Permit CI TY OF TIGARD MECHANICAL PERMIT
�;■ DEVELOPMENT SERVICES PERMIT #: MEC2004 -00661
�II- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/2004
PARCEL: 2S 113AA -00500
SITE ADDRESS: 16100 SW 72ND AVE B -18
SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L
BLOCK: LOT: 00A 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: Relocate ducts & grilles.
Project Value: $500
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 10/4/200 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 10/4/200 $5.80
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911
Final Inspection
Reg #: LIC 38868
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.
224 .
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application • FOR OFFICE USE ONLY
Received
City of Vlgar8
Date/By: (1, y P erm GA
Plan Review
i t N o.: /
GL +� T , /
y:
13125 SW Hall Blvd., Tigard, OR 97223 �
Phone: 503.639.4171 Fax: 503.598.1960 / / �Ad:Ai w , t� Date/By ; Other Permit j AV � � y�y
Inspection Line: 503.639.4175 � hi I y
__„ Date Ready/By: Ju9o! El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1( � Supplemental Information
TYPE OF WORK ' . _' COMMERCIAL FEE* SCHEDULE - USE'CHECKLIST
❑ New construction 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, and profit.
• CATEGORY OF CONSTRUCTION -
Value: $ 50 d , L
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling _CommercialIindustrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE SITE INFORMATION AND LOCATION • Heating/cooling
Job site address: it / 0 a '& j 7 2 / ¢ Air conditioning or pump
�! " o (requires plan site lan showin placement) 14.00
City/ State/ZIP: J /5:44n t D Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: ) o a k / , 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 trap /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
Gas fireplace 10.00
190 J) e ®a/ e- S V9- -5,..-- ilA.,,c (22/ -7e__-- igU (-)a, ,5 A Flue vent for water heater or gas
L fireplace 10.00
£t I i / i N/ i ) sv . I -4 1C"'° 47'" -- �3 � LyY _ � ./`/ t,crCC ip;=C Log lighter (gas) 10.00 ,
i/1a'f 2 ( S'i v"' 0 F. .1 t) l
6t Wood/pellet stove 10.00
. Wood fireplace/insert 10.00
❑ PROPERTY OWNER
Chimney/liner/flue/vent 10.00
❑ TENANT Other: 10.00
Name: / ..---• V d l 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
Other: 10.00
Business name: /�
/`�i / lyi„, 4J.f/ Gia ;L t ,2. /./ Fuel piping
Contact name: g2o e 4 { ,-- � C R $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
2 d sue. / / G ' n - -� a - Gas heat pump
City/ State/ZIP: /•.) A-50' 5' ) Z Z Z Wall/suspended/unit heater
Phone: ( i) 213_4 e // Fax: : (6-43) 2J -,, 7 23 Z Water heater
Fireplace
E -mail: Range
- CONTRACTOR Barbecue
•
Business name: Clothes dryer (gas)
r � e / �� , C'-P Other:
Address: MECHANICAL PERMIT FEES* '
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.:�3 g State surcharge (8% of permit fee)
TOTAL PERMIT FEE 22.6 0
/ This permit application expires if a permit is not obtained within 180
Authorized signature: ,ge4 days after it has been accepted as complete.
Print name: 13R ty e /3 y . l. ,, G ,, i Date: / _ 4.,/ ___„) * Fee methodology set by Tri County Building Industry Service Board
is\Building\Pcnnits\v C- PennitApp.doc 12/03 440- 4617T(11/02/CO IM/WEB)
Mechanical Permit Application - City of Tigard _
Paget - Supplemental Information
Commercial Fee Schedule:
Tb�al valua ion Pe mitt Fees°' x x
$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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ( ,,. Date Requested 2 7 454 k — AM PM BUP
Location ( `F' ( S Suite MEC 0 3
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Stab 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
Final
PASS PLUMBING 1111111
RT FAIL
Post & Beam I � � -
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA L
ECHANICAL
ost & eam
Rough -In
Gas Line
Smo : Dampers
al
PASS PART FAIL
ELEC ' - ICAL
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 D Please . for rei = section RE: 1 Unable to inspect — no access
Fire Supply Line
ADA / D _ • Inspecto • Ext
Iv
Approach/Sidewalk s
Other:
Final DO NOT REMOVE this inspect on record from the job site.
PASS PART FAIL