Permit CITY TIGARD MECHANICAL PERMIT
l l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00407
.,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 6/25/2004
PARCEL: 2S1 01 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 400
SUBDIVISION: TIGARD OFFICE BUILDING 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: Add fire /smoke dampers for new corridor addition.
Project Value: $2,000
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 6/25/200 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 6/25/200 $5.80
Phone: Total $78.30
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911
Final Inspection
Reg #: LIC 38868
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 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(50 46 - 6699.
I sued By: • ! � / J�,:� .� Permittee Signature: Ae (
Call (50 639 -4175 by 7:00 P.M. for inspections neede : the ext business day
Mechanical Permit Application FOR OFFICE USE ONLY
City o f Ti and Received �
`T g Date :' QV Permit No. i • ,,, ■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.639.4171 Fax: 503 4 ;\ Date/By: Other Permit:
Inspection Line: 503.639.4175 ;
Date Ready/By: liffill 0 See Page 2 for
Supplemental www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION . Value: $ a() 0 0
dwelling Commercial/industrial - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 -and 2-family g ❑ Accessory building
11 Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. Ea. _ Total
• JOB SITE INFORMATION AND LOCATION . . -, - . Heating/cooling
Job site address: t� DQ�„y Air conditioning or heat pump
a g o q 54., � Fl / /� ! (requires site plan showing placement) 14.00
City/ State/ZIP: r�J7 Furnace 100,000 BTU (ducts/vents) 14.00
_ Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
� CA�T� Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
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. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: _ 10.00
Tax map /parcel no.: Other fuel appliances _
• - DESCRIPTION OF WORK . . - Water heater 10.00
Gas fireplace 10.00
AD D F 1 77:/$ a — PGA- GORR/ DorL. Flue vent for water heater or gas
.Ql;D) to fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
�! ROPERTY OWNER I ❑TENANT Chimney/liner/flue/vent 10.00
` Other: 10.00
Name: /` "f�'7U5 Environmental exhaust and ventilation
Address: C Range hood /other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (316) 424,/.v3496 Fax: ( ) toilet compartments, utility rooms) 6.80
• ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR .. . • Barbecue
Business name: O �. ?
Clothes dryer (gas)
f Other:
Address: - '
�7$g S L / 7�JdV� MECHANICAL PERMIT FEES*
City/State/ZIP: Potiv 6 &. GIV,V Subtotal
Minimum permit fee ($72.50) 78,0
Phone: (93 )a33..Lem Fax: (503 a3 7.1 %4 Plan review (25% of permit fee)
CCB lic.: 3 8Gs ,.. State surcharge (8% of permit fee) 5
TOTAL PERMIT FEE ed
Authorized signatur ��,( / /_) %�J This p ermit application expires if a permit is not obtained wi hin 80
e V days after it has been accepted as complete.
Print name: /2 ,..,i Date: 7a 3704 * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Pcrmits'MEC- PemtitApp.doc 12/03 440 -4617T (1 I /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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received p Date Requested C � AM PMT Z-
►/, BUP
Location (� l v l j ( I Suite U 0 MEC �
Contact Person A Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: e ELR
Crawl Drain V4 � w
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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
os & e am
Rough -In
Gas Line
Smo e Dampers
I INP PART FAIL
ICAL
Service
Rough -In -i _%L
Low Voltage
����. Lo w Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL •