Permit (7) CITY OF TIGARD MECHANICAL PERMIT
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;., COMMUNITY DEVELOPMENTth
Permit#: MEC2019 00750
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2019
TIGARD Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15875 SW 74TH AVE
Project: NW Mothers Milk Bank Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: Replacing RTU and installing new supply/return ductwork with registers.
Contractor: WILLAMETTE HVAC LLC Owner: JDS LLC
3075 SW 234TH AVE.#206 CRITERION CREEKVIEW LLC
HILLSBORO, OR 97123 BY SPECTRUM REAL ESTATE ADVISORS
1125 SE DIVISION ST#209
PORTLAND, OR 97202
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/13/2019 $601.71
Class of Work: ALT Type of Const: VB Plan Review 11/13/2019 $150.43
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 11/13/2019 $72.21
Stories: Info Process/Archiving-Lg$2.00(over 11/13/2019 $6.00
11x17)
Project Valuation: $20,000.00 Info Process/Archiving-Sm$0.50(up to 11/13/2019 $10.50
11x17)
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 $840.85
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
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 pules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ,ay •btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. `— ,
Issued By: `�„L Permittee Signature: /
Cali i .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 ONLI
City of Tigard ReceivedII aa
k Date/BY IU �� el a* Permit No• b--4,4020/7 r.00 7S
13125 SW Hall Blvd.,Tigard,OR 97223
Plan R�ieQ.. ��
Phone: 503.718.2439 Fax: 503.598.1960 , Other Permit:
k_ Date/B
T 1 G A K D Inspection Line: 503.639.4175 Date Ready/By: v
uns. H See Page 2 for
Internet: www.tigard-or.gov OCTJ019 otifie ethod: ` Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
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.
Value:$$20,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family El Master builder ❑Other: Description Qty. Ea. Total
Heating/cooling:
JOB SITE INFORMATION AND LOCATION
Air conditioning
Job site address:15875 SW 74th Ave. (requires site plan showing placement) 46.75
City/State/ZIP:Tigard OR 97224 Furnace 100,000 BTU(ducts/vents) 46.75
/ /� Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no ,I Project name:Mother's Milk 6.47k/k,L, 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
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
– — Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
Push/pull 7.5 ton RTU. Flue vent for water heater or gas
Install new supply/return ductwork with and registers. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER 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
Phone:( ) Fax:( ) Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
® APPLICANT 0 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 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 lic.:56951 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: / /'`�'t�� This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Print name:michael malstrom Date:10/23/19 * Fee methodology set by Tri-County Building Industry Service Board
C\Building\Permits\MEC-PennitApp.doc 03/07/12 440-4617T(11/02/COM/WEB)
City of Tigard
.1114a COMMUNITY DEVELOPMENT DEPARTMENT
1
T1cARD Building Permit Review — Commercial - No Land Use
Building Permit #: ` 6, --
Site Address: / )f) -2/4 Ate_ Suite/Bldg#:
Project Name: 4i /j,>is Olt,`/k-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review / /
Proposal: /71 e t�-e omit I i"9ph-e- 'xCi,Z7 1 7 h f /fit/
Existing Business Activity: /U/4 II�PC-1 eu/ 6 1
Proposed Business Activity: 1/ // /I
Xerify site address/suite# exists and active in permit syste .
11 iver Terrace Neighborhood: E Yes ri No
ICJ Zoning: /—P
-lel, ermitted Use: ❑ Yes ❑ No ❑ Spec Space
C nfirm no land use required.
Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: _ /4 Date: 6 •
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: (U /2 47
Site Plans: # 2
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: lanning ❑ P oordinator ilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: { Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
i
By Permit Technician: AA , Date: /(2/27 .7
I:\Building\Forms\B1dgPermitRvw_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 App ant:
Revision Notice 2: Date Sent to ' .elicant:
'Revision Notice 3: Date Sent Applicant:
❑ SDC Fees Entered: Was o Trans Dev Tax: ❑ Yes ❑ N/A
d Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Pe
Approved by P rmit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx