Permit (62) City of Tigard • COMMUNITY DEVELOPMENT DEPAR"TME'AL_
11I _ " Re ues IV ;
q t for Permit Action
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 •• 503-718-2439 ••www.tiggo v 201a
CITY ear 71L'lM14D
TO: CITY OF TIGARD
BUILD NG cal�ll l N
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1 960 TigardBuildingPermits@tigard,k.-,.or.gov2/ /�.-
FROM: ❑ Owner ❑ Applicant $ Contractor Ell City Staff r r/l ...
Check(✓)one
REFUND OR Name: /� f�
INVOICE TO: (Business or Individual) \ V�� :-._��
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Mailing Address: s5 W
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City/State/Zip: fila'f VU s. a it k' 0 c 1.72` 2
Phone No.: jo•5_Z 3j.— 7-�-J'7-
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
E' 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 CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: � L7 l S QQO c7 Q
Site Address or Parcel#: :4/ a . - 'CU1, s
Project Name: (/]c7 C ) ,j 0 - /x 7 3 S 4-0 st' ci e,/4
Subdivision Name: Lot#: /4'0
EXPLANATION: b' u‘'(CI i\e-LA i 5 1
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Signature: Date: (7 z/( A
Print Name:
Day,c SC-If1ef�e-rmam.-
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 800/s 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. .7/
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FOR OFFICE USE ONLY
Route to Sys Admin: Date 01�,1, By Route to Records: Dat-- :,,/,1- /2 B 147
Refund Processed: Date j
�/,,,I By
� By � i Invoice Processed: Date By
Permit Canceled: Date ;/,' - By Parcel Tag Added: Date By
I:\Building\Forms\ReVermitAction_ 2314. oc
111
•
TIGARD
City of Tigard
March 1,2018
Arjae Sheet Metal Co.
Attn: David Schevermann
8545 SE Mcloughlin Blvd.
Milwaukie, OR 97222
Re: Permit No. MEC2018-00090
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14945 SW Sequoia Pkwy, #180
Project Name: Wow Burger
Job No.: N/A
Refund Method: ® Check#227678 in the amount of$539.14.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit"receipt in the amount of$
Comment(s): Per applicant's request as job was submitted for the wrong address.
Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
CITY OF TIGARD MECHANICAL PERMIT
14-1 COMMUNITY DEVELOPMENT Permit#: MEC2018-00090
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 02/08/2018
TiC�;ll�-C? 9
Parcel: 2S 112AD01000
Jurisdiction: Tigard
Site address: 14945 SW SEQUOIA PKWY 180
Project: Wow Burger Subdivision: PACIFIC CORPORATE CENTER Lot: 1
Project Description: New RTU,grilles,ducting,and exhaust fan.
Contractor: ARJAE SHEET METAL CO, INC. Owner: PACIFIC REALTY ASSOCIATES LP
8545 SE MCLOUGHLIN BLVD. ATTN: N PIVEN
PORTLAND, OR 97222 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-231-7717 PHONE:
FAX: 503-230-4888
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/08/2018 $601.71
Class of Work: ALT Type of Const: VB Plan Review 02/08/2018 $150.43
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 02/08/2018 $72.21
Stories: 1 Info Process/Archiving-Lg$2.00(over 02/08/2018 $2.00
11x17)
Project Valuation: $20,000.00 Info Process/Archiving-Sm$0.50(up to 02/08/2018 $10.00
11x17)
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: 1 Vent Systems: Total $836.35
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to 1._ C by calling 503 a42.1987 or 1.800 332.2344.
j
Issued By: j' ;f
dallOPP Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard 1 " ':i r ceived 1,
13125 SW Hall Blvd.,Tigard,OR 97223 �. .,ill
i ,"Ilan Review / '�"� Permit No.: pry 11,1 (� �'f ,
■ Phone: 503.718.2439 Fax: 503.598.1960 Dan Review r • Q
Date/By: Other Permit
II(;;,� t Inspection Line: 503.639.4175 111
i M O Date Ready/By: loris: �g(See-Page b ror
Internet: www.tigard-or.gov �,'; , U C Notified Method: /�1�
Supplemental Information
s , .a�.,�+ _; .. T%E ", n.,. L. 'Fi"•, '.m .:; T:sf .E ,i, .1 O. �a II RC v 1 z' ;
❑New construction ' `_ Mechanical permit fees*are based on the value"Of ti.; work
Q�i Addition/alteratibn;trfs'taiein he : . performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other:
2429
tj 4 0 1*--c MTIIC'91‘T n ,tp E Value.$ �G?_ .i
❑ 1-and 2-family dwelling gn Commercial/industrial r .14f0"
� ` tin u ss ick `
❑Accessory building For special information use checklist.
❑Multi family ❑Master builder
❑ Other Description I Qty. I Ea. I Total
T'1 F s , LOCATRt) ii: Heating/cooling:
7
Q Air conditioning 46.75
Job site address: 1 5 6 W 5 O (A K!g_' —
( q Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: O`� a/1 7 2 2-4Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: j.f V�/
Project name: (. 1Q� Heat pump 61.06
i Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
y � Unit heaters(fuel-type,not electric),
`t' 544,; t � tr _P-66:1N1 7,/ 1 y /347; in-wall,in-duct,suspended,etc. 46.75
„'). Flue/vent for any of above 23.32
..v
Subdivision: 1 Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
33.39' loOFQi ' : Gas fireplace/insert
. ; v.
Flue vent for water heater or gas
N giu, Ci�1P.5,4uG 1:1 , Ex tia th54- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
7'1.*''
A 9 . Other: 23.32�.F Fu . "" M 5"y
`« `:: Environmental exhaust and ventilation:
Name: Wow 13 or Range hood/other kitchen
Address: equipment 33.39
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
"" 'A L I ,N , 4 .. 1.„,c Jrr0.0 Other: 23.32
Business name: C, � Fuel piping:
` Pi vvl'1�� $14.15 for first four;$4.03 for each additional
Contact name: U(,j(�( Furnace,etc.
K�1
Address: 8 S E �„ Q*hit v 1 . Gas heat pump
tl ' dJ$� CY Wall/suspended/unit heater
City/State/ZIP: m;[
wow k 1e.f OA 9722.2. Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: ,f Range
(l Aul 6&ar G1e,`60 net Barbecue
NTRACI ?R Clothes dryer(gas)
OtherBusiness name: c awe, nc ( k_ve.
MECHANICAL PERMIT FEES* '
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone: Plan review(25%of permit fee)
( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: GO S35 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: �� * Fee methodology set by Tri-County Building Industry Service Board
Print name: p",-, sh. Date: Qt J (0
I\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Famil Fee Schedule:
'tt � ,. . , . a�. .
$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.
1:\Building\Permits\MEC_PermitApp_040113.doc 2