Permit Support Document (32) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1 0
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Re quest t for Permit //9/ "
q e t Action
TIGARD 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 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ ContractorCity Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
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 CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: /')2,7 C / -006S7
0.
Site Address or Parcel #: eS~r 4) ( jki /..--Avu , 4,,tY...
Project Name: L '11CC t 244e—
Subdivision Name: Lot#:
EXPLANATION: it065„,",„ csc s . jL✓-si...fie,, -e_,/4,„" 0v4 ye) rrs/.I,,,.w ewe.
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Signature: ----A-t-d-g._:-2; Date: /041(ir
Print Name: 7' - A°
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 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: Date /t 4/i r By 4 Route to Records: Date // /9 /t B 1/
Refund Processed: Date / By ', Invoice Processed: Date By
Permit Canceled: Date /j//9/(--' By 1, Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_O 2314.doc
Mechanical Permit Applicatl 0 1 I FOR OFFICE USE ONLY
s
Ipiiii ' City of Tigard 9 r . ReceivedtB . g l i f iv,oGa,c`r(hX, k,
g V.,a `•' ",'".. Date/By. Permit No.:
" 13125 SW Hall Blvd.,Tigard,OR 7
Plan Revi
Phone: 503.718.2439 Fax: 503.598.1960Date/By. ,a Other Permit: �} �.
TIGARD Inspection Line: 503.639.4175 r �C� ?Q Date Read /B Juris. See'Page for
—
h terneC www.tigard-or.gov �n y Ready/By: „73� l�
s t Notified Method: ,twSupplemental Information
Vilt Ih. -� Li 1stw•-'7.1'.:1\!.i' /L..
TYPE' <, COMMERCIAL FEE* SCHEDULE — USE 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
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 5 tt£)L). =d
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-and 2-family dwelling ® Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site addressW Washington Square Rd#6H Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard Oregon 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:6H Project name:L'Occitane Washington Sq. _ 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
Subdivision: Other: 23.32
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
Modify duct work as required,all other A/C components are existing fireplace 23.32
Refurbishing exhaust vents in Restrooms will reuse existing. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
❑ PROPERTY OWNER illi TENANT Environmental exhaust and ventilation:
Name:L'Occitane Range hood/other kitchen
equipment 33.39 _
Address: 1430 Broadway 2nd Floor Clothes dryer exhaust 33.39
City/State/ZIP:New York,NY 10018 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(407)378-6682 Fax:(407)4693499 Attic/crawlspace fans 23.32
El APPLICANT ® CONTACT PERSON Other: 23.32 _
Fuel piping:
Business name:Team K5
$14.15 for first four;$4.03 for each additional
Contact name:Dennis Godsey Furnace,etc.
Address:176 E Highland Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Clermont FL 34711 Water heater
Phone:(407)378-6682 Fax::(407)469-3499 Fireplace
Range
E-mail:Bennis.godsey@expeditepermit.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Out to Bid Other:
MECHANICAL PERMIT FEES* •
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) i Fax:( ) State surcharge(12%of permit fee)
CCB lie.: II TOTAL PERMIT FEE
__j
— - � 111...---- — This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur-�+U _ �„ * Fee methodology set by Tri-County Building Industry Service Board
Print name: P tNNrs Goase---f Date: b JI c/t 3
L'Buildin,,lPermits\MEC_PermitApp_040113 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_PermitApp_040113.doc 2
EINe
407-469-5599 office
407-469-3499 Fax
•
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TRANSMITTAL SHEET
TO: FROM:
Plan Intake Dennis Godsey
COMPANY: DATE:
City of Tigard 8/15/2018
PHONE NUMBER: FAX NUMBER:
503-178-2439
RE:
L'Occitane—9585 SW Washington Square Rd#6H
0 URGENT X FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PEASE RECYCLE
L'Occitane
9585 SW Washington Square Rd#6H
Tigard OR 97223
1. 2 SETS OF MECHANICAL PLANS
NOTES/COMMENTS:
This submittal is for a Tenant Improvement in Washington Square Mall unit# 6H
Please contact me should your require anything additional to complete this process
Thanks
Dennis R Godsey III
Commercial Project Manager
dennis.godsey@expeditepermit.com
407.469.5599 xt 358 office
407.469.3499 fax
Team K5 Construction&Development Coordination,LLC
176 East Highland Ave.
Clermont,FL 34711
- M i CERICH
August 3, 2018
Sargenti Architects
Simone Koufakis Short,
461 From Road, Second Floor
Paramus, NJ 07652
(T) 973,253.9393
Re: L'Occitane @ Washington Square_1106
Dear Simone Koufakis Short,
Final drawings submitted for the above project are "Approved" and ready for permitting. Any
changes needed as requested below can be made and resubmitted to the Landlord in a subsequent
submittal.
If you should have any questions, comments, or concerns regarding this review, please feel free
to contact me.
Sincerely,
r
Charlene Sirokman, RA
Sr. Manager, Tenant Coordination
11411 N.Tatum Boulevsrrd
P hoerili:,AZ 65020
P:602.9.53.6200 F:602,953,6449