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Permit
71° CITY OF TIGARD MECHANICAL PERMIT 111. COMMUNITY DEVELOPMENT Permit#: MEC2018 00366 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2019 I Parcel: 2S103DD01100 Jurisdiction: Tigard Site address: 13939 SW PACIFIC HWY Project: Providence Retail Clinic Subdivision: None Lot: None Project Description: Mechanical work for new tenant build out of(2)exam rooms in existing shell space inside Walgreens. Contractor: AMERICAN HEATING INC Owner: WALGREEN CO#5780 5035 SE 24TH AVE PO BOX 901 PORTLAND, OR 97202-4765 DEERFIELD, IL 60015 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 06/04/2019 $90.55 Class of Work: ALT Type of Const: Plan Review 06/04/2019 $22.64 Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 06/04/2019 $10.87 Stories: Info Process/Archiving-Lg$2.00(over 06/04/2019 $8.00 11x17) Project Valuation: $1,200.00 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 $132.06 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: new return Duct Work: 1 and supplys 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 - •• 2-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 +r 1.800.332.2344. Issued By: Permittee Signature: -/i/ // ark 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 eat.11 inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVE • S //7//G Pemc2s "4/-44 14 "I J 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review _ Phone: 503.718.2439 Fax: 503.598.1960Date/BY S.--3 k ' Other PerreP ��i,O0/s't/ Inspection Line: 503.639.4175 MAY 1 7 2018 Date Re TIGARD P Date Ready/By: loris: 0 See Page 2 for InterrP*' Notified/Method: �"�/ Supplemental Information "ott - J CCC[ CITY OF I-I6Ak7� - d - s 1" Print name. ❑New construction (]Addition/alteration/replacement a.-°1M ,:;I`rt..t.t:rNc�4. „i5J itilt,.4Lte: .ti1� :s tzu oDemolitionMechanical permit fees*are based on the value of the work ®Other:Tenant Improvem performed.Indicate the value(rounded to the nearest dollar)of all ' r „Vf,,, ` tr � t i~ ''. „. ' v : #' mechanical materials,equipment,labor,overhead,and profit. Value $ 1 C.)D ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building - c .- ❑Multi-family 0 Master builder 0 Other: For special information use checklist. f . , `'7 W 4 . t ij L bei it 7s TOM 7717574C47 Description l Qty. I Ea. I Total Job site address:13939 SW PACIFIC WAY Heating/cooling: Air conditioning 46.75 City/State/ZIP:TIGARD,OR 97223 Furnace 100,000 BTU(ducts/vents) 46.75 Suite/bldg./apt.no.: Project name:PROVIDENCE RETAIL CLINIC Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Cross street/directions to job site:SW MCDONALD ST Duct work 23.32 Hydronic hot water system 23.32 e,p Residential boiler(radiator or (/11; s/(t/ /i/X14'We iGK 1'N fGrIsi/Z..c( hydropic) 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 Tax map/parcel no.: Other: 23.32 Other fuel appliances: 041,4444:;''''';t: v,A ° 'a t e ®. 1 _ ° ;,,k,,�_ £ 7 Water heater 23.32 THIS PROJECT CONSISTS OF(2)EXAM ROOM BUILD-OUTS IN AN EXISTING Gas fireplace/insert 33.39 SHELLED SPACE Flue vent for water heater or gas OF THE WALGREENS FACILITY. THE EXAM ROOMS WILL INCLUDE ELEC, fireplace 23.32 MECH,AND PLUMBING Log lighter(gas) 23.32 /16Z/16/1/C-19-1--• Fan-- �-.L Wood/pellet stove 33.39 Wood fireplace/insert 23.32 om` ,,7 � , Chimney/liner/flue/vent 23.32 _. ,._ . � #O - x la . . Cit . f Other: 23.32 Name: Jt,/, .,6,A Srn mph Environmental exhaust and ventilation: ` Range hood/other kitchen Address: \spV St'pt1.eWDAN 5,0c equipment 33.39 sto kt iv.* 9707.. Clothes dryer exhaust 33.39 Ci /State/ZIP: Single-duct exhaust(bathrooms, Phone:(tag) /Z15 • 2ijq 2 Fax:( ) toilet compartments,utility rooms) 23.32 Attic/crawlspace fans 23.32 1 � "` ice 7 4r !v,-,,-.