Fillable Commercial Mechanical Affidavit For Alterations Or Tenant Improvements (City of Beaverton)

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Commercial Mechanical Affidavit For Alterations Or Tenant Improvements (City of Beaverton)

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Form B70-1032 REV 4/14
Mechanical Permit No. __________________________ Plans Examiner _________________________________
(without plans)
(Submittal of form by fax or at over-the-counter times)
Project Name: __________________________________________ Occupancy: ____________________________
Job Address: ___________________________________________ Type of Construction: _____________________
Suite: _________________________________________________
Contractor: _____________________________________________ Phone: ___________________________________ Phone:
I, ___________________________________, Oregon Construction Contractors Board No. ____________, certify the
following is true and reasonably defines the scope of work for this project:
1. All work is limited to one or more of the following:
Bathroom exhaust fan installations and/or replacements.
Commercial kitchen exhaust fan replacements. (Fan Unit Only)
Other ventilation fans with exhaust ducting installation. (Limit 1) (No Type I grease hoods)
Gas piping alterations. (which do not increase the existing systems overall Btu/input demand)
Ceiling diffuser relocations and minor duct extensions. (Duct extension limit 2, not to exceed 12ft ea.)
Re-connection of a rooftop unit(s) less than 400# for re-roofs (same unit).
2. The proposed work does not penetrate or is not located within any fire resistive assemblies.
3. The proposed work does not require seismic bracing.
4. The proposed work does not require structural calculations.
5. The installation shall comply with the current adopted edition of the Oregon Mechanical Specialty Code.
6. The proposed work shall not be concealed until inspected or approved.
In addition, I understand the following is required:
A sketch attached to this document showing the area of work within the building’s structure, and
A copy of this document shall be available for all inspections.
A completed Mechanical Permit application.
Signature: _________________________________________________________ Date: _____________________
CITY OF BEAVERTON
Community Development Department
Building Division
12725 SW Millikan Way / PO Box 4755
Beaverton, OR 97076
Phone: (503) 526-2493 Fax: (503) 526-2550
General Information (503) 526-2222
BeavertonOregon.gov
COMMERCIAL MECHANICAL AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS
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Commercial Mechanical Affidavit For Alterations Or Tenant Improvements (City of Beaverton)

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Completed 2 August 2020

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