Permit CITY OF TIGARD MECHANICAL PERMIT
.11
I COMMUNITY DEVELOPMENT Permit#: MEC2021-00537
TIC;A R Lf 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/22/2021
Parcel: 2S 113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 200
Project: Amica Mutual Insurance Company Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Interior tenant improvement for new tenant to include minor demo of existing partitions,new private offices,
conference room and training room. Re-use existing conference room,open office areas and staff break room.
Contractor: JNB MECHANICAL INC Owner: G&S FC LLC
3315 NE 112TH AVE A40-41 16083 SW UPPER BOONES FERRY RD,
VANCOUVER,WA 98684 STE 120
TIGARD, OR 97224
PHONE: 360-433-9439 PHONE:
FAX: 360-433-9439
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/21/2021 $642.35
Class of Work: ALT Type of Const: Plan Review 07/21/2021 $160.59
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 07/21/2021 $77.08
Stories: Info Process/Archiving-Lg$2.00(over 07/21/2021 $6.00
Project Valuation: $21,556.00 11x17)
Info Process/Archiving-Sm$0.50(up to 07/21/2021 $0.50
Fuel Air Handlers 11x17)
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 $886.52
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
Issued By: HollyVan,D We-e Permittee Signature: OfvAppU,catuiO-n
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.
7,A7, , -E.3
Mechanical Permit Applications�1 / FOR OFFICE USE ONLY
City of Tigard R C l -E I \/ E , Received
7_ ` V M Datc/B 7 1 /�,,� Permit No.:
v 13125 SW Hall Blvd,Tigard,OR 972 y' �"�!�� "p!/ � "f-U(� '
', t7-• Phone: 503.718.2439 Fax: 503.598.1960 Plan Review n�. Other Permit0,46774,..71��
JU L 2 0 2021 Date Rc: /!/�/7� 11
TIGARp Inspection Line: 503.639.4175 DateReadylBy: / 7aris: VQJ e
Internet: www.tigard-or.gov Notified/Methad: reisSupplemental Information
oli
Itr,
CITY OF TIGARL _
,::. z,ef;:, a ?" 4TV. E OF# 1, 13 61 ]f'f _ CIAL FEE*SCHEDULE a115ErCHECRLTStz
,�,( echanicalpermit fees*are based on the value of the work
❑New construction [{h Addition/alteration/replacement perfonned.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor overhead,find profit.
.' , .;`',sue - -y CATEGORY OF CONSTRUCTxON,"•,� ...`_ ;- Nt -e"�; i :'.- RESIl1•ENTIAI.ZQeiAPr--TJ STF11�5�i�+Es* ,
❑ 1-and 2-family dwelling RV Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder ❑OtIier: Description Qty. Ea. Total
Job site a JOB $1TE O Heating/cooling:
.,. . ..... a. ._,,..,.�Tb1F ,.�.... _.. I.00ATIOI�j .`r: ... ,:-
`� Air conditioning 46.75
address: /6,0 Q - S(-A-) CO115 .0 rr'f �,a ite°• �c� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7"-`( car (p Q 7 zZ i r'-'(" Furnace 100,000+BTU(ducts/vents) 54.91
/) i c-� Heat pump 61.06
SuitePoldg./apt.no.: ® Project name: jr� l Duct work
r.^ 77At. 23.32
Cross street/directions to job site: ,W /2 t ce R-vr Hydronic hot water system 23.32
( h�tr��, Residential boiler(radiator or
I'-'1 _ bydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
^ z --". s M ra '�' ' DESCRIPTIOp 0$�W_ORK- j - - Gas fireplacefinsert 33.39
77�� yJ y7 / / ,J, Flue vent for water heater or gas
/l e�o Cet-C- /J c. t' l y�,�1CL tV tit-,C. �bL 1 '14 CO . fireplace 23.32
/aye,of - pit
Yd Gt e t cc Z e- r (1 c't - h oo I.s Log lighter(gas) 23.32
n �e Wood/pellet stove 33.39
d/p p� / iteln.,p(,��h. sfetC'es - pie t4v v✓ii C(Ittii�(c' Wood fireplace/insert 23.32
At, , �L V " / ` "oh5tL?CSI . lobo
j Chironey/liner/flue/vent 23.32
'{,r..e ' '3j OFERTY OWN1L ��' :r:; o- t^ TENANT - 1 �+. -: Other. 2132
/ `"' " Q` `�',,::? Envh•onmental exhaust and ventilation:
Name: 6, 4 5 `-L G qQ/r//te s �,,,11/ Range hood/other kitchen
u�r�w••'rJ 'L erti equipment
Address: JS7 . tr 6l v..C Jeri .# /2 0 Clothes dryer exhaust 33.39
City/State/ZIP: / •r••f-t iu ibl/77 q.72 CVV Single-duct exhaust(bathrooms,
i"v r v^+rw[. oz. `7 toilet compartments,utility rooms) 23.32
Phone:( ) Fax ( ) Attic/crawlspace fans 23.32
.,r _- APPLII'A1Y.T. '. .,. wz.,a:: COgxCTPERSON •,42;-r,
Other: 23.32
Business name:
ON e e cG)a vt('c Art epic. Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: L t 1e C✓�fr ( Furnace,etc.
Address: 33/(' �- l/Z/(4' SU / 4 / Gas heat pump
'r q,t l?� /y�j Wall/suspended/unit heater
City/State/ZIP: Va.i c< u ye 1'"' / G<,, e 9 Y6 O off- Water heater
Phone (? ,yr (/33 9% 7 Fax ( (P23 CJ(( ? Fireplace
E-mail: C# �t r e,hb I'✓Fcm J ! cJ Mtge
r Barbecue
'i_.�,; a.. p._y.,,�VS t,uE.i„FCOACTORw - - -.�_..54 :-n _.. �.s - Clothes shyer(gas)
Business name:f)/V!J r ll ec a/Yl c t�/ �J'),(.. -' Other:
..
In / 'fyy s , Ve " :.}0ECIIdNCC TL POhOtFEES'C :: 3 .''4,
Address:33/5 ) /iZryAVC , i,,, • 14_ qt, -C// Subtotal } .:.
City/State/ZIP: 1,7,0 CO v ye 1^1 (�- Gj g 6 2'd- Plan Minimum permit fee($90.00)
r2l.rn /i2 /� tesurcview(25%ofpermitfee)
Phone:( �FJ 3-qt/67 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: /76/5O v TOTAL PERMIT FEE ( 71Q
,h This permit application expires if a permit Is not obtain ld"rlthin 180
4 j� _ days alter alias been accepted as complete.
Authorized 81 � y(7YC_. / • Fee methodology set by Tri-County Building Industry Service Board
Print name: Date: 7 /t 17./
I:1BuitdingllermitsVME App_040I 3 do, 440-1617r(IIl07/COMAVEB)