Permit CITY OF TIGARD MECHANICAL PERMIT
: ' COMMUNITY DEVELOPMENT Permit#: MEC2022-00822
Date Issued: 10/12/2022
T[G A R L5 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 210
Project: Peck Rubanoff&Hatfield, PC Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: (1)suspended water source heat pump and ductwork modification.
Contractor: EXCEL HVAC INC Owner: PACIFIC REALTY ASSOCIATES L P
PO BOX 1188 ATTN: N PIVEN
CANBY,OR 97013 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 971-930-7194 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/10/2022 $436.61
Class of Work: ALT Type of Const: Plan Review 10/10/2022 $109.15
12%State Surcharge-Mechanical 10/10/2022 $52.39
Occupancy Grp: Occupancy Load:
Stories: Info Process/Archiving-Lg$2.00(over 10/10/2022 $2.00
11x17)
Project Valuation: $13,500.00 Info Process/Archiving-Sm$0.50(up to 10/10/2022 $12.50
11x17)
Fuel Air Handlers
Fuel Types: Electricity 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: 1
Appliances
Vent Fans: Vent Systems: Total $612.65
Hoods: Comm Incinerators: Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: `ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspeCti date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE()NIA
Received r�,
City of Tigard '• Date/By: 'j permit No.: a� hF-�F
�'1 13125 SW Hall Blvd.,Tigard,OR 97223 lk' ._- Plan Review �/ M (� v
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: .1S-41��-} Other Permit:libipl1n4)_ e,ot.is,
TIGARD Inspection Line: 503.639.4175 r,.h I 7 2U22 Date Ready/By: // ) tans. See Page 2 for
Internet: www.tigard-or.gov ) Notifi Method/ />/ Supplemental Information
, �tt+' ii CO RCIAL FEE* SCHEDULE — USE CHECKLIST
t
TYPE OF WORK�r .,
n r11\l) lC1lV Mechanical permit fees*are based on the value of the work
D New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ $13,500.00
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 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:12909 SW 68th Pkwy Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard /OR/97224 Furnace 100,000+BTU(duets/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:#210 I Project name: Peck Rubanoff& Hatfield Duct work 23.32
Cross street/directions to job site: SW Hampton St.and SW 68th Pkwy. 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
Other: 23.32
Subdivision: I Lot no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Install (1) Water Source Heatpump, re-distribute ductwork fireplace 23.32
Log lighter(gas) 23.32
IrQ t) A //Writ? '-p°`C'4-' Wood/pelletstove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name:PHctruSt Range hood/other kitchen
— equipment 33.39
Address:15350 SW Sequoia Pkwy. Suite#300 Clothes dryer exhaust 33.39
City/State/ZIP:Portland /OR/ 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( )503 624-6300 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Excel HVAC, Inc.
$14.15 for first four;$4.03 for each additional
Contact name:Zachary Barber Furnace,etc.
Gas heat pump
Address:15832 SW Upper Boones Ferry Rd. Wall/suspended/unit heater
City/State/ZIP:Lake Oswego /OR/97035 Water heater
Phone:( )503 550-6042 Fax:: ( ) Fireplace
Range
E-mail:zach@excelhvac.net Barbecue •
•
CONTRACTOR Clothes dryer(gas)
Business name:Excel HVAC, Inc. Other:
MECHANICAL PERMIT FEES*
Address:15832 SW Upper Boones Ferry Rd. Subtotal '
City/State/ZIP:Lake Oswego/OR/97035 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( )971 801-3018 Fax:( )
State surcharge(12%of permit fee)
CCB lie.:214345 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: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Zachary Barber Date:08/16/2022
1:\Building'Permils1ME(:_PmnilApp_040113.doc 440-4617f(I 1/02/COMN✓CB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Permits\MEC_PermitApp_040113.doc 2