-...17,,,, .. Other: 23.32 Business name:NAC ARCHITECTURE Fuel piping: Contact name:JILL KURTZ • $14.15 for first four;$4.03 for each additional Furnace,etc. , Address:1203 W RIVERSIDE AVE Gas heat pump City/State/ZIP:SPOKANE,WA 99201 Wall/suspended/unit heater Water heater Phone:(509)838-8240 I Fax::( ) Fireplace E-mail:JKURTZ@NACARCHITECTURE.COM Range : r r. - aV Z,L;f Barbecue Business name: Clothes dryer(gas) W ( ' . , s _ Other: Address: gvr;4 # ,a ti 0 `_ ' 7 City/State/ZIP: A — Subtotal 19000 Minimum permit fee($90.00) Phone: '`-r,3) e -:-- I Fax:( ) Plan review(25%of permit fee) CCB lir.: ( . , State surcharge(12%of permit fee) TOTAL PERMIT FEE 576.31 This permit application expires if a permit is not obtained within 180 t#uthoDZedSi nature: �`"" day after It has beau accapted as latw * Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\MEC_Pennitppp_0401]3.doc 440-4617T(1 t/02/COM/WEB) RE EIVEP N AC MAY172018 ARCHITECTURE CITY OF [IUt1Nj BUILDING DIVISION Transmittal To Building Division Project Providence Retail Clinics-Walgreens Company City of Tigard' Address 13125 SW Hall Blvd Date April 19,2018 City Tigard NAC No. 111 ;18007 State Oregon ZIP 97223 Owner Project No. Sent via FedEx Action For your Review 0 Originals to follow Fax No. From Jill Kurt/NACArchitecture Copy to Email Mail Fax Jordann Smith Cj 0 0 © ❑ Q Q ❑ 0 Transmitted herewithin ❑ Continued on page 2 Copies Description(Date,Drawing No.,Section No.,etc.) • File Code 3 Sets of Architectural Drawings 2 Sets of Mechanical Drawings 1 Plan Review Fee$359.53 1 Architectural permit Application 1 Mechanical permit Application • Comments ❑ Continued on page 2 (Use Alt+Enter to create new tines) - zp The enclosed data is provided as a convenience for use related to the project it represents,and is not represented to be nor permitted to be used for extensions of the projector other projects.Ownership and copyright remain with NAC Architecture(NAC)or its consultants.The data has been prepared using evolving standards and technology,and NAC implies no warrantee that the data is accurate,timely,appropriate for utilization by others,retrievable over a period of time or by technologies other than our own,or that the electronic data medium is free of electronic viruses.By acceptance of this data,the recipient acknowledges the above,and agrees to the fullest extent permitted by law to indemnify,defend,and hold harmless NAC including its Consultants from claims,losses and costs arising out of use of this data. Tigard Transmittaixism >1203 West Riverside Avenue,Spokane,WA 99201-1107 1 of 2 509 838 8240/nacarchitecture.corn eattle"1 Spokane-i Los Ange"es° City of Tigard • COMMUNITY DEVELOPMENT m Building Division TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503318.2439 • www.tilard-• .•ov INVOICE TO: NAC Architecture Customer ID: A Attn: Jill Kurtz Invoice No.: NV2019-00001 1203 W Riverside Ave Invoice Date: 5/20/2019 Spokane,WA 99201 Date Due: 30 Days Case No. Site Address Subdivisio. -Lot#or Project Name Amount Due MEC2018-00366 13939 SW Pacific Hwy Provide, e Retail Clinic $152.08 4 i W � r r Invoice Total: $152.08 ® Please see attach• fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: EC2018-00366 Customer ID: N/A Site Address: 13939 SW Pacific Hwy Invoice No.: INV2019-00001 Project: Providence Retail Clinic Invoice Date: 5/20/2019 Date Due: 30 Days Invoice Total: $152.08 Amount Paid: $ Of e Note: Route copy of receipt to Dianna Howse r ease mail payment to: City of Tigard,Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 I:\Building\Accounting\Invoice.doc 01/14/2011 II Dianna Howse From: Dianna Howse Sent: Monday, May 20,2019 8:51 AM To: jkurtz@nacarchitecture.com Cc: #Building Permit Technicians Subject: MEC2018-00366- Providence Retail Clinic- 13939 SW Pacific Hwy. Attachments: