC TUALATIN, OR 97062 ATTN: FELTON, MATT 520 SW 6TH AVE, STE 610 PORTLAND, OR 97204 PHONE: 503 - 691 -9699 PHONE: FAX: 503 - 691 -8556 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 03/28/2013 $235.31 Class of Work: ALT Type of Const: Plan Review 03/28/2013 $58.83 Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 03/28/2013 $28.24 Stories: Info Process /Archiving - Sm $0.50 (up to 03/28/2013 $1.00 11x17) Project Valuation: $6,000.00 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 $323.38 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 rul adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may bta' a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ../ Cg � Permittee Signature: ( 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 RECEIVE Received FOR OFFICE USE ONLY City of Tigard Date/By: -3 Ze v%i■ ''°.• EC. 0/3-00/7A II I II ° 13125 SW Hall Blvd., Tigard,OR 97223 MAR 28 2013 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 t �q DateBy: Other Permi �Po�0/� ^ / f/ T I G A R D Inspection Line: 503.639 CITY OF TIG Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISIO " Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 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: $ t6 CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1 - and 2-family dwelling CommerciaUindustrial [J Accessory building For spec! a! 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: 9 Sw P /h (requires site plan showing placement) 46.75 YY Furnace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: A ro L9! Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. 0 Pr name: t/y�,n/�,v il ospar ��4 Heat pump ° °�C "``���' r'f U (requ 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) 23.32 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 23.32 t �i � Gas fireplace/insert 33.39 / 9 / J � ����"'L�-� Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( j Fax: ( ) toilet compartments, utility rooms) 23.32 APPLICANT X] CONTACT PERSON Attic /crawlspace fans 23.32 Business name: 01-//12 . �1 Other: 23.32 Fuel piping: Contact name: t�� j 2,1 L. Y $14.15 for first four; $4.03 for each additional Address: �� / Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater rif y Cj& ( ) Water heater Phone: vJ 75 � A / (/ Fax ,+9 �� � Fireplace E -mail: /NTt' t _ & G/ re fiteei )Lt L� a l/ v1 Range � CONTACTOR J Barbecue Business name: OA/Az-- Clothes dryer (gas) /1"0„,..-t"._ �/ Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: /) _ / � � 7/i 5- Subtotal f03 /�� 76 7 Fax: ( ) Minimum permit fee ($90.00) Phone: (p3) / Plan review (25% of permit fee) CCB lic.: / 72-' Z-� State surcharge (12% of permit fee) TOTAL PERMIT FEE 3, signature: This permit application expires if a permit is not obtained within 180 Authorized St r f J days after it has been accepted as complete. Print name: C_ - L._ (....4.-->r 1.4 ) t_-L t- I Date: Y /2j / 13 • Fee methodology set by Tri -County Building Industry Service Board 1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 440 -4617T (f 1 / /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee:. $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. • $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • 1:\ Building \Pennits\MEC- PermitApp.doc 03/07/12 2