Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2O20-00662
13125 SW Hall Blvd.,Ti Date Issued: 10/29/2020
and OR 97223 503.718.2439 TfC�AI'. t. 9
Parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: Moda Health Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&i
Project Description: Provide split system AC unit to/and associated duct work to support clean room installation.Clean room is by
others.
Contractor: MACDONALD MILLER FACILITY SOLUTIONS Owner: PACIFIC REALTY ASSOCIATES
12911 NE AIRPORT WAY ATTN: N PIVEN
PORTLAND,OR 97230 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 971-244-0901 PHONE:
FAX: 971-244-0902
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/29/2020 $1,687.41
Class of Work: ALT Type of Const: VB Plan Review 10/29/2020 $421.85
Occupancy Grp: F-1 Occupancy Load: 12%State Surcharge-Mechanical 10/29/2020 $202.49
Stories: 1 Info Process/Archiving-Lg$2.00(over 10/29/2020 $16.00
11x17)
Project Valuation: $63,000.00 Info Process/Archiving-Sm$0.50(up to 10/29/2020 $17.50
11x17)
Fuel Air Handlers
Fuel Types: Electricity Units<10000 cfm: 2
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: 3 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 2 Vent Systems: Total $2,345.25
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 100
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: k.Nro\ 14,janc-'C�,< Permittee Signature: o, o�I,Cq 4O�
�1 Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
—:- to/I f2..o— es'
Mechanical Permit Applica yFc� FOR OFFICE USE ONLY
of Tigard
a.IC Received
City g Permit No.:
Date/By: /0 Z- 0• MC�ZbZt'�-tb�o(oZ
13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
Pri
Phone: 503.718.2439 OCT 01 2020 pate By: ' _ - * 'i Other Permit.
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ® See Page2for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method/a �b Su lementallnformation
nl III (1!r,!C nlliln[n‘t U �q 7�D ���y ei
PP
I ,,,r-:1 'eq
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
0 New construction , dditionialteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,p overhead,and profit.F?
CATEGORY OF CONSTRUCTION Value:$ 3 U o 0, 00
El1-and 2-family dwelling , m ID Accessory building RESIDENTIAL EQUIPMENT I SYSTEMS
Far special information use checklist.
❑Multi-family 0 Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: C t/Z l 0 6 � .--/ �,k ., Air conditioning D 46.75
1--/
Furnace 100,000 BTU(ducts/vents) 46.75
f
City/State/ZIP: ( a4 1 6� q a-??y
/ ,t Furnace I OQ000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: //4/I,1) cik Heat pump ., 61.06
n J�' Duct work 23.32
Cross street/directions to job site: d41 ) 5t j
V t� 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
Other fuel appliances:
Tax map/parcel no.:
Water heater 23.32
_ DESCRIPTION OF WORK Gas fireplace/insert 33.39
'Pal
'/ // ( 1]� , I_ I / / �. ,` Flue vent for water heater or gas
1 1 l/ lk / �Y � Cl �ll l e/4 I L' AL'L vi / v fireplace 23.32
U SX 1 L ( jd 1 tL -' 177Log lighter(gas) 23.32
/ /� 0`�1,r, Wood/pellet stove 33.39
�,�kl /'�,_1.� (�` /, ' `j��f ,��1/���JG`J�" - vv/ ' Wood fireplace/insert 23.32
r�7�' 6 U i,. 1 fll/9 C` [ t''u//';-) i Chimney/liner/flue/vent 23.32
El-PROPERTY OWNER -TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 4 G v Range hood/other kitchen
Address: /61.........00 (I� .7g,� � equipment 33.39
/9 /, / d) ^ q 7 g�, ` Clothes dryer exhaust 33.39
City/State/ZIP: Ut (/!/L y Single-duct exhaust(bathrooms,
Phone:( ) Fax: ( )
toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
APPLICANT EONTACT PERSON Other: 23.32
Business name: J/V 1 i490 oa `!, 1-," Fuel piping:
Contact name: Ie`G� �t 7 wf/� $14.15 for first four;$4.03 for each additional
^V / �V t
cp� /L;4GasFur heat ptc.Address: ,a1FiIJ Gas heat pump
City/State/ZIP: UV '-/Af/l, U 4 r— Wall/suspended/unit heater
/� Z Water heater
Phone:(103 p 4 2 _,9113 Fax::( ) `! '7/_ vl(r!_ v 7d W Fireplace
E-mail: 1
� �/��Lj� ��I� 7--l/t/1 6) i?-Il26iG 1 t•l h7/ Range
Barbecue
CONTRACTOR
Clothes dryer(gas)
Business name: U v lv 1� ///—Ill 1,�; Other:
Address: 1 "A„,v1 Fir� [� 11 MECHANICAL PERMIT FEES*
v1 Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:(JCS) ,9-6€9__ „Sly Fax:(9-9i ?y_ 0 1U a Plan review(25%of permit fee)c? State surcharge(12%of permit fee)
CCB lie.: j� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
•
Authorized signature: days after it has been accepted as complete.
Print name:JOS'5
* Fee methodology set by Tri-County Building Industry Service Board
// jo t—(� Date: // pj/�
1:1BuildingTertnits\MEC Pemri 2520.. 440-4617T(11/02/COM/WEB)
City of Tigard
ligCOMMUNITY DEVELOPMENT DEPARTMENT
I
T►c nz D Building Permit Review — Commercial - No Land Use
Building Permit #: MG20ZO -OQ (Q6,2
Site Address: l ti(CID MPI 17. Suite/Bldg#:
Project Name: 1J10,61§1,
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: K-Q)t 'ID(7 1Al eO,wt(Caa.
Existing Business Activity: t1.1/tc..Proposed Business Activity: .
Ve
rify site address/suite# exists `and active in permit system.
'X River Terrace Neighborhood: ❑ Yes 0 No
5 Zoning: l—L
T Permitted Use: ❑ Yes 0 No ❑ Spec Space
Confirm no land use required.
.Business License:
Exists: 0 Yes 0 No,applicant was provided a business license application
Notes: SGYC.Zh(O( :;t,l p tyA -
Approved by Planning: } n Z—`. Date: t O(5(Zp
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: /Q/c7�2o2O
Site Plans: #
Building Plans: # .2—
Building Permit#: g"-Enter building permit#above.
Workflow Routing: al--Planning 0 Permit Coordinator NI-Building
Workflow Sign-off: [YSign-off for Planning(include notes from planning review)
Route Application Documents: l uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 7�j�
2O
By Permit Technician: Date: /0//fir
I:\Buildin gTornulBldgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
D Conditions"Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes: LEIV
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Appli .• t:
Revision Notice 2: Date Sent to A.. 'cant:
Revision Notice 3: Date Sent . Applicant:
❑ SDC Fees Entered: Was. o Trans Dev Tax: ❑ Yes ❑ N/A
d Trans SDC: ❑ Yes 0 N/A
Parks SDC: 0 Yes 0 N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:\Building\Forms\B IdgPennitRvw_COM_NoLandUse_111819.docx