Permit CITY OF TIGARD BUILDING PERMIT
111
'' COMMUNITY DEVELOPMENT 1 , Permit#: MEC2016-00274
T/ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 PAW" Date Issued: 06/20/2016
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Lululemon Minor Modification Subdivision: None Lot: None
Project Description: New air handling units with new ductwork and diffusers. 8/15/16:REPRINTED permit to show change of
contractor.
Contractor: PROTEMP ASSOCIATES INC Owner: PPR WASHINGTON SQUARE LLC
9788 SE 17TH AVE PO BOX 847
PORTLAND, OR 97222 CARLSBAD, CA 92018
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee 06/20/2016 $982.71
Occupancy Grp: M Occupancy Load: Plan Review 06/20/2016 $245.68
12%State Surcharge-Mechanical 06/20/2016 $117.93
Dwelling Units: Info Process/Archiving-Lg$2.00(over 06/20/2016 $6.00
Stories: 1 Height: ft 11x17)
Bedrooms: Bathrooms: Misc Administration Fee 08/15/2016 $45.00
Value: $35,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $1,397.32
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 • ' suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility No" -tion Center Those .le. are set forth in OAR
952-001-0010 through OAR 952-001-0090.%may obtain a copy of the rules or direct questions to OUNC by cal' g 5r .232.198 or 1.800.332.2 ,.
0--
411111110
Issued By: Permittee Signature:
03.639.4175 by 7:00 a.m.for the next available inspection date.
This perm' car.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 • COMMUNITY DEVELOPMENT DEPARTMENT
• Request for Permit Action
T I G A R C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD ,
Building Division'
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tig' 1 io .giv?016
FROM: ❑ Owner .Applicant ❑ Contractor ❑ cit#
to i 1 rI
Check(✓)one
'
REFUND OR Name: iv\ eczar kt
INVOICE TO: (Business or Individual) /14 SA
Mailing Address:
City/State/Zip: ci U-&- v R-1 C la 51512?
Phone No.: -- 03 6;7:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTORONPERMIT (do not cancel permit).
�/
Permit#: \ , . tQ 9(�
Site Address or Parcel#: '3 acs�} z� Qom . - ' o
Subdivision Name: Lot#: �—'—
E PLANATION•
Signature: , /é4 _ ,NFII. Date: APV-- 14
Print Name: IMIESIMIREFAMCgillr
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer •.y authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Dated /S /0 By 4,'7. Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPetmitAction_092314.doc
CITY OF TIGARD MECHANICAL PERMIT
IrCOMMUNITY DEVELOPMENT Permit#: MEC2016 00274
1
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2016
TIGARD g Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Lululemon Minor Modification Subdivision: None Lot: None
Project Description: New air handling units with new ductwork and diffusers
Contractor: HORIZON RETAIL CONSTRUCTION Owner: PPR WASHINGTON SQUARE LLC
1500 HORIZON DR PO BOX 847
STURTEVANT,WI 53177 CARLSBAD, CA 92018
PHONE: 262-638-6000 PHONE:
FAX: 262-638-6015
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/20/2016 $982.71
Class of Work: ALT Type of Const: IIB Plan Review 06/20/2016 $245.68
Occupancy Grp: M Occupancy Load: 12%State Surcharge-Mechanical 06/20/2016 $117.93
Stories: 1 Info Process/Archiving-Lg$2.00(over 06/20/2016 $6.00
11x17)
Project Valuation: $35,000.00
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: 2 Vent Systems: Total $1,352.32
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: fan coil
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires y•. o follow the rules adopt-• by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-•!1-00'0. You may obtain a c•py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
41110
Issued By: ,tF Permittee Signature: ` , �i� �.t��
Call 3. 9.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit ApplicfttEIVjij
i FOR OFFICE 1 SF ONLN
City of Tigard Receiveyd ,/®� �� H f O
Date/B y ' Permit No.: I�ODO,�]
1111 13125 SW Hall Blvd.,Tigard,OR 97223
= Phone: 503.718.2439 Fax: 503.598.1960 Plan Review �
Date/By: �V•1_ _ :am Other Permit: 4v"0'lo„"p,l3
Inspection Line: 503.639.4175 J
T I G A R D p APR 187.016 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
'Ll'ili 01' 1 141(1R110
q.YP j V i G 11V1fit()N COMMERCIAL PEE* SCHEDULE—USL'CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction ® Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
O Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ J5QOC1
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENTt SYSTEMS FEES*
❑ 1-and 2-family dwelling ® Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
r"`
` 955 ,JOB SITE INFORMATION AND LOCATION •
Air conditioning 46.75
Job site address:SW washington square Rd Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:#T19 Project name:Lululemon washington Sq. Duct work 23.32
Cross street/directions to job site:SW washington square Rd&SW GreenburgRd Hydronic hot water system 23.32
Residential boiler(radiator or
(N)Air handling units W/(n)ductwork&diffusers 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:Chilled Water 1 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF W RK Gas fireplace/insert _ 33.39
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
0 PROPERTY OWNER ® TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Lululemon athletica Range hood/other kitchen
- equipment 33.39
Address:1818 Cornwall Avenue Clothes dryer exhaust 33.39
—
City/State/ZIP:Vancouver,BC,V6j1C7 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 2 23.32
Phone:(604)351-0299 Fax:( ) Attic/crawlspace fans 23.32
4 ® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Engineer of Record-Randall A.Nelson
$14.15 for first four;$4.03 for each additional
Contact name:Randall A.Nelson Furnace,etc.
Address: 14817 West 95th Street Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Lenexa,KS 66215 Water heater
Phone:(913)322-5110 Fax::( ) Fireplace
Range
E-mail:randynelson@acertusgroup.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:TBD
44n Z AA,„./ 6..„t.S ,/r;'W MECHANICAL PERMIT FEES*
Address: l�y (L,tt /) Subtotal
City/State/ZIP: �`y�� ;5_ L ?3Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(� 3�`��� Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 91-5"e/ 6„//‘., TOTAL PERMIT FEE
)4 `Q Jk/ This permit application expires if a permit is not obtained within 180
r / days after it has been accepted as complete.
Authorized signature: �/ �. / J * Fee methodology set by Tri-County Building Industry Service Board
Print name�jw/,Ay4 a R!►, F+ ej Date:6/2dJ 6
I:\Building\Permits\MEC_PennitApp_040113.doc 440-4617T(I l/02/COM/WEB)
ACERTUS
CONSULTING GROUP,LLC
LETTER OF TRANSMITTAL:
Date: 04/15/16
To: Project Information:
Company: City of Tigard Project Description: Lululemon -Tigard, OR
Attention: Brandon Taggart Project#: 1620071
Address: 13125 SW Hall Blvd Submittal: Permit
Tigard, OR 97223
Telephone: 503-718-2439
We are issuing to you the following via:
® Overnight Delivery-Priority ❑ Overnight Delivery-First 8AM ❑ Local Courier ❑ Drop Off
COPIES DATE DESCRIPTION
2 04/15/16 Signed and Sealed Mechanical Drawings.
1 I 04/15/16 Permit Application
The above items are issued to you:
❑ For Your Use ® As Requested ❑ For Approval
Comments:
From: Brooke Harrison
Page 1 of 1
` 14817 West 95th Street • Lenexa,Kansas 66215 • P 913 322 5150 • F 913 322 5155 • www.AcerfusGroup.com