Permit CITY OF TIGARD MECHANICAL PERMIT
'' 1 a COMMUNITY DEVELOPMENT Permit#: MEC2021-00599
Date Issued: 8/24/2021
T[GARTD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY
Project: Jersey Mikes Subdivision: None Lot: None
Project Description: Replace(1)5 ton(1)6 ton,direct replacement. Replace(1)4 ton with a(1)6 ton and curb
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC CROSSROADS PROPERTIES INC
9788 SE 17TH AVE BY WYSE INVESTMENT SERVICES CO
PORTLAND, OR 97222 810 SE BELMONT ST#100
PORTLAND,OR 97214
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/23/2021 $530.59
Class of Work: ALT Type of Const: VB Plan Review 08/23/2021 $132.65
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 08/23/2021 $63.67
Stories: Info Process/Archiving-Lg$2.00(over 08/23/2021 $4.00
Project Valuation: $17,200.00 11x17)
Info Process/Archiving-Sm$0.50(up to 08/23/2021 $44.50
11x17)
Fuel Air Handlers
Fuel Types: Natural Gas 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: 2
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $775.41
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Houy vavvVezW Permittee Signature: OwA7��]- cation
r'�4
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
:...$ 212
Mechanical Permit Application FOR OFFICE USE O.NL)
City of Tigard Received U N/ z .,
✓zg. "`tr tz''" �O �G' Permit No.:
13125 SW Ha11 Blvd.,Tigard,OR 97221i I L _:J iVE Date/By: b � ,�Z�.00599
0 IIIII
Plan Review" ,sr ..�.�l
Phone: 503.718.2439 Fax: 503.598.1960 Date/Hy: -2) -Ili
Other Permit:
i I G A R D Inspection Line: 503.639.4175 '; `, 0 2021 21 Date Ready/By: I�� ' oils: ® See Page 2 for
Internet: www.tigard-or.gov Ad/Method: ""'V Supplemental Information
CITY OF TIGARD G
t IT Iq ,l u',la `��,J
TYPE OF WOttIr CO RCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction _Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ /72 Jv
CATEGORY OF CONSTRUCTION A
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling .,Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /i ,QS- 5 ✓,,i/ A C,lie /4.-f y Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: /o f-f1 j fJ' A 9 7 221 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: (A-J-E V Ml k rr 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
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
C tib /) L '-4 a , ( /OA �/,e GEC y. Flue vent for water heater or gas
c 6f �v S Ton w �.�,�,� fireplace 23.32
Rr/04 C-C 6, y iih w l f 4 C /Oh cot d <(.ir i Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
❑ PROPERTY OWNER Zr TENANT Environmental exhaust and ventilation:
Name: \re rye / /V,lei' Range hood/other kitchen
Address:// 70 3 N S i„„, pe CIle;< /Iv/y equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: /) ft/41 j 0 n 122 2 1 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
Ea APPLICANT 0 CONTACT PERSON Other: 23.32
/ Fuel piping:
Business name:
! >s 1"J yi/' //��tiG/(� f r, r 1 ( $14.15 for first four;$4.03 for each additional
Contact name: 4 O L,//f r. h- Furnace,etc.
Address: 9 7 tZ S • '7 /ti �� Gas heat pump
V Wall/suspended/unit heater
City/State/ZIP: PQ r 7/4,4 cj I 0 9 7 222 Water heater
Phone:(5b3) rf 9 301,3 Fax: :(S✓J ) 3 - 77e7 Fireplace
,.�� 2 Range
E-mail: /Q U I S n "�1 '" )f r 'Prb Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: �''4.y.,,l Y, fps , ; /G�/ 4-. Other
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: J ?b''Att 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: - _�� �/� .�r- * Fee methodology set by Tri-County Building Industry Service Board
Print name: X u v/5- 1 .t-0 Y3 Date: 2/2
I:\Building\Permits\MeC_PermitApp_040113.doc 0TT(uu/02/COM/WEB)
Niginrok
City of Tigard.
III r COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - No Land Use
TIGARD
Building Permit #: /1 t G'�,Z. /--C/( ) S 5
Site Address: ( I 10 C .(Ai PAGIf1L thak-)"( Suite/Bldg#:
Project Name: t 0 IIQ.e-S
(Name of commercial busindss occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: f2vor M Q (uLU L ,Q•4462AAPh'T "
Existing Business Activity:
Proposed Business Activity:
Verify site address/suite#exists and active in permit system.
El River Terrace Neighborhood: ❑ Yes 1Vo
��g• C v�
ermitted Use: Yes ❑ No ❑ Spec Space
Confirm no land use required.
Business Licens •
Exists: Yes ❑ No, applicant was provided a business license application
Notes:
Approved by Planning: ✓ Date: P 3 C
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
1114MS1111111111111. d
Building Permit Submittal
Original Submittal Date: O /L-/,z 1
Site Plans: #
Building Plans: # _2_
Building Permit#: �'Enter building permit#above.
Workflow Routing: ❑ Planning ❑ Permit Coordinator u ding
Workflow Sign-off: — Sign-off for Planning(include notes from planning review)
Route Application Documents: Eli -;fig: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: T a IM 64.5 hi frrc5..... o_`1 V[w £sti g fill ['S Ql/cf-d'P-- e- C --
By Permit Technician: 4- Date: /L)
I:\B uilding\Forms\BldgPernvtRvw_COM_NoLandUse_l 11819.docx
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
❑ Approve. OT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Ap. . •a t:
Revision Notice 2: Date Sent • -pplicant:
Revision Notice 3: Date t to Applicant:
D SDC Fees Entered: ash Co Trans Dev Tax: ❑ Yes El N/A
Tigard Trans SDC: ❑ Yes ❑ N '
Parks SDC: ❑ Yes ❑ N/A
❑ OK to ssue Permit
roved by Permit Coordinator: Date:
I:\Building\Forms\B1dgPermitRvw COM_NoLandUse_111819.docx