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Permit CITY OF TIGARD „,.,�a MECHANICAL , _ . ,,. i ,, DEVELOPMENT SERVICES PERMIT ll� - -!�+� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # DATE ISSUED: 04 / 16M / 98 MEC98 -0136 8 PARCEL: 1S136DA -00100 SITE ADDRESS...: 11308 SW 68TH PKWY SUBDIVISION • ZONING: MUE BLOCK • LOT • JURISDICTION: TIG CLASS OF WORK.. :ALT FLOOR FURN : 0 EVAP COOLERS: 0 TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0 OCCUPANCY GRP.. :B VENTS W/0 APPL: 0 VENT SYSTEMS: 0 STORIES • 0 BOILERS /COMPRESSORS HOODS : 0 FUEL TYPES 0 -3 HP : 0 DOMES. INCIN: 0 :GAX 3 -15 HP : 0 COMML. INCIN: 0 MAX INPUT: 0 BTU 15 -30 HP : 0 REPAIR UNITS: 0 FIRE DAMPERS ?..: 30 -50 HP : 0 WOODSTOVES..: 0 GAS PRESSURE...: 50+ HP : 0 CLO DRYERS..: 0 NO OF UNITS AIR HANDLING UNITS OTHER UNITS.: 2 FURN < 1O0K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 0 FURN > =1O0K BTU: 0 ) 10000 cfm: 0 Remarks: Tenant improvement - mechanical. Adding two vav boxes. Owner: FEES PROVIDENCE HEALTH SYSTEMS type amount by date recpt 4805 NE GLISAN PRMT $ 25.00 B 04/16/98 98- 305004 PORTLAND OR 97 PLCK $ 6.25 B 04/16/98 98- 305004 5PCT $ 1.25 B 04/16/98 98- 305004 Phone #: Contractor: FULLMAN SERVICE CO LLC 5805 SW HOOD AVE $ 32.50 TOTAL PORTLAND OR 97201 -3716 Phone #: 224 -5221 Reg #.. : 122310 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Mechanical Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection 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 by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-01 -010 through OAR 952- 001 -0080. You way obtain copies of these rules or direct questions to OUNC by calling (503)246 -9187. Issue By: 6_ Permittee Signature: ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for inspections needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ • Plan Check #,� S CITY OF TIGARD Mechanical Permit Application Recd By 8 er 13125 SW HALL BLVD. Commercial and Residential Date Recd 1 4 - (0 TIGARD, OR 97223 Date to P.E. (503) 639 -4171, x304 Date to DST - i qg s• Print or Type Permit # I/ -1`►Q Called Incomplete or illegible applications will not be accepted e of Development/Project � Description t'1) V 1 el 'e A/1 LU .1. ) v Mathin &RV Table 1A Mechanical Code CITY PRICE AMT Job Street Address Suite# A) Permit Fee -0- -0- 10.00 Address l lbl7 f or LA) d h _ Bldg# [ City/State' Zip 1.) Fumace to 100,000 BTU 6.00 I (,t ,v i 01\ including ducts & vents Name (or name or business) � C �� I 2.) Fumace 100,000 BTU+ 7.50 Owner Prn V 1 d iv (.P, 1 J SkINIS including ducts & vents Mailing Address l 3.) Floor Fumace 6.00 4 5 ) t✓ ( 71 1 . ca .10 including vent C�'y(state Zip Phone 4.) Suspended heater, wall heater 6.00 1 (✓Y l l a in d 0)\ or floor mounted heater N (or name of business) 5.) Vent not included in appliance permit 3.00 Pf (.1 2) ftv) Occupant Mailing Address 6.) Boiler or comp, heat pump, air cond. 6.00 to 3 HP: absorb unit to 100K BUT City /State Zip l Phone 7.) Boiler or comp, heat pump, air cond. 11.00 3-15 HP; absorb unit to 500K BTU" Contractor Name . 