Permit (25) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019-00286
T i( .\R i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2019
Parcel: 2S 101 AA09800
Jurisdiction: Tigard
Site address: 12570 SW 69TH AVE
Project: George Fox Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: Replacing(1)4-ton RTU.
Contractor: WILLAMETTE HVAC LLC Owner: PLAZA PROPERTIES LLC
3075 SW 234TH AVE.#206 3835 SW KELLY AVE
HILLSBORO, OR 97123 PORTLAND, OR 97239
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/21/2019 $385.81
Class of Work: ALT Type of Const: Plan Review 05/21/2019 $96.45
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 05/21/2019 $46.30
Stories: Info Process/Archiving-Sm$0.50(up to 05/21/2019 $17.50
11x17)
Project Valuation: $11,480.00
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 $546.06
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
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 m. obtain a copy of the rules
or direct questions to OUNC by calling 503.23 987 or 1.800.3 2.2344.
(}1.2,%e-
Issued By: f Permittee Signature: / a
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 ONEY
City of Tigard Received
g - ',s ate/B •: — Permit No.: C� ,y
111
II 13125 SW Hall Blvd.,Tigard,OR 97223
RECEIVE y 7 g 01 M°E~�1 i~CL)4;
a•lan Review
Phone: 503.718.2439 Fax: 503.598.1960 )9'
� ` �� Other Permit:
Inspection Line: 503.639.4175 Date/By: 7
T 1 G A R D p p �}}((��§(, Date Ready/By: Juris: Ed See Page 2 for
Internet: www.tigard-or.gov A L t�1 J Noti ethod 4) Supplemental Information
v�r a • L4 L.c.moi.✓/i
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
,le- t„_ Value:$$11,480.00
CA1 EGOI')tf'OF COPD I EIIL"I ION RESIDENTIAL EQUIPMENT/S yTEMS FEES *
❑ 1-and 2-family dwelling ®Commercial/industrial D Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
DOBE INkORMATION,AND LOCATIODNN ;,i Heating/cooling:
: Air conditioning
Job site address:12570 SW 69th Ave (requires site plan showing placement) 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name:George Fox Heat pump
(requires site plan showingplacement) 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:
4 :x
, DESCRIPTION 5'ORi{ s Water heater 23.32
Push/pull 4 ton RTU Gas fireplace/insert 33.39
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
C}=PROPERTY OWNER J tD TENANT Chimney/liner/flue/vent 23.32
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
®' APPLICANT ID�CONTACT;PERSON . Attic/crawlspace fans 23.32
Business name:same as below Other: 23.32
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
Phone:( ) Fax::( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR- - Barbecue
Business name:Willamette HVAC,LLC Clothes dryer(gas)
Other:
Address:3075 SE Century Blvd Suite 206 _ wiEGIIANICAI,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
Authorized signature: 914.4._r_Ai
This permit application expires if a permit is not obtained within 180
Print name:michael malstrom Date:4/26/19 * Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PermitApp.doc 03/07/12 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
`T` ta Yaltatlo� z `� Pe:,
$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.doc 03/07/12 2
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12570 SW 69TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2019-00286
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor