Permit CITY OF TIGARD MECHANICAL PERMIT
,� COMMUNITY DEVELOPMENT Permit#: MEC2020-00565
T t G A 1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/5/2020
Parcel: 2S103DD00850
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 10
Project: Domino's Pizza Subdivision: None Lot: None
Project Description: Install new Type 2 oven hood,exhaust fan w/curb;MUA curb mtd;2 restroom exhaust fans,balance exh and DOA
Contractor: MOE HAUS CONSTRUCTION Owner: D W SIVERS CO
7735 NE HWY 99 4730 SW MACADAM AVE#101
VANCOUVER,WA 98665 PORTLAND, OR 97239
PHONE: 360-718-5332 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/03/2020 $339.28
Class of Work: ALT Type of Const: VB Plan Review 10/03/2020 $84.82
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 10/03/2020 $40.71
Stories: 1 Info Process/Archiving-Lg$2.00(over 10/03/2020 $6.00
11x17)
Project Valuation: $9,700.00
Fuel Air Handlers
Fuel Types: Natural Gas Units< 10000 cfm: 1
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 $470.81
Hoods: Comm Incinerators: Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 10
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 0 1_1100 332.2344.
`Issued By: Permittee Signature: r
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.
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Mechanical Permit Application FOR OFFICE USE Ori-1
h g FIECEIVED Received 'h M 020 A �66,5
. 131 Of Tigard Permit No.: L-r/ (T/(f
Received
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13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi5�
Phone:503.718.2439 Fax:503.598.1960 AUG 2 4 2020 Dete/By: `'1"3.-ao - Jf� Other Permit: r� i. o�0_ 31
T I G A R 0 Inspection Line:503.639.4175 Date Ready/By: 7� luris: ❑ See Page 2 for
Internet:www.tigardor.gov CITY OF TIGARD Notified/Method: /y/y° iri /I Supplemental Information
ic"/",., 14 -.COMMERCIAL FEE*SCHEDULE—USE CHECKLIST
TYPE OF WORK Mechanical permit fees*are based on the value of the work
LJ LJ performed.Indicate the value(rounded to the nearest dollar)of all
❑New construction ❑ XAdditiot>alteration/replacement mechanical materials,equipment,labor,overhead,and profit.
Demolition Other: Value-9700
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
L i L l For special information use checklist.
0 1-and 2-family dwelling XCommercial/industri El 0 Accessory building Description Qty. Ea. Total
Multi-family Master builder Other: Heating/cooling:
JOB SITE INFORMATION AND LOCATION Air conditioning 46.75
Job site address: 13815 SW Pacific Hwy. /o Furnace 100,000 BTU(ducts vents) 46.75
Furnace 100,000+BTU(ducts vents) 54.91
City/State/ZIP:Tigard,OR Heat pump 61.06
Suite/bldg./apt.no.: Project name:Domino's Bakery Store Duct work 23.32
Hydronic hot water system 23.32
Cross street/directions to job site: Residential boiler(radiator or
Gaarde St. 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: 23.32
Subdivision: Gaarde Lot no.: Other fuel appliances:
Water heater 23.32
Tax map/parcel no.:R478806 Gas fireplace/insert 33.39
DESCRIPTION OF WORK Flue vent for water heater or gas
Install new Type 2 oven hood,Exhaust fan w/curb;MUA curb mtd;2 restroom exhaust fans fireplace 23.32
Log lighter(gas) 23.32
Balance exh and DOA Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
El El
PROPERTY OWNER TENANT Environmental exhaust and ventilation:
Range hood/other kitchen
Name:Hamilton Holdings,LLC
equipment 33.39
Address:7735 NE Hwy 99 Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
City/State/ZIP:Vancouver,WA 98663 toilet compartments,utility rooms) 23.32
Phone:- 503-805-7800 Fax:( ) Attic/crawlspace fans 23.32
Other: 23.32
APPLICANT X CONTACT PERSON Fuel piping:
Business name: Design Associates S14.15 for first four;S4.03 for each additional
Furnace,etc.
Contact name:John Gilmore Gas heat pump
Address: 15016 NE 27'h St Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98684 Water heater
Fireplace
Phone:( 360-606-4462 Fax: :( ) Range
Barbecue
E-mail:Gilmore.da@gmail.com Clothes dryer(gas)
CONTRACTOR Other:
Business name:MoeHaus Construction MECHANICAL PERMIT FEES*
Subtotal
Address: 7735 NE Hwy 99 Minimum permit fee($90.00)
City/State/ZIP: Vancouver,WA 98663 Plan review(25%of permit fee)
Phone:( 503-805-7800 Fax:( ) State surcharge(12%of permit fee)
,hu TOTAL PERMIT FEE
CCB lie.: e*J- I7c� ..-�
. , This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:" A_- *Fee methodology set by Tri-County Building Industry Service Board
Print name: ici/ej/ , Date: y .1b4
I'Hailrlina'il+*rmasSMEC VermilAep 040113.doc i440--461 (11/02) OOMM/WEB)
City of Tigard
11111 • COMMUNITY DEVELOPMENT DEPARTMENT
TiGARD Building Permit Review — Commercial - No Land Use
.81.E
Building Permit #: AG .OZp-005(o,$
Site Address: 13815 SW Pacific Hwy Suite/Bldg#: 10
Project Name: Domino's Pizza
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Mechanical work
Existing Business Activity: Fast food eating & drinking establishment
Proposed Business Activity: Fast food eating & drinking establishment
❑o Verify site address/suite#exists and active in permit s'sstem.
❑ River Terrace Neighborhood: 0 Yes L"I No
❑r Zoning: C-G U
CIPermitted Use: L`i Yes No U Spec Space
❑ Confirm no land use required.
QBusiness License: N/A
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Notes:
Approved by Planning: _i .��. Date: 8/25/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: Q8 29-Zd2a
Site Plans: # 2-
Building Plans: # 2-
Building Permit#: Lrr l nter buildingermit# above. y
Workflow Routing: Planning Permit Coordinator R Building
Workflow Sign-off: `nTSign-off for Planning(include notes from planning review)
Route Application Documents: L�Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: as 2,7ZOZv
I:1Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: , Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to . .plicant
Revision Notice 2: Date Se. o Applicant:
Revision Notice 3: Da < ent to Applicant:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
L 1Bui Id ing1F orms1B1dgPermitRvw_COM_N oLand U se_111819.docx