Fillable (Without roof structure engineering) Community Development Department Building (City of Beaverton)

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(Without roof structure engineering) Community Development Department Building (City of Beaverton)

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Form B70-1011 Revised 01/15/16
Mechanical Permit No. _________________________ Plans Examiner _________________________________
(Without roof structure engineering)
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:
(Check which one applies): *Existing curb to remain__________ *New curb to be installed__________
1. The existing roof mounted HVAC unit (to be removed) has a total weight of _______________ pounds.
2. The proposed roof mounted HVAC unit (replacing the existing unit) has a total weight (weight includes new
unit, new transition curbs, economizers, and all other component weights) of _______________ pounds. The
proposed unit’s weight must be equal to or less than the existing unit.
3. The existing roof mounted HVAC unit (to be removed) has a total height of _______________ inches.
4. The proposed roof mounted HVAC unit (replacing the existing unit) has a total height of _______________
inches. The proposed unit’s height cannot be substantially taller than the existing unit.
5. The proposed roof mounted HVAC will be located in the same location as the existing unit being replaced.
6. The installation shall comply with the current adopted edition of the Oregon Mechanical Specialty Code.
7. The proposed work shall not be concealed until inspected and approved.
*This affidavit does not eliminate the need at the time of inspection in the field for: attachment of unit to existing curb
details; attachment of unit to new curb and new curb to structure details; an engineered design for unit anchorage
to existing curb or anchorage of unit to new curb and new curb to structure for units weighing over 400 pounds; plans
and details for unit locations; unit cut sheets; SEER/EER ratings, curb connections; smoke shut-down; etc. If multiple
units are involved list them below:
Existing Unit Weight: _______________ Pounds New Unit Weight: _______________ Pounds
Existing Unit Weight: _______________ Pounds New Unit Weight: _______________ Pounds
Existing Unit Weight: _______________ Pounds New Unit Weight: _______________ Pounds
Existing Unit Weight: _______________ Pounds New Unit Weight: _______________ Pounds
In addition, I understand the following is required at the time of permit application submittal:
A completed Mechanical Permit application
A copy of all the applicable information shall be available on the job site for all inspections.
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 REPLACING ROOF MOUNTED HVAC UNITS
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(Without roof structure engineering) Community Development Department Building (City of Beaverton)

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Completed 2 August 2020

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