Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00355
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 W� Date Issued: 07/28/2011
l 1'r!1 RI) Parcel: 2S 112 DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Replace (3) RTU's & (2) HP's, modify distribution ducts. 8/31/11, adding gas piping and ductless split system, no
change in valuation.
Contractor: GOHMAN MECHANICAL Owner: PACIFIC REALTY ASSOCIATES
14505 SE HWY 212 ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 658 -1892 PHONE: 503 - 624 -6300
FAX: 503 - 658 -6925
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/28/2011 $1,109.71
Class of Work: ALT Type of Const: IIIB Plan Review 07/28/2011 $277.43
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 07/28/2011 $133.17
Stories: 2 Info Process/Archiving - Lg Sheet (over 07/28/2011 $6.00
11x17)
Project Valuation: $40,000.00 Info Process /Archiving - Sm Sheet (up to 07/28/2011 $13.50
11x17)
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: 1
Heat Pump: 2
Appliances
Vent Fans: Vent Systems: Total $1,539.81
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: 1 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 • • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center. • •ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir ct ques 'ons to OUNC by - •mg r': '2.1987 or 1.800.332.2344. •
Issu d By: Permittee Si. nature: 47")(
4
Call 503.639.4175 by 7:00 a.m. for the next available inspec ".n 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.
CITY OF TIGARD
MECHANICAL PERMIT
1 111 1 1 • : COMMUNITY DEVELOPMEN Permit #: MEC2011 -00355
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S 112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Replace (3) RTU's & (2) HP's, modify distribution ducts.
Contractor: GOHMAN MECHANICAL Owner: PACIFIC REALTY ASSOCIATES
14505 SE HWY 212 ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 658 -1892 PHONE: 503 - 624 -6300
FAX: 503 - 658 -6925
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/28/2011 $1,109.71
Class of Work: ALT Type of Const: IIIB Plan Review 07/28/2011 $277.43
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 07/28/2011 $133.17
Stories: 2 Info Process /Archiving - Lg Sheet (over 07/28/2011 $6.00
11x17)
Project Valuation: $40,000.00 Info Process /Archiving - Sm Sheet (up to 07/28/2011 $13.50
11x17)
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: 2
Appliances
Vent Fans: Vent Systems: Total $1,539.81
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
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 f. , .w the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth .in OAR 952 - 001 -0010 through OAR 952-001-09'1. You may .• a cop of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: y ermittee Signature:
All
Call 503.639.4175 by 7:00 a.m. for the next available inspecti • n 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 ApplicatioREC i. FOR OFFICE USE ONLY
City of Tigard D Received _
Date /By: ) ii t4 Permit No.: M &-Cdr I— (X1 3S�
I r ° 13125 SW Hall Blvd., Tigard, OR 97223 JU L '� oC
Plan Review ►
- Phone: 503.718.2439 Fax: 503.598.1960 2 8 2011 Date /By: � ` • �/ 7 ( p
� Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Rids' ® See Page 2 for
Internet: www.tigard- or.gov B u h -v"1�1 C � N Method: / ' ) 1, /� ', Supplem Information
V
' TYPE &is i"gf „ t COMMERCIAL., FEE r SCHEDULE „65,0CHECIQ.ISTp ;.
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.
" g ..n ,�. 1 Value: $ 'f' j® —.,, , •''
«i . a" .,ym $` y ` . C' - •sa'k4"F aam8 °a+� X ,c:. S t - 3 F 'o p"
„ ?4 61''EGORY OFaCONS RUetibN4 .... ' ' , .. ;` „' A� ' 42E SIDEN U IPMENT / "SSYSTE M S $F EES*
❑ 1 -and 2-family dwelling commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
t a ' A _ ,t0 JOBB' FORMATIO AIV L'OCA�TIONh ", , ."'" Heating/cooling:
�.-- r.....xu.�.. .. y - A cond
Job site address: /,_-_,-- i . s Si�� 4 p/z L,•z>/ (requires site plan showing placement) 46 75
l Furnace 100,000 BTU (ducts /vents) 46 75
City /State /ZIP: ll r � .sk0 ' L. 97 a.4 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: // 0 Project name: '-- S Heat pump
�/�/�TG • / �//1 ��% 5 (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. OE 7, , K � A ”
� ' � � � ��'�' Water heater 23.32
Gas fireplace 33.39
leGP 44 -4F g .e:r '5 4av0 a /./P 15 /7/0 Flue vent for water heater or gas
fireplace 23.32
D757 u'T? o t' 2vc--T Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
' x : & '' ❑ iko- RTY-OWNER 4 - R ® r Chimney /liner /flue /vent 23.32
�.. o_... ru. u < Other: 23.32
Name: P4C 77 U S Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
{_ , " ` ' r A ttic /crawls acefans 23.32
� � APPLICANT � ```�, � - CONT'ACTw ' PERSOI\� , � � ��, p
Business name: 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
Fireplace
E -mail:
Range
: 4,, t a'4W tT CO1VrTRACTOR.: 1:', 'r. )i 0 ` i 1 l t, ? " Barbecue
Business name: �o.Iy Clothes dryer (gas)
J � Other
Address: /i5 S 5 - .4F: J Qi o� ' t ; `=,1,0*, - *" *GAL4PERMIT ` 1 r
City/State /ZIP: �k /,f'j �j / 07. s Subtotal
!/ �' — Minimum permit fee ($90.00)
Phone: (fin ) ���,_. .-4:7 Fax: (5 ) e i s„ 9 Plan review (25% of permit fee)
CCB lie.: //, c2 en State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
Authorized signature. days after it has been accepted as complete.
Print name: (?I�Z/g�� Wzyry T Date: 7/2 Fee methodology set by Tri- County Building Industry Service Board
I \ Building \Permns \MiOC- PermitApp.doe 9/09/10 440 -4617T COM/WEB)
Building Division
Over- The - Counter (OTC) Mechanical Permit
T I CARD Check List
Project Description: l " � 'ti ICt e- T(
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: Oregon Specialty Code: 240 IC)
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) ,%j Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump Z
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers • Gas Outlets
Woodstove Duct Work ( Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $ 44 0)O60 FEES DUE
$ ((, 7 Mechanical Permit Fee
$ '' , Plan Review
$ , 12% State Surcharge
$ i ,O Info Proc /Arch, Lg (over 11x17 $2.00)
Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff: 4 1;5 aT,5 t
Date /Time: $ ')3 TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \Building \Forms \OTC - MEC.docx 01/13/2011 f 1 ° Ti/