Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: MEC2015 00425
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/30/2015
Parcel: 2S101AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: HVAC modifications and adding(1)vent fan for(3)new offices in the library,and(1)ADA restroom adjacent to the
library.
Contractor: OWNER Owner: GEORGE FOX UNIVERSITY
GEORGE FOX UNIVERSITY ATTN: FINANCIAL AFFAIRS
1101 N VILLA RD 414 N MERIDIAN
NEWBERG, OR 97132 NEWBERG, OR 97132
PHONE: 503-554-2011 PHONE:
FAX:
FEES
Specifics:, Description Date Amount
Type of Use: COM Permit Fee 06/30/2015 $84.41
Class of Work: ALT Type of Const: Plan Review 06/30/2015 $21.10
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 06/30/2015 $10.13
Stories: Info Process/Archiving-Sm$0.50(up to 06/30/2015 $0.50
11x17)
Project Valuation: $1,000.00
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: 1 Vent Systems: Total $116.14
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N• -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir, t questions to •■ —fling 503.232.1987 or 1.800.332.2344.
Is ed By: • Permittee Signature: (r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ,,E1 v E1) FOR OFFICE IISE ON 1
City of Tigard Date/By: �/�+ ` Permit No.: �C S.-/y�(f,Z
• 13125 SW Hall Blvd.,Tigard,OR 9722311 Plan Review Kw!
Phone: 503.718.2439 Fax: 503.598:1950 3 15 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: r�ris: ® see Page 2 for
TIGARD eady y g
Internet: www.tigard-or.gov an Or IIGAltD Notified/Method: Supplemental Information
13 U!ILDLJtIALL IS.I
•"--- TYPE OF WORK COMMERCIAL FEE* SCHEDULE– USE CHECKLIST
• Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit. _
CATEGORY OF CONSTRUCTION Value:$ `0� �-
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air Job site address:
/27.C..3 .544) 4 a Al Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7/6-4 ) 9722-3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 4,5, ' Re7t ,
Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Moeii`/, s"rz' % ,
'VC J -T Afs7/' fireplace 23.32
4' ) _ 7. ��? t)IA/� town ,r Log lighter(gas) 23.32
i' �I Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑TENANT ocher: _ 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) , 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue _
CONTRACTOR Clothes dryer(gas)
Business name:(EO zklf U A%, Other:
MECHANICAL MOUT FEES*
Address: Vid1 \I I...LA, Subtotal
City/State/ZIP: af4, t /*V Al la Minimum permit fee($90.00)
cos) 1 Plan review(25%of permit fee)
Phone:(cu,) 6s4-2p1% Fax:(SOS) 5S4.2 00A State surcharge(12%of permit fee) ,,I
CCB lie.: TOTAL PERMIT FEE +`/I. This permit application expires if a permit is not obtain 180
#11114 /// days after it has been accepted as complete.
Authorized signatu / / / * Fee methodology set by Tri-County Building Industry Service Board
Print name:, . -h •I Date: (p---34)-13
I:\Building\Permits\MEC PermitApp_040113.doc 440-46171(11/02/COM/WEB) •
1
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_040113.doc 2
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