Permit C ITY OF TIGARD MECHANICAL PERMIT
4"'NW� A DEVELOPMENT SERVICES PERMIT #: MEC2004 -00613
JII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/2004
PARCEL -00500
SITE ADDRESS: 15883 SW 72ND AVE BLDG -B
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 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: 1 DOMES. INCIN:
ELE 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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Walk - in freezer. Value: $11,250
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 9/14/200 $249.05
PORTLAND, OR 97224 [MECPLN] Plan Rev 9/14/200 $62.26
[TAX] 8% State Surchart 9/14/200 $19.92
Phone: Total $331.23
Contractor:
SHEPLER REFRIGERATION
3961 N WILLIAMS AVE
PORTLAND, OR 97227 REQUIRED INSPECTIONS
Phone: 503 - 282 - 7255 Cooling Unt Insp
Final Inspection
Reg #: LIC 92342
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 -00 e . • r• • • h OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503 "46 -6699.
/
■ Is ued By: L !�1�ri 4, ,i I / ' Permittee Sign re: J��� �
/ .
cl
Cal - ' 9-4175 by 7:00 P.M. for inspections needed the next business day
IS8831'5 tea 7
ed,hu� W11tT
Mechanical Per - t' FOR OFFICE USE ONLY
•
� ® Received
City of Tigard Date/By: 7 p 6 J Permit No.;,„ - I ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.5 8 0 1 4 2004 Uds , v I Ix, Date/By: f' - Z 9 ' 0 `9 A j - Other Permit:
Inspection Line: 503.639.4175 JJ ' { _oj,1 A 1 I Date Ready/By: lin ® See Page 2 for
Internet: www.ci.tigard.or.us CITY ( O F TI �F}G (A�Rj D Notified/Method: Supplemental Information
BU• �� 1 YY y`VO , :COMMERCIAL FEE* SCHEDULE = USE CHECKLIST
• ❑ New construction EL Addition /alteration/replacement 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, an profit.
• CATEGORY OF CONSTRUCTION • - . Value: $ Q q----
•. - RESIDENTIAL EQUIPMENT A YSTEMS FEES*
❑ 1- and 2- family dwelling ZCommercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION - Heating/cooling
Job site address: ! Air conditioning or heat pump
c � �'3 �' V (requires site plan showing placement) 14.00
City/ State/ZIP: --- r( G>e) 2D 0 62, g 122-4- Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.:( 2 Project name: EV A I>�- -� ap34 -41 Furnace 100,000+ BTU (ducts/vents) 1
LT
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
) P'i: t�� 1 N5TPS tL A W UL- 1 N EF- €EZEE- Flue vent for water heater or gas
U ACA _ _ \ r ,� (_ O Y1 Eb \ fireplace 10.00
<
rte{- L}zIte �>7 L Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00
.. Other: 10.00
Name: 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 ❑ CONTACT PERSON • Attic /crawlspace fans 10.00
Business name: 5 LI P V r Other: 10.00
Y\
Fuel piping
Contact name: ,.j 0,1 l 1N/N (S $5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
1 (). N'\ C . _a Gas heat pump
City/State/ZIP: �� Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
•
� r \ } Clothes dryer (gas)
Business name: � � /
S =tC �� 1,....--) ' Other:
Address: c�� e ` 1 , u 1 Lek `v ") P1'VG= MECHANICAL PERMIT FEES*
City/State/ZIP: p, cF--Z � f -as o t\ 122 7 Subtotal Rcfi - pg'
) Fax: (�p1j) `L gZ'"7 6'� Minimum permit fee (572.50)
Phone: (
Z� �2 � Plan review (25% of permit fee) , y(p
CCB lic.: 12 3 i State surcharge (8% of permit fee) /2 - y y
"I_ 11- o 1 / 1 TOTAL PERMIT FEE 32,/, a
Authorized signature: ' ` /V„ ThIs permit application expires if a permit is not obtained within 80
t� days after it has been accepted as complete.
Print name: OM-y\F pi t - Ie_g_t s I Date: 9 ( • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Petmits\MEC- PennitApp.doc 12/03 440 -4617T (11 /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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1/ AM PM BUP
Location / 5 S S3 47d, Suite MEC a00
Contact Person Ph ( ) Z$ �- - 7�5� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ��%✓ -- �� . -i1. - �' , ELC
Footing
Foundation ELC
Ftg Drain Access: 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 I
Roof
if
Other:
Final
PASS PLUMBING FAIL MORA ___ 1
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
'ASS . PART FAIL
EL RICAL
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 ca or reins' -ction RE: ❑ Unable to inspect — no access
Fire Supply Line Kt, 1
i
Approach/Sidewalk Date Inspector l , / Ext
Other:
Final DO NOT REMOVE thls Inspection record from the job site.
PASS PART FAIL