Permit (80) INCITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00238
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/05/2017
E 0ARD g Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Project: Dale Engle CPA Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Add(1)return air grille
Contractor: EXCEL HVAC INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 1188 ATTN: N PIVEN
CANBY, OR 97013 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 971-930-7194 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/05/2017 $69.06
Class of Work: ALT Type of Const: Plan Review 04/05/2017 $17.27
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 04/05/2017 $8.29
Stories:
Project Valuation: $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 $94.62
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: return air grill
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC byecalling 503.232.1987 or 1.800.332.2344. '
Issued By:61\s".)
�_�COPermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONE)'
City of Tigard Received 7 G A �70Q a 3g
g g ~ 1 'al' f Date/By: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
= Phone: 503.718.2439 Fax: 503 598.1960' Other Permit: n
71
Date/By: L !'c:94/7-'0 DO 7
T I GA R D Inspection Line: 503.639.4175 Date Read/B Juris: ® See Page 2 for
Internet: www.tigard-or.gov - i7 r; Y y'
%l,i 5 ,',Ti/ Notified/Method: Supplemental Information
TYPE 003402/1&01" I 14::,A i4 9 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction Additioryl�Ite hili T'CpIaeethent performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition Other:
Value:$ $'OO
CA EGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
T h Air conditioning 46.75
Job site address: Z CZ S M, Pk i.Jl/ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:T/5.d p V (74 . / Furnace 100,000+BTU(ducts/vents) 54.91
'1 Heat pump 61.06
Suite/bldg./apt.no.: /s--0 ��
Project name: T`�+ ,(�G p4 Duct work 23.32
Cross street/directions to job site: is G � Le C. 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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
' DESCRIPTION 0--i v 1. 33.39
x' Gas fireplace/insert
_ Flue vent for water heater or gas
ADD ` "J � t ii v ae l& CS R t LG C fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
, P UPE.r. `, OWNER . i1t;. p, Other: 23.32
Environmental exhaust and ventilation:
Name: PAtyh o S j 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:(may ) ,2 y_e_,3 06 Fax:( ) Attic/crawlspace fans 23.32
RSfi% Other: 23.32
F� � �� CANT 0 pro,. ,� '� � r Er. ...
Business name:
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: :..k,:-.---et----.4..\x
/, i I Furnace,etc.
Address: Gas heat pump
WalUsuspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: Range
�G KCS"` , ,r Cl/CZ-G //vA e-•�igr Barbecue
r°r - - ,, -- ,\, --, �3, � . f Clothes dryer(gas)
Other:
Business name:
�,k'C G%G /�UiQC'. _Z--)JC. r': ,„ MECHAPTICAL PB#MJT FEE 't
Address: , ?0. ,, O* //60 E, Subtotal ,06
----
City/State/ZIP: Minimumpermit fee($90.00)
C�.ugy (7 270 3
Phone:(9)/ ) 93.0 _ 7! Fax:( ) Plan review(25%of permit fee) 7 7. a
State surcharge(12%of permit fee) g.29
CCB lic.: /Si 3 4/- 3/9,, / TOTAL PERMIT FEE Q4.(pg-
This permit application expires if a permit is not obtained Within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:"3C7< /...2i / :,---T-- Date: 17,32/
l��7
I:\Building\Permits\MEC_PermitApp_0.0113.doc 440-4617T(11/02/COM/WEB)
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_PernritApp_040113.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12909 SW 68TH PKWY 150, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2017-00238
Inspection Type: Inspector:
699 Mechanical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor