Permit (73) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00441
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/16/2016
TIGARD g Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9609 SW WASHINGTON SQUARE RD LO2B
Project: Shoe Mill Subdivision: None Lot: None
Project Description: (1)VAV box,(1)exhaust fan,and duct work modifications for TI.
Contractor: HVAC INC Owner: PPR WASHINGTON SQUARE LLC
5188 SE INTERNATIONAL WAY PO BOX 847
MILWAUKIE, OR 97222 CARLSBAD, CA 92018
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/16/2016 $398.51
Class of Work: ALT Type of Const: Plan Review 06/16/2016 $99.63
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 06/16/2016 $47.82
Stories: Info Process/Archiving-Lg$2.00(over 06/16/2016 $4.00
11x17)
Project Valuation: $12,000.00 Info Process/Archiving-Sm$0.50(up to 06/16/2016 $2.00
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:
Appliances
Vent Fans: 1 Vent Systems: Total $551.96
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: VAV Box
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You .y obtain a copy of the rules
or direc =•-stions • •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued =y: — Permittee Signature: 1) ./
Call 503.639.4175 by 7:00 a.m.for the next available inspectio dat=.
This permit card shall be kept in a conspicuous place on the job site until corn• - on of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1(l It(l I l l( l l ',I. O\I l
Received
City of Tigard Date/By: 16 Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 AIS /�, , �� '��� -r
(`J' V Plan Review
i Phone: 503.718.2439 Fax: 503.598.1960RE Date/By: Other Permit: A /
r I�. Iz 1 Inspection Line: 503.639.4175 Date Ready/By: ® See Pagefor��`/
Internet: www.tigard-or.govJUN 1 d 2016 Notified/Method: #1110' Supplemental Information
TYPE OF WORD►` OF TIGARDw� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ DIVISION
Mechanical permit fees*are based on the value of the work
New construction Addition/alteratt performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$ a '��0 --
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling , Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
CrIfyi JOB SITE INFORMATION AND LOCATION Heating/cooling:
� )(�`ln C �,Q p Air conditioning
Job site address % SV) VV-(.J• ` J(" • `J p ir`oLk (requires site plan showing placement) 46.75
_ e D �� Furnace 100,000 BTU (ducts/vents)
46.75
City/State/ZIP: rk
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.:1)0).)51 I Project name: JV 1 p.. .., '\ ` Heat pump
IN
l (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
� Sc+ t` � \ `r \i‘ " 0-4N1 (� Gas fireplace/insert 33.39
v\ V � Ute' WIt� ��� Flue vent for water heater or gas
5V,r t /' VV/V)
�� v�I„ fireplace 23.32
tM 1N� ,�y 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
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name:HVAC,Inc. FuelP p r m
g:
Contact name:Jody DePew $14.15 for first four;$4.03 for each additional
Address:5188 SE Internaitonal Way Furnace,etc.
Gas heat pump
City/State/ZIP:Milwaukie,OR 97222 Wall/suspended/unit heater
Phone:(503)462-4822 Fax::(503)462-6555 Water heater
Fireplace
E-mail:jodyd @hvacincorp.com Range
CONTRACTOR Barbecue
Business name:HVAC,Inc. Clothes dryer(gas)
9,1/y.AOther.
Address: ..) MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee($90.00)
Plan review(25%of permit fee)
CCB lic.:50897 6/9,# State surcharge(12%of permit fee) i537,
} t TOTAL PERMIT FEE '74Authorized signature: This permit application expires if a permit is not obtaiwithin 180
days after it has been accepted as complete.
Print name:Jody DePew\ Date: X0 1 l { * Fee methodology set by Tri-County Building Industry Service Board
I:'Building\Permits\MEC-PennitApp.doc 03/07/12 440-4617T(I1IO2/COM/WEB)