Permit (155) CITY OF TIGARD MECHANICAL PERMIT
: • ' COMMUNITY DEVELOPMENT Permit#: MEC2018-00881
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2018
TIC ;�It t� 9 Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#20
Project: New Horizons Wellness Services Subdivision: VARNS ACRES Lot: 9
Project Description: Moving existing grills to conform to new grid ceiling and room layout. Extend duct where needed. Sensor will be
pulled as separate electrical permit by contractor.
Contractor: JACOBS HEATING&AIR CONDITIONING Owner: TRIANGLE POINTE TWO LLC
4474 SE MILWAUKIE 901 NE GLISAN ST, STE 100
PORTLAND, OR 97202 PORTLAND, OR 97232
PHONE: 503-234-7331 PHONE: 503-297-8791
FAX: 503-296-5351
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/13/2018 $423.91
Class of Work: ALT Type of Const: Plan Review 11/13/2018 $105.98
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/13/2018 $50.87
Stories: Info Process/Archiving-Lg$2.00(over 11/13/2018 $2.00
11x17)
Project Valuation: $13,000.00
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: Vent Systems: Total $582.76
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
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 4490. Y. may obtain a copy of the rules
or direct questions to OUNC by cap 503. 2.1987 or 1.800.332.2 44.
Issued By: 1� _ , �,`/ ,r: Permittee 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 ONLY
City of Tigard 11 / DateivReceived d y
= q 13125 SW Hall Blvd.,Tigard,OR 9722 t .n` y G �� ��
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 O r 'e'
Inspection Line: 503.639.4175 Q`/ 1 3 2018 Date ��i v
TIGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TiGARD
BUI�.D!NG D€ n ti.JN CON MERCIAL;FEE*;SCHEDU E'— USE CHECKLIST
TYPE"tOF";WORK
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
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
. .. $13,0000.00
,, : CATEGORY OF CONSTRUCTION.,: : FEES*
Value:
IESIDFNTTAT EQUIPMENT%S S EMS
❑ 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:
Air conditioning 46.75
Job site address:13333 SW 68th Parkway Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97233 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no. 02,0 Project name:New Horizons TI Space Duct work 23.32
Cross street/directions to job site: 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
.DESCRIPTION OF,WORK: Gas fireplace/insert 33.39
Flue vent for water heater or gas
Move existing grilles toconform to new grid ceiling and room layout.Extend duct fireplace 23.32
.Relecatc..soxsors..fex uewu roona-ktyeut Log lighter(gas) 23.32
Where needed.
t� llStr� i,�.l b _, Wood/pellet stove 33.39
ptlii-ed O5 S2! YCL,Y FAf•'f y I c,,,,I p,(m by Wood fireplace/insert 23.32
f_ Chimney/liner/flue/vent 23.32
/'
lzXL Other: 23.32
PROPETY";ONER` " 0 TENANT :rQRW
Environmental exhaust and ventilation:
Name:Triangle Pointe TWO,LLC Range hood/other kitchen
equipment 33.39 I
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 0 CONTACT PERSON
Other: 23.32
" Fuel piping:
Business name:Jacobs Heating and Air Conditioning
$14.15 for first four;$4.03 for each additional
Contact name:Andrea Bowlds Furnace,etc.
Address:4474 SE Milwaukie Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97202 Water heater
Phone:(503)234-7331 Fax::(503)296-5351 Fireplace
Range
E-mail:andreab@jacobsheating.com Barbecue
CONTRACTOR ' .. . Clothes dryer(gas)
Business name:Jacobs Heating&Air Conditioner Other:
.:2.,',..MECHANICAL PERMIT FEES*
Address:4474 SE Milwaukie Ave Subtotal
City/State/ZIP:Portland,OR 97202 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)234-7331 Fax:(503)296-5351
State surcharge(12%of permit fee)
CCB lic.:1441 t C l(�! a TOTAL PERMIT FEE
// (� This permit application expires if a permit is not obtained within 180
l�i_c" V
days after it has beenuaccepted complete.
Authorized signature: � * Fee methodology set by Tri-County Building Industry Service Board
Print name:ANDREA BOWLDS ��/J Date: 11/8/2018
i\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13333 SW 68TH PKWY STE 20, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2018-00881
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor