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Permit (205) CITY OF TIGARD MECHANICAL PERMIT )11 , COMMUNITY DEVELOPMENT Permit#: MEC2016-00810 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2016 Tic 1=.C� g Parcel: 1 S136DD05300 Jurisdiction: Tigard Site address: 11850 SW-67TH AVE, STE#150 Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Modification of registers and grilles for TI Contractor: WILLAMETTE HVAC LLC Owner: PNWP LLC#2 3075 SW 234TH AVE.#206 PNWP LLC HILLSBORO, OR 97123 6600 SW 105TH AVE#175 BEAVERTON, OR 97008 PHONE: 503-259-3200 PHONE: FAX: 503-848-2597 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 12/01/2016 $277.46 Class of Work: ALT Type of Const: Plan Review 12/01/2016 $69.37 Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 12/01/2016 $33.30 Stories: Info Process/Archiving-Lg$2.00(over 12/01/2016 $2.00 11x17) Project Valuation: $7,483.00 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 $382.13 Hoods: Comm Incinerators: Required Items and Reports(Conditions) Woodstoves: Gas Fireplaces: Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: Fire/Smoke Dampers: This per s' ' issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other app -.de law. All 'prk will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of i uance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt-'n a copy of the rules or direct questions to OUNC • calli ! 50 32.1987 or 1.800.332.2344. Issued By: L j Permittee Signature: ii , r•-r)4_ p Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit AppR t o` -, }i FOR OFFICE USE ONLY Cl Of T 1 and "� Received nn �� Permit No.: H f_(D 0.6//a—00 gi g Date/By: /lag- (O /By: _ a 13125 SW Hall Blvd.,Tigard,OR 97223 a Plan Review i Other Permit:/, O/ M fA7 Phone: 503.718.2439 Fax: 503.i)i._A1603 _ RecDateive TI GARD Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov ' R'_$ •4 ', 1 Notified/Method. Supplemental Information p T l ,W I y'I t a.'i. COMMERCIAL FEE* SCFIEDIYLI:_':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 ❑Other: mechanical materials,equipment,labor,overhead,and profit. ❑Demolition Value:$$7,483.00 CATEGORYOF CONSTRUCTION EN'TIALL+QIITPMET FSY�MSFEES* ❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist. D Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total Heating/cooling: JOB SITE INFORMATION AND LOCATION Air conditioning Job site address: 11850 SW 67th Ave (requires site plan showing placement) 46.75 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP:Tigard OR Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name:American Family Insurance 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 Flue/vent for any of above 23.32 Subdivision: Lot no.: 23.32 Other: Tax map/parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 Gas fireplace/insert 33.39 Relocate/add registers and grilles to accommodate new office layout. Flue vent for water heater or gas fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNER-, d TENANT Other: 23.32 Name: Environmental exhaust and ventilation: Range hood/other kitchen Address: equipment 33.39 City/State/ZIP: Clothes dryer exhaust 33.39 Single-duct exhaust(bathrooms, Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32 APPLICANT • © CONTACT PERSON Attic/crawlspace fans 23.32 Other: 23.32 Business name:same as below Fueli in P P g: Contact name: $14.15 for first four;$4.03 for each additional Furnace,etc. Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater Phone:( ) Fax: :( ) Water heater Fireplace E-mail: 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 Minimum permit fee($90.00) Phone:(503)259.3200 Fax:(503)848.2597 Plan review(25%of permit fee) CCB lic.:56951 State surcharge(12%of permit fee) 4 r)44..j? TOTAL PERMIT FEE . 30.,i..3 This permit application expires if a permit is not obtained within 180 Authorized signature: ...t) iv days after it has been accepted as complete. Print name:michael malstrom Date: 11/30/16 * Fee methodology set by Tri-County Building Industry Service Board 1:\Building\Permits\MEC-PermitApp.doc 03/07/12 440-4617T(11/02/COM/WEB)