Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019 00801
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2019
Parcel: 2S 101 AD02700
Jurisdiction: Tigard
Site address: 12625 SW 69TH AVE
Project: Dr. Hayden Subdivision: WEST PORTLAND HEIGHTS Lot: 1-8, PLL
Project Description: Replacing a 2.5 ton split system.
Contractor: WILLAMETTE HVAC LLC Owner: MCCROSKEY, JOHN B
3075 SW 234TH AVE.#206 1380 MORNING SKY CT
HILLSBORO, OR 97123 LAKE OSWEGO, OR 97034
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/14/2019 $271.84
Class of Work: ALT Type of Const: VB Plan Review 11/14/2019 $67.96
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 11/14/2019 $32.62
Stories: Info Process/Archiving-Sm$0.50(up to 11/14/2019 $6.00
11x17)
Project Valuation: $7,288.00
Fuel Air Handlers
Fuel Types: Electricity 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: 1
Appliances
Vent Fans: Vent Systems: Total $378.42
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
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. Xou'm.y obtain a .opy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued By: 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 Appl' FOR OFFICE USE ONLY
«'fA
City of Tigard =` t Received
Date/By: /1 AZ_ M 14 ' 0 c„.1.0/S P2!
IN III 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
�II " Other Permit:
_ Phone: 503.718.2439 Fax: 503.59M46 i.to€9 Date/By: J) )'3
T 1 G A R D
Inspection Line: 503.639.4175 Date ReadyBy: / / Juns: ® See Page 2 for
Internet: www.tigard-or.gov ') Notifie ethod: Supplemental Information
TYPE OF WORK 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 ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$7,288.
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address:12625 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.: Project name:Dr.Hayden Heat pump
(requires site plan showing placement) 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:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
Push/pull a 2.5 ton split system.
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
❑ PROPERTY OWNER I 0 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 0 CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name:same as below
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
J Fireplace
E-mail: " riAa/5-frw r� oft(I -f/r/ /t Range
CONTRACTOR Barbecue
.1
Business name:Willamette HVAC,LLC
Clothes dryer(gas)
Other:
Address:3075 SE Century Blvd Suite 206 MECHANICAL PERMIT FEES*
City/State/ZIP:Hillsboro,OR 97123 Subtotal
Phone:(503)259.3200 Fax:(503)848.2597 Minimum permit fee($90.00)
Plan review(25%of permit fee)
CCB lie.:56951 State surcharge(12%of permit fee)
_ TOTAL PERMIT FEE
-id (' This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name:michael malstrom Date• ? /V/4//, * Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PermitApp.doc 03/07/12 440.461M/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.doc 03/07/12 2
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
T1cARD Building Permit Review — Commercial - No Land Use
o
Building Permit #: 7fri Z-C--2,0( - TO
Site Address: ,7(Qc cj{) 6 ,74 6,e, Suite/Bldg#:
Project Name: bT a ,41
(Name of commercial •,siness occupying the space. If vacant,enter Spec Space.)
Planning Review f�
Proposal: //Pi Ov( //% /r1f �a -9 s--- -7 ).?-) O / �i 1-0--
Existing Business Activity: % 1//! 01A 4/ c 4 e
Propos usiness Activity: / l /1
Verify site address/suite# exists and active in permit sysste
1"VI`t -r Terrace Neighborhood: ❑ Yes Ly' No
1! •ning: `TM
Ei rtmtted Use: Yes ❑ No ❑ Spec Space
Co inn no land use required.
12,7f
a Business License:
Exists: Yes ❑ No, applicant notified to obtain business license
Notes:
Approved by Planning: •----_________ — Date: /// —?
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: it(7/f/
Site Plans: # ,Z
Building Plans: # Z
Building Permit#: Enter building permit# above.
Workflow Routing: Planning ❑ ppnittnator ,uilding
Workflow Sign-off: ►' ign-off for Planning(include notes from planning review)
Route Application Documents: ►' I uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: i tz 4 A.-.1Li/ Date:Li/ 4,
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_060116.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to A. cant:
Revision Notice 2: Date Sent to 'pplicant:
Revision Notice 3: Date Sen o Applicant:
❑ SDC Fees Entered: Was' Co Trans Dev Tax: ❑ Yes ❑ N/A
T'•.rd Trans SDC: ❑ Yes ❑ N/A
arks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Pe $'t Coordinator: Date:
I:\Building\Fonns\BldgPennitRvw COM_NoLandUse_070915.docx