Permit i CITY OF TIGARD, � �, MECHANICAL PERMIT
"" COMMUNITY DEVELOPMENT PERMIT #: MEC2007-00446 DATE ISSUED: 7/23/2007
�tttG�srsA 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135BD -00300
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD MEDICAL MALL
Project Description: Replace existing rooftop unit. Project Value: $6,000
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: 3 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
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:
> 10000 cfm:
Owner: FEES
HAZEL INTERNATIONAL, INC AND Description Date Amount
HIGASHIYAMA HIGHLANDS CO, LTD
BY NORRIS + STEVENS REALTORS [MECH] Permit Fee 7/23/2007 $159.50
PORTLAND, OR 97204 [TAX] 8% State Surcha 7/23/2007 $12.76
Total $172.26
Phone:
Contractor:
WILLAMETTE HVAC SERVICE
PO BOX 23334
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 628 -6841
FAX 503- 848 -2597
Reg #: LIC 56951
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 adopt d in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt.' copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is • ued By: _ ;.� Permittee Signature: k
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
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 - . 3 oEPF.VC Nalja �r T
'ff t City of Tigard Date/By. 7 �3 o Permit No.: No_eo96o7
V 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
a P hone: 503.639.4171 Fax: 503.598 1960 Other Permit:
� Date /By:
,T G A li D Ins Line: 503.639.4175 Date Ready /By: lures: g
Internet: www.ti and -or. ov Supplemental Se Page for
* = >- g g N oti fied/Method: � Supplemental l Information
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE USE CHECKLIST
ID New construction Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead and profit.
CATEGORY OF CONSTRUCTION
Value: $ 4
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 4 735 szAj n / Air conditioning or heat pump
is /// !�►,,,.. (requires site plan showing placement) 14.00
City /State /ZIP: Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: 3 4 Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
- DESCRIPTION OF WORK- Water heater 10.00
` Gas fireplace 10.00
n v I a- c, `, JO C V p,.,.\ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
. ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
• ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax::( )
Water heater
Fireplace
E -mail: Range
CONTRACTOR . Barbecue
Business name: `L 't- - `L � v i 4 v Clothes dryer (gas)
a-N'� Other:
Address: ]'JO )341 h cp. 3 3 3 9 MECHANICAL PERMIT FEES*
City /State /ZIP: a Dv q ?,g $l Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: S S'/ State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print name: — �� Date: �[ �'/� ' Fee methodology set by Tri- County Building Industry Service Board
1: \ Building \Permits \MEC- PermitApp.doc 01 /19/07 440 -4617T (11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$ 1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction •
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00' $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
•
fraction thereof, to and including • °
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and -
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
•
I:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: Mf:C2007- 081,16
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ! Ott ': ;
7 INSPECTION WORKSHEET FOR DATE: 10/171201, TIME: 7 :02AM PAGE: 18
C
SITE ADDRESS: 04735 SW SHADY L.N CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Replace existing rooftop unit. Project Value: $6,000
No plan review required.
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: WI HVAC SERVICE PHONE #: 603 00..68, 1
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Messgge
699 Mechanical final 057780 -02 603- 762 -4986 Y
Corrections /Comments /Instructions:
0 : 00
C4 A PARTIAL APPROVAL n CANCEL [ I NO ACCESS
AIL IN CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ■ Date: b 1 1 1 6 Phone #: (503) 718 -
MI