8.) Boiler or comp, heat pump, air cond. 15.00 FU, (/(11 ■x A U/ l r 15-30 HP; absorb unit.5 -1 mil BTU" Prior to permit Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50 issuance, a copy S C ■G1,41 1 In )lcil 30-50 HP; absorb unit 1- 1.75mi1 BTU" of all licenses City/State Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50 are required if iooy ()( 6 02-n / 22y -5 221 > 50 HP; absorb unit 1.75 mil BTU" expired in COT regon Const. Cont. Board Lic.# Exp.p te 11.) Air handling unit to 10,000 CFM 4.50 2 database 1 2.31 () a Architect Name 13.) Non - portable evaporate cooler 4.50 Avl�- r, +sr.t1 Oahn)1,t)Sic.( _ or Mailing Address 14.) Vent fan connected to a single dud 3.00 l7os rC mi., o l v. 6/vKl 740 Engineer Airy/State Zip Phone 15.) Ventilation system not included in 4.50 limit O I 0 177 1 q Z,.. -7,2177 appliance permit Describe work New 0 Addition 0 Alteration ® Repair 0 16.) Hood served by mechanical exhaust 4.50 to be done Residential 0 Non - residential 0 Additional Description of work: 17.) Domestic incinerators 7.50 I Yl Su�.Z) V h V (j(X / 18.) Commercial or industrial type 30.00 /6/ f i�Qy» ✓414, A f - 171/ Incinerator Existing use of f 19.) Repair units 4.50 building or property 20.) Wood stove 4.50 Proposed use of 21.) Clothes dryer, etc. 4.50 building or property 22.) Other units 4.50 Type of fuel - oil 0 natural gas ® LPG 0 electric 0 23.) Gas piping one to four outlets 2.00 I hereby acknowledge that I have read this application, that the 24.) More than 4 -per outlets (each) .50 information given is correct, that 1 am the owner or authorized agent of the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL laws. Signature of Owner /Agent �Date *SUBTOTAL 1 C� �C% -r a 4 /// l / J/f 6 p 5% SURCHARGE Contact Person Name Phon PLAN REVIEW 25% OF SUBTOTAL L 7. 1 - 6,.> 1 TOTAL i:\rn chpmt.doc (rev 9 "Minimum permit fee is $25 + 5% surcharge • "Residential NC requires site plan showing placement of unit. OVER - THE - COUNTER (OTC) PERMIT COMMERCIAL MECHANICAL PERMIT CHECK LIST Description of Project: Tl — 14:2P /A/A 2 — Class of Work: ek-'r Floor Furnace: Evap Coolers: Type of Use: Co sh Unit Heaters: Vent Fans: Occupancy Grp: Vents w/o Appl: Vent Systems: Stories: Boilers /Comprsrs: Hoods: Fuel Types - 0 - 3 HP. Repair Units: / / / / 3 -15 HP. Wood Stoves: Max Input: Btu: Air Handling Units Clo Dryer: Fire Dampers: < = 10000 cfm: Oth Units: Gas Pressure: H / M / L > 10600 cfm: Gas Outlets: No. Of Units: Furn < 100k Btu: Furn > =100k Btu: NOTES: $ a 6 Permit Fee Gas Line Inspection $ �� Plan Review - anical Inspect • $ / a 5 5% State Surcharge Cooling Unit Inspection $ Additional Permit Fee Shaft Inspection $ Additional Plan Review Fee Hood Inspection $ Inspection Fee Fire Suppr Inspection $ Miscellaneous Fee Duct Inspection Fire Alarm Inspection Fire Damper Inspection REMARKS: Miscellaneous Inspection Fire Alarm Inspection 1. = nspection €<F t ;; £.t. ASS : PERMt`#'S;( REV) t ; new ;: .�tE3>��:addit�cg « Jtt_T.. aeon ACS aECesav ::>::>:::::>::><:::;;:::; :;;;;::;::;<.:;;::;;;• >:::;;::: FND found on; OTF€.!� other, DEM = dernnl on* REP::- : air, FPS 3z fire. otect on s . tem..NOTE_USE ©TH:FO FENCES, <:; >: > >> >i ` • RETAIMNG•WAL :.DEFACHEDDECKS ::SIGNS, AWNIN CANOPIE ;:: >:> , :::::::....::::.::::::..::.::::>:;;:><::::>::::>::><.::._.:.::...::... :.::.:::::::..::.....::::::.: >. is \ovrcntr.doc (dst) 8/97 1