MEC2018-00366_Invoice_052019.pdf; MEC2018-00366.pdf Importance: High Hello Jill, Attached please find invoice for plan review fees due for a mechanical permit submitted for the Providence Retail Clinic project located at 13939 SW Pacific Hwy. The permit application and plans were submitted by your company and plan review was completed in May 2018,and the permit was never issued and permit fees are past due for plan review completed. A mechanical contractor submitted for another permit and the work was performed under that permit which is now closed. Please submit payment due in the amount of$152.08 at your earliest convenience to City of Tigard—Building Division, 13125 SW Hall Blvd.,Tigard,OR 97223. Or you can pay the fees online at https://aca.accela.com/tigard/Default.aspx by searching for the permit record number MEC2018-00366 under the Building tab. An online account/login is not required to pay fees online. Please email me to let me know if you pay the fees online. Thank you. Dianna L. Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard,OR 97223 503-718-2430 Direct 1503-718-2439 Permits DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." T 1 City of Tigard Tel: 503.718.2439 Location: Inspection Date: 13939 SW PACIFIC HWY, TIGARD, OR, 97223 June 13, 2019 at 8:17:18 AM Record Type: Record ID: Commercial - Mechanical MEC2018-00366 Inspection Type: Inspector: 699 Mechanical final Chip Barnett Result: PASS - NoCofO Comments: Inspections done under permit MEC2018-00474 Violation Summary: Inspector Contractor Mechanical Permit Application "�j�` FOR OFFICE USE ONLY City of Tigard i^ eceived IN e iw 1 7 �i' .�Mt�� Permit l)i p ©0j /_ `. - �an J fJ f�fG7 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review,^ Phone: 503.718.2439 Fax: 503.598.1960 y 2018 Date/By: J--3 f k j' Other PerPP �J/Iii dl`C'-/ TIGARD Inspection Line: 503.639.4175 MAY 1 7Date Read/B _ - furs: d fJ J Internet: w w tr,-••-or.go Ready/By: /Le ® See Page 2 for />I p� - �t` 1� Notified/Method: 0 CITY! 4 6 ff '',.• �l t Supplemental Information • = r a "` ..:;,4,„,i'7-.1,1” ! 8 si-r r Print name: El New construction Addition/alteration/replacement _ , El DemolitionMechanical permit fees*are based on the value of the work._ ®Other:Tenant Improvem performed.Indicate the value(rounded to the nearest dollar)of all z ' ` mechanical materials,equipment,labor,overhead,and profit. El1-and 2-family dwelling ® ❑Accessory building Commercial/industrial Value $$19,000 00 ❑Multi-family 0 Master builder � � � . 0 Other For special information use checklist. c P I% .-Z- t ''''A'-''''''''"'-' tiri .. . ®. , �Q ?O * Description • ,. ,.�'' ra,s, P Qty. Ea. Total Job site address:13939 SW PACIFIC WAY Heating/cooling: Air conditioning 46.75 City/State/ZIP:TIGARD,OR 97223 Furnace 100,000 BTU(ducts/vents) 46.75 Suite/bldg./apt.no.: Project name:PROVIDENCE RETAIL CLINIC Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Cross street/directions to job site:SW MCDONALD ST Duct work 23.32 Hydronic hot water system 23.32 Residential boiler(radiator oreVir •„re /k"Ce`/ fG 1. re �/ hydropic) 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 Tax map/parcel no.: Other: 23.32 Other fuel appliances: . ,. ... 'a. it. .* 0 `3 . Water heater 23.32 THIS PROJECT CONSISTS OF(2)EXAM ROOM BUILD-OUTS IN AN EXISTING Gas fireplace/insert 33.39 SHELLED SPACE Flue vent for water heater or gas OF THE WALGREENS FACILITY. THE EXAM ROOMS WILL INCLUDE ELEC, fireplace 23.32 MECH,AND PLUMBING Log lighter(gas) 23.32 /17EeAfy6 - Fan-- `-X Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 . sF ®ti" ` ther:. .,e,t , ,. ,. . _w , ,., 4 ... ,-` O 23.32 Name: Environmental exhaust and ventilation: Range hood/other kitchen Address: \si,, , St-hca.Wckv, 51 'G.JO1i equipment 33.39 City/State/ZIP: StokkL,t wrk 9g�22 Clothes dryer exhaust 33.39 Single-duct exhaust(bathrooms, Phone:(2. t. ) 1.I5 • /jig 2. Fax:( ) toilet compartments,utility rooms) 23.32 '< ,... u; � ;� . �� - 0 � Attic/crawlspace fans 23.32 Other: 23.32 Business name:NAC ARCHITECTURE FuelPp g► in : Contact name:JILL KURTZ - $14.15 for first four;$4.03 for each additional Furnace,etc. Address:1203 W RIVERSIDE AVE Gas heat pump City/State/ZIP:SPOKANE,WA 99201 Wall/suspended/unit heater Phone:(509)838-8240 Fax::( ) Water heater Fireplace E-mail:JKURTZ@NACARCHITECTURE.COM Range ,:-W1.