Permit J - •
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00241
"' DATE ISSUED: 5/12/03
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S113AC -00101
SITE ADDRESS: 16655 SW 72ND AVE 800
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P
BLOCK: LOT: 029 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: TI: 1 new 2 ton RTU, gas piping. 1 new unit heater, remodel existing distribution duct for new tenant.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 5/12/03 $271.70
PORTLAND, OR 97224 [MECPLN] Plan Rev 5/12/03 $67.93
[TAX] 8% StateTax 5/12/03 $27.17
Phone: Total $366.80
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 233
Mechanical Insp
Reg #: LIC 38868 • Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: Z Permittee Signature: � �- �- ���(,! ��1/} 9
Call (503) 639 -4175 by 7:00 P.M. for inspections ne -ded a nex.1%usiness day
MecJanical Permit Applicat ion FOR OFFICE USE ONLY
Received Mechanical 7 C
Date/By: Permit No'Q 3 - 0 0 0
Cit y Tigard Ti and Planning Approval Building
13125 SW Hall Blvd.
DateBy: Permit No.:
Plan Review Other
Tigard, Oregon 97223 Date/By: 5 '/ Z'aj�� J3 Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
I t':
Contact Case No.:
Internet: www.ci.tigard.or.us , e el � fl.
Contac Juris.: Z See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
f ew construction ['Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling __Commercial /Industrial Value: $ / � S 0 See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description 1 Qty 1 Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: /� ASS Sw 7 JAI 0 Gas heat pump 14.00
Suite #: T Bldg. /Apt. #: L Duct work 14.00
Project Name , Hydronic hot water system 14.00
ro
J Name—oPy T , 2O , t/ Residential boiler
Cross street/Directiofis to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Repair Lot #: r u nits 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/ tip tai o 7 'ere./ Go s P � i A / Q- Flue vent (water heater /gas fireplace) 10.00
_ Log lighter (gas) 10.00
7 ' ' ' ' " ' �7 / '7AirmDCe� , --'�'s Wood/Pellet stove 10.00
0 -1,S'77r. J ,a, i 71oni D": i -Fir& ,tick' 9a ? Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
)' OWNER 1 ❑ TENANT Other: 10.00
Name: /7,441, T� 05 / Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: Clothes dryer exhaust 10.00
City /State /Zip: Single duct exhaust
Phone: Ga5'__�c, Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: Gas heat pump **
E-mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: o / L2rrl p /5SS"4cr_ `Dt Fireplace **
Range **
Address: 971- i 7 t'' ` .live BBQ **
City /State /Zip: / 0 ; L.rtio , (7_ `- 7 . Clothes dryer (gas) **
Phone: -, -.�/ / Fax: 0, �.z - X 761 Other: **
CCB Lic. #: 3 : s�� Total:
Mec hanical Permit Fees*
Authorized C .41 Subtotal: $ , ` 1. 70
Signature: J 9 / �A Date: 5//.03 Minimum Permit Fee $72.50 $
-kW._ Z y t y t P lan Review Fee (25% of Permit Fee) $ (, `7. ,j
/ (Please print name) State Surcharge (8% of Permit Fee) $ ;�. 7 . / 7
TOTAL PERMIT FEE $ 3 /i 4,, 8Q
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Form \MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
6 di )
Commercial Fee Schedule: •
Total Valuation: `,Permit Fee: ;
$1.00 to $5,000.00 Minimum fee $72.50 /
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 tU
for each additional $100.00 or fraction � d u
thereof, to and including $10,000.00. / _ -� i /
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and /) .y
$1.54 for each additional $100.00 or a
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or \
fraction thereof, to and including � �
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assu Valuations Per_ Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor fumace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 50Ik to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU p
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets / 360
Each additional outlet 63 •
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms \MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION .% Bus)�essj amine: (503) 639 -4171 MST
BUP
Received /_ Date Requested — AM PM �_ BUP
Location / 6 . 1S- 'a ! Suite irk MEC 3 _daa ch
Contact Person 1 ( Ph ( ) S('l (D i T ? PLM
Contractor 0 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
1
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Gas ine
Smoke Dampers
Fin -
PART FAIL
E TRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA W1/0 3 j
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION MST
Business Line: (503) 639 -4171
BUP
Received Date Requested /i7,/ / 3 AM PM BUP
Location /ib 1o� Suite S MEC '5 " ^4360341
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
• Int Sheath/Shear , ,
Framing , P
Insulation
Drywall Nailing 404 till I. Ak
1
Firewall
/,(A/1.01. ` 1 ✓ � 7
Fire Sprinkler S �� C%�
Fire Alarm
Susp'd Ceiling
C /
Roof �� f`
I� / , /f1 d . �. /I1 4. /
Other
Final "
PASS PART FAIL /���� / J (,r W _ -
PLUMBING '- / - 7).(J v/ U `/
Post & Beam
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
C1 iAN AL
Post & Beam
Rou -h -In
mo e Dampers
Final
•j PART FAIL
L CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LJ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA l r-( 1 ,
Approach /Sidewalk Date Inspector ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL