Permit •. •
CITY TIGARD MECHANICAL PERMIT
�� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00589
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/7/03
PARCEL: 2S111 DC -00701
SITE ADDRESS: 15985 SW 72ND AVE
SUBDIVISION: FANNO CREEK TRACTS ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 2
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: 1
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: 1
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: TI: Beauty salon.
Owner: FEES
PACIFIC REALTY Description Date Amount
15350 SW SEQUOIA PKWY #300 [MECH] Permit Fee 10/7/03 $72.50
PORTLAND, OR 97224 [TAX] 8% StateTax 10/7/03 $5.80
Total $78.30
Phone: 503 624 - 3000
Contractor:
MK CONSTRUCTION & TRADING
6633 NE SANDY
PORTLAND, OR 97213 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 335 - 3726
Final Inspection
Reg #: LIC 133894
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 -00
Is ed By: \ ;,,:iI� l i j Permittee Signature:
_ Call (503) 6 = -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
Date/By: Permit No.:In 'S,3 - a) 5 9
City of Tigard Planning Approval Building (�
y g Date/By: Permit No.�,�lJ 1 .Dg73 - OD �P03
13125 SW Hall Blvd.
A,. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
� Date/By: No.:
Internet: www.ci.tigard.or.us A 1` Contact Juris.:
® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees' are based on the total value of the work
0 Additio ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description 1 Qty 1 Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: . address: 4 S2J grs w 1 2 tkv e Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
l,o t..3 PACi'�1C Hydronic hot water system 14.00
Project Name: S
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
S W U PPE4a 130.0 N 'ES FF 1:112 4 Unit heaters (fuel, not electric)
d P G.0t -1 'Rini NESS PA-5 1U ) (in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15 _
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
( � NA-oJ 1 1 M p 20 d E'M F M T Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
- Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
[PROPERTY OWNER 1 ❑ TENANT Other: 10.00 _
Environmental Exhaust & Ventilation
Name: NU iC 4/4Li -f ACSoc- A- S _ L. P Range kitchen equipment 10.00
Address: (1 Sw SEQuoi A - pkwy if 3 DO Clothes dryer exhaust / • 10.00
City /State /Zip: F tL p p Q or? P 24 Single duct exhaust
PhoneCP^.) 62¢ 3 0O 0 Fax: (Sn3)( 24)7 ) S (bathrooms, toilet compartments,
9 APPLICANT _ ❑ CONTACT PERSON utility rooms) 9 6.80
Name: M t thi s. t'LiI Chia A 4.' A-p),. - LLC Attic /crawl space fans 4 10.00
Address: , E,3 5 N� g c v i) Other: 10.00
�( Fuel Pipin
City /State /Zip: f.oCUtj si p l o Q eci 2A 3 * *($5.40 for first 4, $1.00 each additional)
Phone Sa ; 3x_31 V I Fax: Gas heat e •*
pump
E -mail: WalUsuspended/unit heater ••
CONTRACTOR Water heater • •
Business Name: M -(Dug ; uc l - ., - r
�afD /At* ;mi. t* Fireplace •'
Address: 6 3 3 N ESA -N P y l) l u D Range •*
City /State /Zip: rof - u -lad pt 00 Q 1 Clothes dryer (gas) ••
Phone:(3) i 3.t -3 f F�S.tc 3)7i1� - 8 2 3 Other: **
CCB Lic. #: 4 2 q Total:
2 3 1 9 S Mechanical Permit Fees*
Authorized g n
Signature:
Si l.t _ -n 2oQ3 - Date: Subtotal: $
gatur �¢� Minimum Permit Fee $72.50 $ 7�. 4.3
i4-44A-t--5-44 AV A--*-3 k LA-M Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5 O
TOTAL PERMIT FEE $ 7R', 3o
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri-County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
•
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
•
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP 3 — O �644
Received Date Requested l0 — 1 AM PM BUP
Location / 6 g 77.4i4 l�'U'� Suite MEC 3 o '7
Contact Person Ph ( ) 7 a d -*boo? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain 6 U ( - *tar ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors q�o� � " / <<G L 4 g L
Ext Sheath/Shear
Int Sheath/Shear c /C._
Framing
Insulation
Drywall Nailing
f irewal �
ire Sprin
Fire Alarm
Susp'd Ceiling
Roof
Other:
Ina
PART FAIL r
PLUMBING
Post & Beam
Under Slab /
Rough -In
Water Service I
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
PART FAIL
E CTRICAL
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: Unable to inspect - no access
Fire Supply Line
ADA Date / Z - / - a 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection- record from the job site.
PASS PART FAIL