-- r V" `-2 Barbecue Business name: Clothes dryer(gas) b Other• Address: "'"1 43.4**'41:AiitlitiatAiritAi*A.1.*Aal City/State/ZIP: n Subtotal 19000 Minimum permit fee($90.00) Phone:5-033) c- -- I Fax:( ) Plan review(25%of permit fee) CCB lic.: State surcharge(12%of permit fee) TOTAL PERMIT FEE 576.31 This permit application expires if a permit is not obtained within 180 Authorized signature: Z:::: _____.07 / * Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) , City of Tigard • COMMUNITY DEVELOPMENT = Building Division TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov INVOICE TO: NAC Architecture Customer ID: N/A Attn: Jill Kurtz Invoice No.: INV2019-00001 1203 W Riverside Ave Invoice Date: 5/20/2019 Spokane, WA 99201 Date Due: 30 Days Case No Site Address Subdivision-Lot#or Project Name Amount Due MEC2018-00366 13939 SW Pacific Hwy Providence Retail Clinic $152.08 Invoice Total: $152.08 ® Please see attached fee schedule for description of fees due. (Detach and return this portion with payment.) Case No.: MEC2018-00366 Customer ID: N/A Site Address: 13939 SW Pacific Hwy Invoice No.: INV2019-00001 Project: Providence Retail Clinic Invoice Date: 5/20/2019 Date Due: 30 Days Invoice Total: $152.08 Amount Paid: $ Office Note: Route copy of receipt to Dianna Howse Please mail payment to: City of Tigard,Building Division Attn: Dianna Howse 13125 SW Hall Blvd. Tigard, OR 97223 I:\Building\Accounting\Invoice.doc 01/14/2011 CITY OF TIGARD FEE AND PAYMENT HISTORY ilINI a . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TfC AR D MEC2018-00366 - 13939 SW PACIFIC HWY, TIGARD, OR 97223 Providence Retail Clinic Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Info Process/Archiving-Lg$2.00(over 230-0000-43135 $8.00 $8.00 $8.00 11x17) Plan Review 230-0000-43111 $144.08 $144.08 $144.08 Totals for Fees $152.08 $152.08 $0.00 $152.08 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount Total Payments: Balance Due: $152.08 Dianna Howse From: Dianna Howse Sent: Monday, May 20, 2019 8:51 AM To: jkurtz@nacarchitecture.com Cc: #Building Permit Technicians Subject: MEC2018-00366- Providence Retail Clinic - 13939 SW Pacific Hwy. Attachments: MEC2018-00366_Invoice_052019.pdf; MEC2018-00366.pdf Importance: High Hello Jill, Attached please find invoice for plan review fees due for a mechanical permit submitted for the Providence Retail Clinic project located at 13939 SW Pacific Hwy. The permit application and plans were submitted by your company and plan review was completed in May 2018, and the permit was never issued and permit fees are past due for plan review completed. A mechanical contractor submitted for another permit and the work was performed under that permit which is now closed. Please submit payment due in the amount of$152.08 at your earliest convenience to City of Tigard—Building Division, 13125 SW Hall Blvd.,Tigard, OR 97223. Or you can pay the fees online at https://aca.accela.com/tigard/Default.aspx by searching for the permit record number MEC2018-00366 under the Building tab. An online account/login is not required to pay fees online. Please email me to let me know if you pay the fees online. Thank you. Dianna L. Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 1