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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00019 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011 Parcel: 1 S 1260000300 Jurisdiction: TIGARD Site address: 9355 SW WASHINGTON SQUARE RD T19 Project: VERIZON WIRELESS Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Mechanical TI to modify existing duct work; provide and install (1) 12,000 btu Mitsubishi ductless split system. Contractor: ARJAE SHEET METAL CO, INC. Owner: PPR WASHINGTON SQUARE LLC 5510 SE MCLOUGHLIN BLVD. 2235 FARADAY AVE STE #0 PORTLAND, OR 97202 CARLSBAD, CA 92008 PHONE: 503 - 231 -7717 PHONE: FAX: 503 - 230 -4888 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 01/12/2011 $297.13 Class of Work: ALT Type of Const: VB Plan Review 01/12/2011 $74.28 Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 01/12/2011 $35.66 Stories: 2 Info Process /Archiving - Lg Sheet (over 01/27/2011 $6.00 11x17) Project Valuation: $8,200.00 Info Process /Archiving - Sm Sheet (up to 01/27/2011 $1.00 11x17) Fuel Air Handlers Fuel Types: Units < 10000 cfm: 1 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: 1 Heat Pump: Appliances Vent Fans: Vent Systems: Total $414.07 • 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 •regon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ma obtain a cop, of t rule or direct questions to • - • C by calling 503.232.1987 or 1.800. 2.2344. Issued By "ermittee Signature: � atif Call 503.6 ` " • =x :00 a.m. for the next availabl 'nspection .ate. This permit card shall be kept in a conspicuous place on the job site gtil co pletion of the project. Approved plans are required on the job site at the time of each - inspection. 1 Mechanical Permit ApplicationCED ' ( . Received p ,,� ea /9 � ax "o City of Tigard iir PermitNo!V�C.� /i ( y �� D•nc/Bc• /: �/ .� v • ." 13125 SW hall 131,vd.,'I igard,OR 97223 JAN 1 2 '�01 flan Review "'� ii i;. Phone: 503.639.4 171 Fax 503 Date:!By: f J l I' Other Permit �, �� ®/© � e: 2 4 2,...5" .� C' Inspection Line: 503.639.4175 �+V lads: El See Page 2 for K� TIGARD I ef Internet: vvww.tigard or.gov CITY OF Dine Ready /By: g Notified /Method; �i( nupplemental Information BUILDING DIVISION - ,., f 1't'E OF WORK _ C {!1\I L f FE *;'SCHEDULE US C HECKI 1ST:.' ❑ ®Addition /altcrati n , .r...... , _ .., New construction on /replacement Me.cllanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. FN 1 1 � Value $ 8200 00 ,� 7, '' - C �!'.CGORY OF CON STR LICT10Na — . 11'SIDI at. I I ,&EQUIPMENT / SYSTEMS EEES* I 111 1- and 2-family dwelling. ® Commercial /industrial ❑ Accessory building �. _._ Baal information use checklist. ❑ 1Multi- fnntily ❑ Master builder ❑ Other: o;. :..i Qty. Ea. Total JO ' 511I? INFO RIV I OCaVHON '`- - 1Ica nu /cooling � B � Air conditioning Job site addres° . sw Washington Square Rd (regri:rs site plan showing placement) _ 46.75 City/Slate/ZIP: "I•iga•tl Furnace 100.000 B'I'D (ducts /vents) 46.75 Purn■co 100.000 +13 (ducts /vents) 54.91 Suite /bldg. /apt. no •1.19 J Project name: Verizon Wireless Ilan ;lump 61.06 Cross street/directions to job site: Dnet n. tic 23.32 — — — 1lv drmie hot water system 23.32 — Re;i/'.rlitial boiler (radiator or hvaronie) 23.32 — _ — __ — _-- Unit heaters (fuel -type, not electric), in -, in -duct a rspended, etc. 46.75 Flue! am for any "I above 23.32 Subdivision: Lot no.: I — - I 1 23.32 Ta:; in;l•,'nt!rcel no.: 011111 me! appliances DESCRIPTION OF'! WORK _ ? a With 'cater 23.32 — _---- .---- ...------ -.__ —. Gas ii: enlace 33.39 Modify existing ductwork per plans I•Iue :ill or watcr heater or gas Provide and install (1) 12,000 btu Mitsubishi ductless split system fircpl:I c 23.32 Log lttauer tgas) 23.32 \V'I: ,t! • ;Het let stove 33.39 — — -- l \y,,,, ' Icltlace /insert 23.32 — — — Glum k y/I In: r /ilac!\vnt 23.32 I'ROI'LRT1. "O\VNER ,r TENANT , Ot 1rl . 23.32 Name: Flo i nnl csllaustand ventilation Pa;;_: +,nd'otlicr I itches Ad dress: cqui; • nit _ 33.39 City /State / /.IP: -- I c I, ' dryer •.•.\1•' 1st I 33.39 I :Sift suct cNhuu: t (bathrooms, Phone: — ) I Fax: ( ) — _site: •nipa:;inenis, utility rooms) 23.32 Z :.PPI..l( 'st' ❑ PERSON I /flu: inIsp;lccfans 23.32 = — = -- — — 1 0;t1' 23.32 13usines naine: Arjtie Sheet Metal I — — -- — — Fort :.;piny' Contact. name: heath Ruin:mister ` 514.15 for first four; $4.03 for each additional Address: Silt $1-_,' Mel . ougltlill — -- — p "vi etc . ___ (.1'r: -' 7i1 :iiii City /State / /II': Portland Or W,I:I�L.,;•;IVIt i': •:i1 heater I — — -- \Nate I -ate' -- Phone: (503) 231 -7717 Fax: : (503) 230 -4888 -- — I • ire, E -mail: heath a arjae.cont I 0a't•' ..& CONTRACTOR" .. 1 1 13,,!!, 13tsin_ • name: ar sheet metal 2, Addre :5510 se melnuglllin II CI IAN C i PERMIT FEES* City /: l tc / /.II': porll;tnd Or Subtotal -- — , — - 1 Minimum permit fee ($90.00) Phone: (503) 231 -7717 I r 903) 231 4888 —_ — f � Man review (25% of permit fee) CC13 lie.: 61)835 /Ti — — Slate surcharge (12% of permit fee) /, - - -- T - - - TOTAL PERMIT FEE t . 1;11.- ...ii 01 1 r n' :uien expires if a permit is.not obtained within ISO Authorized aien; t .I' - ' I 'In,a .'liar 1 has beim accepted as complete. i. Print name: c Date: / /2...---/ / -- — ' • : ,,,l 'Is a un set by Tri- Coty Building Industry Service Board t\ BoildiacA 'anuils'Air.:- !',•iwiiApp.do, I/dullS' . 440 461Tr( I1/02 /CIIMATIS) Mechanical Permit Application - City of Tigard Page - Supplemental Information Commercial & Multi- Family Fee Schedule: T o(al Valuation: Permit Fee: b11, ..4 $0.00 io $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. S 1 0,000.0 I 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. $50.0t "1.01 to S100,000.00 $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. S 1 00,000.01 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 \13uildi c \I'cm ilts \ \IFC- PermivApp.doc 10/01/09 2