Permit CITY TIGARD MECHANICAL PERMIT
Al 4411 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00089
- I ± 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 3/3/04
PARCEL: 2S112DC -00100
SITE ADDRESS: 15675 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Extend air lines to production area. $1295 valuation
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 3/3/04 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 3/3/04 $5.80
Phone: Total $78.30
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202
Phone: 239 - 4600 Final Inspection
Reg #: LIC 33135
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 c Iling
(503)246-6699.
Issued By: Permittee Signature: A il r
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY .
Received 1 Mechanical
Date/By: 1 1 -3 /b q yo/--- Permit No.intL aiVy pV0 g 7
Cit of Ti ilyd Planning Approval Building
.7 b Date/By: Building
No.:
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
Emil t 1 Date/By: Case No.:
Internet: www.ci.tigard.or.us �� I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' - Name/Method: Supplemental Information.
: TYPE OF WORK ' FEE *SCHEDULE' . USECHECKLIST • :.'.
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
[ Addition/alteration/replacement ❑- other: ate the value (rounded to the nearest dollar) of all
.. - ,' •CATEGORY-OF C _ ONSTRUCTION ';'r' ` .:r mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling E 'Commercial/Industrial Value: S f f " See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family . RESIDENTIALEQUIPMENT/SYSTEMS FEE* SCHEDULE . .
Description 1 Qty 1 Fee(ea.) 1 Total
El Master Builder ❑Other:
Heating/Cooing
-. JOB SITE'INFORMATION:lid LOCH ION -:'".' :. s Furnace - add -on air ,conditioning** 14.00
Job site address: /L-616- SW 7 A AN, G Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
Project Name: / j� K tr GOLf Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters•(fuel, not electric)
(in wall, in duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units " 12.15
Other Fuel Appliances_
Tax map /parcel #: . Water heater 10.00
• .. _ .. - :DESCRIPTION•OF WORK •: .: Gas fireplace 10.00
L..% ,rizi Jesi, _4 l R L)wl T 0 Pile . arr fin/ Flue vent (water heater /gas fireplace) 10.00
f2iP� • Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
❑°PROPERTYOWNER ::"';'••:-.'::[..! li TENANT' :'' ::_'T `- - Other: 10.00
Name: N,, , 619Lr Environmental Exhaust & Ventilation
t Range hood/other kitchen equipment 10.00
Address: l ,.,-6 "tr s W 7;_ra __Iwo.
Clothes dryer exhaust 10.00
City /State /Zip: j ; ,a Q V _ 97 2L 4
Single duct exhaust
Phone: FaX' (bathrooms, toilet compartments,
'Q'APPLICANT ::,. '.. ONTACTPERSON- utility rooms) 6.80
Name: R0>4 hrikr , j , - 50,1 f Attic/crawl space fans 10.00
Other: I 10.00
Address: 13 .9 5 E 6.,.141'0,4 TT
Fuel Piping
City /State /Zip: (Jog., t.-0Nej Oa ii 2 2,,, ••(s5.40 for first 4, $1.00 each additional)
Phone: 503- 23 1 Fax: 23, 7o3 $ Furnace, etc. ••
Gas heat pump • •
E -mail: 5MITTy f)Ael taxi c -0N MfA'.bTiN ..AjrY Wall/suspended/unit heater ••
CONTRACTOR �q 1 r• Water heater ••
Business Name: A wi gt, c A,,1 1 k..jj $aG . Fireplace ••
Address: 1,33 SE 6,-.,„,,,„-,, r�} Range ••
City/State/Zip: A/1TL•,11.4J OR G) wL Clothes dryer (gas) ••
Phone: s-93 23 x^1600 Fax: R3°1 ='7 Other: _ ••
CCB Lic. #: 3 a — Total:
Authorized Mechanical Permit Fees*
Signature: Date: 3i3/4/ Subtotal: $
Minimum Permit Fee $72.50 $ - •
J1 GAB 'k r _r. 5;,,r4/ Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ , j • jf V
TOTAL PERMIT FEE $ )
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service froai
180 days after it has been accepted as complete. ••Site plan required for exterior A/C units.
i:\Dsts\Permit Forms \ M ec Perm i tApp .doc 0 1/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503),j 5 -
INSPECTION DIVISION Business Line: (503) • • + MST
BUP
Received Date Requested _3 -4/ AM PM BUP
Location /5 69 75-- " 411i Suite C MEC 1 f — D 00 8r
Contact Person Ph ( ) 7 / 3 - as6 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner CO L r G ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: j, SIT
Post & Beam !�- `T' `l k�'✓
Shear Anchors
A (7 iitx (it «./ c,,,r sLe,,
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
V") i
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
Smoke Dampers
Ina
PART FAIL
TRICAL
Service
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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date - 3A - Y Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL