Permit CITY OF TIGARD MECHANICAL PERMIT
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��,� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00627
��I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG
Project Description: Replace existing AC 2 with new, add new cooling unit split system and new grilles in switching station
equipment shed. Located in north end of parking lot. Value: $9,600.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
Owner: FEES
TIGARD TRIANGLE I LLC Description Date Amount
4650 SW MACADAM AVE STE 220 [MECH] Permit Fee 10/3/200f. $224.30
PORTLAND, OR 97201 [TAX] 8% State Surchar€ 10/3/200f $17.94
Total $242.24
Phone:
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97222
Phone: 503- 462 -4822
Reg #: LIC 50897
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 503 - 246 -6699
or 1- 800 -33 - 44.
Issued =\ : /_ / _ i �,; Permittee Signature: _A
Call 503 - 639 -4175 by 7:00 a.m. for inspections thag Ines: day.
This permit card shall be kept in a conspicuous place on the job site • I completion of the project.
Approved plans are required on the job site at the time of each inspection.
MP.chfanical Permit Annlication FOi( ()Frick i si: OVi v
City of Tigard D�By: to i t 6 ' 0 I Permit No.: , it .„ 606 a
13125 SW Hall Blvd., Tigard, OR 97223 it:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 , r . :; p��g Other Perm
Inspection Line: 503.639.4175 J
� ' I � � Date Ready/By: FRI y: See Page 2 for
Internet: www.ci.tigard.or.us ,,,,,;.�. Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction E.Additio terati placement 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: $ `6 4;00. 00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling t /Commercial/industrial ❑ Accessory building
❑ Multi - family For special information use checklist.
❑ Master builder ❑Ot her. Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Ct Air conditioning or heat pump
Job site address:
13 a a 1 SW (0s Pe (requires site plan showing placement) 14.00
City / State/ZIP: Fumace 100,000 BTU (ducts/vents) 14.00
_ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:
Ut �n bu 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
rep[A" ,MO(S J 1'r, , AC a -. ,1 4., f a Flue vent for water heater or gas
() J / fireplace 10.00
1 e..{. I LI C OC LC�I4 x 4 T ` V V'✓1 a N ef.4) Log lighter (gas) 10.00
ey ..:, � Wood/pellet stove 10.00
r Wood fireplace/insert 10.00
Tf PROPERTY OWNER I ❑ TENANT Oi t er: y/liner /fiue/vent 10.00
+ Other: 10.00
Name: _ - /'a*-g- 7 ,f , Lf.. / Environmental exhaust and ventilation
Address: 44/4' <j rind a/p NJ SrE '-,0 Range hood /other kitchen
equipment 10.00 •
City /State/ZIP: jfLQ 41/2- 97 AO/ 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; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZIP: WalUsuspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E-mail: Range
CONTRACTOR Barbecue
Business name: 6 ' 1 a t� Clothes dryer (gas) ,
1 r _ Other:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Phone: ( ) I Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
f This permit application expires if a permit is not obtained within 180
Authorized signature: P.,13 yJ (/1/l/a/P days after it has been accepted as complete.
Print name: 5 ke/J`7 v .t___ t S. yl Date: :\B � • Fee methodology set by Tri- County Building Industry Service Board
I
iuilding\Pe mitsMEC- PmnitApp.doc 12/03 44 I7T (1 /o2/ COM/W®)
Mechanical Permit Application - City of Tigard
Paget - S up p leme n tal 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 \PenmitsMMEC- PennitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MFG2006-00627
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10f4 /7U0!.,
Phone: (503) 639- 4171u -"t
Inspection Requests (24 Hrs.): (503) 639 -4175 ;'I
INSPECTION WORKSHEET FOR DATE: 1/6/2006 TIME: 7:OOAM PAGE: 16
SITE ADDRESS: 13221 SW 69TH PKWY CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: VERIZON CUE BUILDING
DESCRIPTION: Replace existing AC 2 with new, add new cooling unit split system and new grilles in switching
station equipment shed. Located in north end or parking tot. Value: $9,600.
OWNER: TIGARD TRIANGLE I LLC, PHONE #:
CONTRACTOR: HVAC INC PHONE #: 603 - 462.41822
Inspection Request Scheduled For: Date: 1/ &2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 024429-01 971 - 221.6344 Y 1+74 1 t 54--
Corrections /Comments/ Instructions:
• C./
•
i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
YO Inspector: Date: 1 Phone #: (503) 718