Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: MEC2017-00078
13125 SW Hall Blvd.,Ti Date Issued: 02/02/2017
T E,G A f�.0 and OR 97223 503.718.2439 9
Parcel: 2S 101 AA07600
Jurisdiction: Tigard
Site address: 12540 SW 68TH AVE A
Project: Keith Doty DDS Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: (1)3 ton RTU.
Contractor: WILLAMETTE HVAC LLC Owner: BGG PROPERTIES LLC
3075 SW 234TH AVE.#206 AGF PROPERTIES LLC
HILLSBORO, OR 97123 11255 SW CHICKADEE TER
BEAVERTON, OR 97007
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/02/2017 $207.21
Class of Work: ALT Type of Const: VB Plan Review 02/02/2017 $51.80
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 02/02/2017 $24.87
Stories: Info Process/Archiving-Sm$0.50(up to 02/02/2017 $5.00
11x17)
Project Valuation: $5,000.00
Fuel Air Handlers
Fuel Types: Natural Gas 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 $288.88
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 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 ma obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 oi -780.73"3272544.
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 Application FOR OFFICE USE ONLY
Cityof TigardtVC' Received i �,,*
g Date/By: 1 �j I 7 Permit No.:�/•EGX 1-7`IJW 2
111 q 13125 SW Hall Blvd.,Tigard,OR 9 "" Plan R�
Phone: 503.718.2439 Fax: 503.59 (V).
Date/By: .. 2.....11. Other Permit:
T I GA R D Inspection Line: 503.639.4175 \V1' Date Rea.• I.y: loris: tg See Page 2 for
Internet: www.tigard-or.gov 0`` Notified/Metho02
d. 7 f-377 -"- Supplemental Information
a -
TYPE t3F WOI; 0 r v `� _ COMMERCIAL FEE* SCHEDULE USE CHECKLIST
) �" Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteratio performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: \ mechanical materials,equipment,labor,overhead,and profit.
Value:$$5,000.00
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 ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address:12540 SW 68th Aik.ve (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.:A Project name`Suit- " r.plae n^entHeat pump
lee, L Ar, re uires site Ian showin• .lacement 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
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
push/pull 3 ton RTU 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 I 0 TENANT Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
El APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name:same as below
Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Fireplace
Range
CONTRACTOR Barbecue
Business name:Willamette HVAC,LLC Clothes dryer(gas)
Other:
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)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name:michael malstrom Date: 1/31/17
* Fee methodology set by Tri-County Building Industry Service Board
1\Building\Permits\MEC-PermitApp.doc 03/07/12 440-46171(11/02/COM/WEB)