Permit CITY OF TIGARD MECHANICAL PERMIT
1111 a - COMMUNITY DEVELOPMENT Permit#: MEC2014-00652
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/26/2014
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE
Project: Kassay Clinic Subdivision: WEST PORTLAND HEIGHTS Lot: 34
Project Description: Modification of ducts and installation of new exhaust fan
Contractor: ARJAE SHEET METAL CO, INC. Owner: BEVELAND BUILDING LLC
8545 SE MCLOUGHLIN BLVD. 12511 SW 68TH AVE
PORTLAND, OR 97222 PORTLAND, OR 97223
PHONE: 503-231-7717 PHONE:
FAX: 503-230-4888
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/26/2014 $291.51
Class of Work: ALT Type of Const: Plan Review 11/26/2014 $72.88
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/26/2014 $34.98
Stories:
Project Valuation: $8,000.00
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 $399.37
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
Utilit Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o irect questions to UNC b calling 503.232.1987 or 1.800.332.2344.
Is ued By: b .00e/ / 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 FOR OFFICE USE ONLY
1711,, City of Tigard Recei��,By,ved fe Permit No.: - �-/10 -ice 6
13125 SW Hall Blvd.,Tigard,OR 9722ECEIVED Plan Review jI
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov
N O V 2 6 201 A T Notified/Method: �j Supplemental Information
IV V (U COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical pennit fees*are based on the value of the work
❑New construction ®Addition/altISION performed. Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S$8,000.00
CATEGORY OF CONSTRUCTION Jet QUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
Air conditioning 46.75
Job site address: 12511 SW 68TH AVE Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP:TIGARD,OREGON 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:DR.KASSAY Duct work 23.32
Cross street/directions to job site: 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
Other: _
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert _ 33.39
Flue vent for water heater or gas
REDISTRIBUTION OF AIR/NEW EXHAUST FAN fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert , 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ® TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:DR KASSAY Range hood/other kitchen
equipment 33.39
Address:SAME AS ABOVE Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) fax:( 1 Attic/crawispace fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32
Business name:ARJAE SHEET METAL CO Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:HEATH BURMEISTER Furnace,etc.
Address:8545 SE McLOUGHLIN BLVD Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:MILWAUKIE.OREGON 97222 Water heater
Phone:(503)231.7717 Fax::(503)230.4888 Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:SAME AS ABOVE Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum pennit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.:60835 TOTAL PERMIT FEE
'Phis permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building industry Service Board
Print name:CHRIS OMPSON I Date: 11.26.14 I
Ir.Building,Permits.MEC_PermitApp_040113.doc 440-46)7r(1102,COMIWEB)
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.
I:\Building\Pennits\MEC_PermitApp_040I I 3.doc 2