Permit p CITY OF TIGARD MECHANICAL PERMIT
111 3 COMMUNITY DEVELOPMENT Permit#: MEC201500615
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2015
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE#210
Project: NW Capital Management Subdivision: VARNS ACRES Lot: 9
Project Description: (1)new VAV box,(2)ceiling fans&duct modifications
Contractor: HVAC INC Owner: TRIANGLE POINTE TWO LLC
5188 SE INTERNATIONAL WAY 901 NE GLISAN ST, STE 100
MILWAUKIE, OR 97222 PORTLAND, OR 97232
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/09/2015 $578.85
Class of Work: ALT Type of Const: Plan Review 09/09/2015 $144.71
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 09/09/2015 $69.46
Stories: Info Process/Archiving-Lg$2.00(over 09/09/2015 $4.00
11x17)
Project Valuation: $19,100.00 Info Process/Archiving-Sm$0.50(up to 09/09/2015 $3.50
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 $800.52
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o . irk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Ce -r. Ti' e rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You •y a'in a copy of the rules
or di•-ct questions to OU _ •y c-ling 503.232.1987 or 1.800.332.2344.
Iss d By: 0 / Permittee Signature: 1r '
Call 503.639.4175 by 7:00 a.m.for the next available inspect' n date
This permit card shall be kept in a conspicuous place on the job site until co •pleti•n of the project.
Approved plans are required on the job site at the time of each ins••c on.
Mechanical PermitAPPIi itteErvErt FOR OFFICE USE ONLY
Received
City of Tigard Date/By: q�94 S Permit No.:/f e Als-d0 c/6r-—
_-° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review J_
Phone: 503.718.2439 Fax: 503.59 Date/By: Other Permit: /�r�n
Inspection Line: 503.639.4175 ��� 9 2015 Date Read /B Juris See Page I S�00���
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF FIGARO
TjJ!i N SW COMMERCIAL FEE* SCIIEDULE — USE CHECKLIST
Mechanical permit tees*arc based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 1 ! I
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUiPMENT I SYSTEMS FEES*
❑ 1-and 2-family dwelling g Commercial/industrial ['Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ✓s•�'.) 3 3 J� w i#t `t oAl Furnace 100,000 BTU(ducts/vents) _ 46.75
City/State/ZIP: l'1 V r i V ate} f Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: . .. Project name:Iyi Ip t vr--k- Duct work 23.32
Cross street/directions to job site: NU) C_11-%. 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
y�
n p I Flue vent for water heater or gas
j
MVO V Hv )i, ( ') f hV1�' ;iji l 1 f fireplace 23.32
a 1n �• Log lighter(gas) 23.32
W� !r 1 J Wood pellet stove 33.39
Wood fireplace/insert _ 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER Other: 23.32
CI PROPERTY TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans _ 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: ' A L LA Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Q .1(3- Furnace,etc.
Address: �, % t Jam '-t-' l Gas heat pump
l J^ Wall/suspended/unit heater
City/State/ZIP: , 1 ( (>1...---1 Water heater
Phone:(9)3) 1/4..4 '>. u1�) ./ I Fax::( ) i4c� lo�—�) Fireplace
t f^ Range
E-mail:: 1%(Lj� t l v a U V `CA✓F , w \ Barbecue .
"1 a CONTRACTOR Clothes dryer(gas)
Other:
Business name: ..4k.,/(),t(./ �-LV I L 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.: )'V\ J 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: l • Fee methodology set by Tri-County Building Industry Service Board
Print name: `, Date: /I.\BuildingTermils\ME C_PermitAA p_040113.doc 440-466ITr(1/IT"
O COM/'EB)
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\Permits\MEC_PermitApp_040113.doc 2