Permit CITY OFTIGARD MECHANICAL PERMIT
1 Permit #: MEC2012 -00424
l 1 COMMUNITY DEVELOPMENT i s
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
TIGARLT' g �� A 7 Parcel: 2S113AC00101
Jurisdiction: TIGARD
Site address: 16655 SW 72ND AVE 400
Project: Microlnterconnects Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 37
Project Description: (1) 6 ton NC
**REPRINT 8/15/12 Correct ASI and work description Reprinted for addition to scope of work and
valuation. '
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/14/2012 $360.41
Class of Work: OTR Type of Const: IIB Plan Review 08/14/2012 $90.10
Occupancy Grp: F -1 Occupancy Load: 12% State Surcharge - Mechanical 08/14/2012 $43.25 •
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 08/14/2012 $13.50
•
11x17)
Project Valuation: $28,500.00 Permit Fee 10/22/2012 $457.20
Plan Review 10/22/2012 $114.30
Fuel Air Handlers 12% State Surcharge - Mechanical 10/22/2012 $54.86
Fuel Types: Units < 10000 cfm: Info Process /Archiving - Lg $2.00 (over 10/22/2012 $2.00
Gas Pressure: Units > 10000 cfm: 11x17)
Furnaces Boilers & Compressors
Furnaces < 1001K BTU: 0 -3 HP: - Furnaces >= 1001< 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 $1,135.62
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
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 N• "cation ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You obtain a copy of the rules
or dire• questions to O • C by calling 503.232.1987 or 1.800.332.2344.
Issued :y: . 1.1. 4_,.„ Permittee Signature: /f/
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.
V CITY OF TIGARD I I MECHANICAL PERMIT
•
lig s COMMUNITY DEVELOPMENT Permit #: MEC2012 -00424
T t (A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
Parcel: 2S113AC00101
Jurisdiction: TIGARD
Site address: 16655 SW 72ND AVE 400
Project: Microlnterconnects Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 37
Project Description: (1) 6 ton 'NC
"REPRINT 8/15/12 Correct ASI and work description"
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES •
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/14/2012 $360.41
Class of Work: OTR Type of Const: IIB Plan Review 08/14/2012 $90.10
Occupancy Grp: F -1 Occupancy Load: 12% State Surcharge - Mechanical 08/14/2012 $43.25
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 08/14/2012 $13.50
11x17)
Project Valuation: $10,500.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers E. 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 $507.26
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. T
Issued By: Permittee Signature: Q A P / ( o .
_____„&libe/__Aeizt_ 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.
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00424
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
Parcel: 2S113AC00101
Jurisdiction: TIGARD
Site address: 16655 SW 72ND AVE 400
Project: Microlnterconnects Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 37
Project Description: (1) 6 ton A/C Must be placed within 5 side yard setback and approved rear yard setback
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/14/2012 $360.41
Class of Work: ALT Type of Const: Plan Review 08/14/2012 $90.10
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 08/14/2012 $43.25
Stories: Info Process /Archiving - Sm $0.50 (up to 08/14/2012 $13.50
11x17)
Project Valuation: $10,500.00
•
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 $507.26
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
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 les adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You o ain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 Ap ' atio m A R FOR OFF ICE tisl ONI_)`
t._. y - ,,_. p. a
Cl of Tigard I ' ' ° y i ' �— Received r
City g 4 r ,. I ' v� Da teJBy: Permit N 44 40 (,. -u •
° 13125 SW Hall Blvd., Tigard,0 `97223
Plan Review �i �
t C Phone: 503.718.2439 Fax: 503.5 o1 4 2012 eig Other Permi
T I G A R D Inspection Line: 503.639 Date Ready/13y. kris: 65 See Page 2 for
Internet: www.tigard - or.gov . Ay ..- 1( ' . ) Notified/Method: - Supplemental Information
TYPE -60 WORK
COMMERCIAL 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, Iabol, overhead, and profit
Value: $ in)
CA G RY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling CommerciaL/industrial 0 Accessory building For special Information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /6' < Ctv 761- rat A to (requires site plan showing placement) 46.75
l ) � Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: N 4 V�) (/l Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: (-w A.E./e—ut ' / - Heat pump
(requires site plan showing placement) 61.06
Cross street/diredions to job site: Duct work 23.32
e / / a ,� Hydronic hot water system 23.32
(/I 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
/ Gas fireplace/insert 33.39
V�j�l� 6 �'I �/ 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
ROPFFF���TY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
/ Other: 23.32
Name: / ��u Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
P APPLICANT CONTACT PERSON Attic/crawlspace fans ' _ 23.32
O J'� /J / Other:
`
Fuel to 23.32
Business name: r7i,iui
Contact name: 4p 44 ) ,/ $14.15 for first four; $4.03 for each additional
Address: Fumace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: (."3) ' 4 y ra Fax: : ( ) Water heater
�y 2...s,-).., Fireplace
E -mail: /�� (, l !/ � A ��'�) / t Range
(� CONTRA Barbecue
Business name: - 0 : Clothes dryer (gas) ,
92 /`'� 2 - � I Other
Address: r MECHANICAL PERMIT FEES*
City /State /ZIP: Cu � �� O / ‘4, 7 / ! S Subtotal
Phone: ( ) °�" may/ - Fax: Minimum permit fee ($90.00)
�b3 �� ((J�� ( ) Plan review (25% of permit fee)
CCB lie.: ' 7 2— (7 J „ State surcharge (12 %ofpermit fee)
f/� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
, days after it has been accepted as complete.
Print name: / ) ��� /At) vt.-t, �
r ____ 77 /..___ ate: t 7--- • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC - PermitApp.doc 03/07/12 440- 4617T( I /02/COM/WEB)
FOR OFFICE USE ONLY — SITE ADDRESS: ((12LeSS 7/-( ��
This form is recognized by most building departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
T I G A R [D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
OCT 1 8 2012
FROM:
CITY OF TIGARD
COMPANY: a BUILDtNG DIMS
PHONE: 3 (� / - % 477 By:
RE: l C..Qtp` - �S" 5w 79, 6-t. 4 o o f av a -06) Vg-
(Site Address) (Permit Number)
t 0120 (X.) ��.t2C0 eX
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: I Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing.. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: L am _ (-43a-t ( l
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Description: Amotunt Due:
$ 45 • 9°
$ I 1y. 30
•
$ 5K•f
$ a - pO
Special _ — et L = ( • 54'
Instructions:
Reprint Permit (per P : a Yes No ❑ Do
Applicant Notified: P ate: /o /g �9 - c 5a0 w /el„ Initial
I: \Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012
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.
I:\ Building \Pennits\MEC- PermitApp.doc 03/07/12 2
° Building Division
Over- The - Counter (OTC) Mechanical Permit
TIGARD
Check List
Project Description: { 1409 (CAL--- Ee, g I 0- - D490
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: Oregon Specialty Code: �AV)
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $ (.) FEES DUE
$ Mechanical Permit Fee
$ 0, I Plan Review
$ 4:3,2 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ l' r'_' Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ ' O ?.2,& TOTAL FEES DUE
•
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I:\Building\Forms \OTC - MEC.docx 01/13/2011