Permit •
C ITY OF TIGARD MECHANICAL PERMIT
bf DEVELOPMENT SERVICES PERMIT #: MEC2004 -00822
201
- 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/2004
PARCEL: 2S112DD -00200
SITE ADDRESS: 15618 SW 72ND AVE
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
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: Replace grills w/ new & replace some existing duct work. Valuation $5000.00.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 12/21/20( $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 12/21/20( $5.80
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233-6911
Duct Inspection
Reg #: LIC 38868 Final Inspection
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.
Issued By: Permittee Signature:
(503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechnicid Permit Application FOR OFFICE USE ONLY
City of Tigard ED Receivd 'yam Z permit N o . 131SW Hall Blvd, Tigard, OR 9 C � ' @ DateB ,z / -,. 1 l ,c do d y - a)12 -p�
Plan Review Other Permit.
Phone: 503.639.4171 Fax: 503.59 .1 60 / • s; rEi DateBy: r k A L/ -go )
Inspection Line: 503.639.4175 E� 2 lop ■ r !I I( Date Ready/By: Suns: ® See Page 2 for
Internet: www.ci.tigard.or.us L A Notified/Method: . )( Supplemental Information
:, '` ��� f�. �Wpm '''cz � ^
4 `-, '` COMMERQI °A'L FEE *•'SCEtEDiJLE A3SECHECKLIST•
lI 1L •
�� Mechanical permit fees* are based on the value of the work
❑ New construction Cl. i • . i ' on/replacement
i, performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other: mechanical materials, equipment, labor, overhead, and profit.
y u
Va] e: $ Q O 0, 6 �
•; � r ,,�� ,� '° • • CATEG�ORY•OF CONSTRUCTION ! ,� : - '
RESIDENTIAL EQUIP MENT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling ommercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family Master builder ❑ Other: Description Qty. I Ea. I Total
. , ;,+JOB SITE INFORMATIO N. AND LO CATION . Heating/cooling
Air conditioning or heat pump
Job site address:
6--- 1 7 s ,..v `7 (requires site plan showing placement) 14.00
City/ State/ZIP: / i f AQst U ,ti�� a • Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: /9cG - a i D 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
1 ' , +'(. - a `" t''' Water heater 10.00 • r ,. �• I.OF •WORK
Gas fireplace - 10.00
R ee l G 42. L { i • J , V Lv a 4 4i/ 14 .vG Flue vent for water heater or gas
fireplace 10.00
ReA• 1-- -_ £evh e O% C)c-1i /N/ L. gai t a. AiGInJ Log lighter(gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
' RO . .. OWNER :., ( Chimney/liner/flue/vent 10.00
,
d I tIEIYANT; r 'k "r'; Other: 10.00
Name: Pic 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 •
::. `" ,'.:' ±C O • ' TA CT RSON Attic /crawlspace fans 10.00
r PE Other: 10.00
Business name: P/O ...'� lfoe i'4 Wit' G' Fuet t io
P�P� f;
Contact name: eR , e /L. -- $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 9 7 gr.- s e __ / 77 . i9'.4__ . Gas heat pump
City/State/ZIP: / 3 7( ,,ak. 6 O") 9,22_1- Wall/suspended /unit heater
Phone: 60 ) s / S .... s S ( 4 - 0 1 ) Fax: : 01 ) 43 g- 57, 7 Water heater
Fireplace
E -mail: Range
. ., ._ CTOR Barbecue
CONTRA
Clothes dryer (gas)
Business name:
Sf4 /4-% 3d�re-- Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7� ,.r0
Plan review (25% of permit fee)
CCB lic.:3 8' g ,4 - State surcharge (8% of permit fee) 5
TOTAL PERMIT FEE 7?•_,f 0
Authorized signature: This permit application expires if a permit is not obtained within 180
! days after it has been accepted as complete.
Print name: ifZ Kue_ r?. 80;A) Gti Date:/ Z`, v • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits \ MEC- PermitAoo.doc 12/03 440 - 4617T (1 I /02/COM/WEB)
• Mechanical Permit Application - City of Tigard `` -
Page 2 - Supplemental Information
Commercial Fee Schedule:
;T'ota'l Valuation ;r...^ j° Pernit Feei;;i
$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 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (5d3) 639 -4171 MST
cy BUP
Received Date Requested ,^, /e; - - z- AM PM BUP c�
Location 1 Suite MEC DD � ' Od o Z Z
Contact Person Ph ( ) 579 o/ 9 g 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 APAIV
PASS PART FAIL . ;/ W- Mir
PLUMBING ✓� MIN �
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Sm. ,Dampers
0:4 S PART FAIL
ELEC RICAL
ce
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call .r reinsp- , ion RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date ` /, Inspector Ext
Other:
Final DO N • REMOVE this inspection record from the job site.
PASS PART FAIL