Permit C ITY OF TIGARD MECHANICAL PERMIT
Ai DEVELOPMENT SERVICES PERMIT #: MEC2003 -00118
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/17/03
PARCEL: 1 S136DA - 00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
BLOCK: LOT: 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:
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:
Remarks: Alteration to existing ductwork
Owner: FEES
BENENSON 68TH PARKWAY Description Date Amount
KEY LLC, THE [MECH] Permit Fee 3/17/03 $72.50
BY FIRST AMERICAN TAX VALUATIO
WORCESTER, MA 01615 [MECH] Permit Fee 3/17/03 $5.80
Total $78.30
Phone:
Contractor:
HUNTER DAVISSON INC
1800 SW PERSHING
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 234 - 0477 Duct Inspection
Final Inspection
Reg #: LIC 01612
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: /� Permittee Signature:
Call (503) 9-4175 by 7:00 P.M. for inspections ne- red the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical An
Date/By: � I' 0 5 & L Permit No.: i f� ( Z 1 j
�1 - ct9 //9
Planning Approval Building 7
City of Tigard Date/By: Permit No.: p 2 403-0(.9/0s - -
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�ain I . ;rA Date/By: Case No.:
Internet: www.ci.tigard.or.us . � I I l Contact Juris.: ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 - Name/Method: Supplemental Information.
TYPE OF WORK :.COMMERCIAL FEE* SCHEDULE - USE CHECKLIST', -- :: :.:,
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
0 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: $ a&OtJ See Page 2 for Fee Schedule
❑ Accessory Building 0 Multi- Family RESIDENTIAL. EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description 1 Qty 1 Fee(ea.) 1 Total
❑ Master Builder ❑ Other: Heating/Cooling
•• JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: !(308" StA/
Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
Project Name: foa vJeit/CC /911 6, -A-ne_ Hydron t hot water system 14.00
Pro
1 Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
/441 AJCS 20 ,+-c) &,J 601 05 r O^/ Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
6dfr' P S�iz Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK . Gas fireplace 10.00
I0 /*2 &cam' / 64((k3 /3 Flue vent (water heater /gas fireplace) 10.00
A0.0
L.' AM Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
[]PROPERTY OWNER . 1 ESIENANT - Other: 10.00
Name: PvOv �J OA TIA (OATI�� Environmental Exhaust &Ventilation
Range hood/other kitchen equipment 10.00
Address: /(50,r Sc,i 6 a' i'H Clothes dryer exhaust 10.00
City /State /Zip: 7 02 5'72.23 Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
['APPLICANT I eCONTACT PERSON utility rooms) 6.80
Name: /10.4 nsZ a1 isSOA.1 — (U1}<.tr) /1 f (d/4VL Attic /crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR . Water heater **
Business Name: AA A/112_ ai9tx,Sp J
Fireplace **
0 Se R$2JG/W Range **
Address: /() BBQ **
City/State/Zip: : & RA/ 0 Clothes dryer (gas) **
Phone: `,, t O f 7 7 Fax: ,a /c-,2r- , Other: **
CCB Lic. #: , Total:
e cancal Permit Fees*
Authorized Date: 3 - �_o9 Subtotal: $
Signature: Minimum Permit Fee $72.50 $ 1 2_ . 5
✓ V `
.i)4 -v�.D ,1 n Plan Review Fee (25% of Permit Fee) $
l/ (Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
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 Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
. Page 2 - Supplemental Information
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
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
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.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount •
Furnace to 100,000 BTU, including 955
ducts & vents
Fumace > 100,000 BTU including ducts 1,170
& vents
Floor furnace 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
I01k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>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:
•
•
i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM -PM ' BUP
Location [) 3 d d 6 1 h/- Suite MEC 3 - C 6 lle
Contact Person Ph ( ) 7 'd 3 - / 73 7 PLM
Contractor 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
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In \ i
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P - T FAIL
4
• = Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl 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
Approach/Sidewalk Date "/ v d 3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL