Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
' n COMMUNITY DEVELOPMENT ++ � Permit#: MEC2022-00387
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I Date Issued: 5/20/2022
":"' Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Project: ACE American Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Adding and relocating grills to accommodate new office layout.
Contractor: WILLAMETTE HVAC LLC Owner: PACIFIC REALTY ASSOCIATES L P
3075 SE CENTURY BLVD STE 206 ATTN: NI PIVEN
HILLSBORO, OR 97123 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/18/2022 $291.51
Class of Work: ALT Type of Const: Plan Review 05/18/2022 $72.88
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 05/18/2022 $34.98
Stories: Info Process/Archiving-Lg$2.00(over 05/18/2022 $2.00
Project Valuation: $8,000.00 11x17)
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 $401.37
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Grills
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: • ' Permittee Signature: X� 4 G
Call 50 .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. 1
Approved plans are required on the Job site at the time of each Inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard F� I /E�' Received
23_ V Er) Date/By: �� . ,.
i • 13125 SW Hall Blvd.,Tigard,OR 9 �' �
;I 0 Plan Review
11 Phone: 503.718.2439 Fax: 503.598.19b(IA� 1 Date/By Other Permit:
n Inspection Line: 503.639.4175 M 8 322 Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARL
TYPE OF(t RI{G fVN()'NCOMMERCIAL 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:$$8,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 12909 SW 68th PKWY (requires site plan showing placement) 46.75
City/State/ZIP:Tigard OR Furnace 100,000 BTU(ducts/vents) 46.75
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.:450 Project name:Ace American Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Add or relocate supply,return,and OSA grilles or registers to accommodate the Gas fireplace/insert 33.39
Flue vent for water heater or gas
new office layout fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone:( ) Fax:( ) Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name:same as below Other: 23.32
Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: WalUsuspended/unit heater
Phone:( ) Fax::( ) Water heater
Fireplace
E-mail:mmalstrom@willamettehvac.com Range
CONTRACTOR Barbecue
Business name:Willamette HVAC,LLC Clothes dryer(gas) _
Other:
Address:3075 SE Century Blvd Suite 206 MECHANICAL PERMIT FEES*
City/State/ZIP:Hillsboro,OR 97123 Subtotal
Phone:(503)259.3200 Fax:(503)848.2597 Minimum permit fee($90.00)
Plan review(25%of permit fee)
CCB lie.:56951 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
'y, t' i-,M . This permit application expires if a permit is not obtained within 180
Authorized signature: 1fLAL. win+Mn days after it has been accepted as complete.
Print name:michael malstrom Date:5/12/2022 * Fee methodology set by Tri-County Building Industry Service Board
I:,Building\PermitaJtiEC-PemitApp.doo 03/07/12 4404617T(nrovCOM/WEB)