Permit • CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2015-00403
Date Issued: 06/29/2015
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Scholls Clinic Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Replacing(4)RTU's.
Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
5035 SE 24TH AVE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97202-4765 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Specifics: Description Date Amount
Type of Use COM Permit Fee 06/29/2015 $690.61
Class of Work: ALT Type of Const: VB Plan Review 06/29/2015 $172.65
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 06/29/2015 $82.87
Stories:
Info Process/Archiving-Sm$0.50(up to 06/29/2015 $10.00
11x17)
Project Valuation: $23,500 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 $956.13
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit •• ification .- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to 0 C b allin 503.232.1987 or 1.800.332.2344.
� J , LG
ssued By: K 1 Permittee Signature: �i,r��a
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Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFIR I. I ■i O\1.1
Received
City of Tigard , Date/By: - Permit No.: tm �_I •� y
• 13125 SW Hall Blvd.,Tigard,OR ' ti
Phone: 503.718.2439 Fax: 503.59 4.1 t, .1 "' Plan Ry e h / 2 ' Other Permit:Date/By:
T I GARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov A l�' Notified/Method6� ��4,-.7, �']'T�� Supplemental Information
�T►?1.
COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
TYPE OF WORK . ,, 't,tkgs."
---- e` Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alter i$t/replacement$ l(IT\ performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition El Other: "1111 1)1 mechanical materials,equipment,labor,overhead,and profit.
Value:$23,500
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. _ Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12442 SW Scholls Ferry Road Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP:Tigard OR 97223 Furnace 100,000+BTU(duets/vents) 54.91
/ Heat pump 61.06
Suite/bldg./apt.no.:roof / j Project name:Prov Scholls,F g4A414- G1 IIN,Z-__,..
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
Replace AC 4 gas pack roof top unit. disconnect/reconnect gas piping 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 ❑ TENANT Other: 23.32 _
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39 _
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32 _
Fuel piping:
Business name:American Heating Inc. $14.15 for first four;$4.03 for each additional
Contact name:Brandon Hutchinson Furnace,etc.
Address:5035 SE 24th Ave Gas heat pump
WalUsuspended/unit heater
City/State/ZIP:Portland,OR.,97202 Water heater
Phone:(503)239-4600 Fax::(503)239-7038 Fireplace
Range
E-mail:b.hutchinson@americanheating.net Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:American Heating Inc. Other:
MECHANICAL PERMIT FEES*
Address:5035 SE 24th Ave Subtotal
City/State/ZIP:Portland,OR.,97202 Minimum permit fee($90.00)
Plan review(25%of pennit fee)
Phone:(503)239-4600 Fax:(503)239-7038
State surcharge(12%of permit fee)
CCB lie.:33135 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Authorized signature: i9, l • Fee methodology set by Tri-County Building Industry Service Board
Print name:Brandon Hutchinson Date: A0�3-l_4.*
I:\Building\Permits\MEC_PennitApp_040113.doe 440-4617T(11/02/COM/1WEB)
L
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.
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