Permit CITY OF TIGARD MECHANICAL PERMIT
; N. .71 COMMUNITY DEVELOPMENT " Permit#: MEC2018-00706
T f G R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 , Date Issued: 10/04/2018
etc "�� 5 Parcel: 1S135DA02400
‘O\r Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Installing commercial hood. 10/25/18:REPRINTED to correct address from 11035 to 11045.
Contractor: V&A BUILDER LLC Owner: BROOKSIDE RCF LLC
16508 SE OATFIELD RD 5987 SE ROBHIL DR
MILWAUKIE, OR 97267 MILWAUKIE, OR 97222
PHONE: 503-502-5924 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/04/2018 $277.46
Class of Work: ALT Type of Const: VB Plan Review 10/04/2018 $69.37
Occupancy Grp: 1-3 Occupancy Load: 12%State Surcharge-Mechanical 10/04/2018 $33.30
Stories: Info Process/Archiving-Lg$2.00(over 10/04/2018 $2.00
11x17)
Project Valuation: $7,500.00
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:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $382.13
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 Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions tooO UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: \ �X\ Permittee Signature: 13� (. ;�W(1 ®(T1tc
���JJJ"`��� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. ,Y\ �+
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
• COMMUNITY DEVELOPMENT Permit#: MEC2018-00706
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/04/2018
A l D9 Parcel: 1S135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Installing commercial hood.
Contractor: V&A BUILDER LLC Owner: BROOKSIDE RCF LLC
16508 SE OATFIELD RD 5987 SE ROBHIL DR
MILWAUKIE, OR 97267 MILWAUKIE, OR 97222
PHONE: 503-502-5924 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/04/2018 $277.46
Class of Work: ALT Type of Const: VB Plan Review 10/04/2018 $69.37
Occupancy Grp: 1-3 Occupancy Load: 12%State Surcharge-Mechanical 10/04/2018 $33.30
Stories: Info Process/Archiving-Lg$2.00(over 10/04/2018 $2.00
11x17)
Project Valuation: $7,500.00
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:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $382.13
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 Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OU ' ' calling 503.2 . 987 or 1.801.332.2344.
Issued By: /‘T„�`' ^ Permittee Signature:
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 FOR Orel( 1. ( SF Oy1,1
City of Tigard S E[ 2018 n a `� 6. / Permit ��''oZU� ��
't13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II Phone: 503.7182439 Fax: 503.598.1960 Date/By: q "a.Y'j Other tit!CA P',00rj"�
r 1 G;\R D Inspection Line: 503.639.4175 Date Ready/By: Juris: //�(!�RI See Page 2 for
Internet: www.tigard-or.gov otified/Methorf7 l (lie., Supplemental Information
-
= h✓; �=WORK ,t, t'
�E* Sd ' %>
u ` yMechanical permit fees*are e on the value of tilework
wor
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$7500.00
. ' CA'IE € iEOlT1GOPI
1SW ., lAf� ,
❑ I-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
OB OM „�N AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:11035 SW HALL BLVD. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD OR.97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldgJapt.no.: I Project name:Brookside Memory Care 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: l Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
O. OF "OW(' ! Gas fireplace/insert ., 33.39
r°° Flue vent for water heater or gas
COMMERCIAL HOOD INSTALLATION fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove , 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
Q F ' OWNER t, ' 'El+leir;
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
>�e OpixOI r <,ctorrAcr PJM Other: 23.32
Business name:V&A BuilderLLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Vasile Handolescu Furnace,etc.
Address:16508 SE Oatfield Rd. Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Milwaukie Or.97267 Water heater
Phone:(503)502-5927 I Fax::(503)653-3970 Fireplace
Range
E-mail:v.a_builderlk@yahoo.com Barbecue
CONTT A "OI Clothes dryer(gas)
Other:
Business name:V&A Builder LLC
. . CTAI 1Cit.L 1 TEES* ,
Address:16508 SE Oatfield Rd. Subtotal
City/State/ZIP:Milwaukie Or.97267 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)502-5924 Fax:(503)653-3970 State surcharge(12%of permit fee)
CCB lic.:169582 ✓ r TOTAL PERMIT FEE
.tli► This permit application expires if a permit is not obtained within 180
-4r (, _ f days after it has been accepted as complete.
Authorized signature: GO' • Fee methodology set by Tri-County Building Industry Service Board
Print name:Vasile Handolescu Date:08-29-2018
1:1Building\Permits\MEC PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
totalValiatio Pernot
$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
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2018-00706
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor