Permit C ITY OF TIGARD MECHANICAL PERMIT
k DEVELOPMENT SERVICES PERMIT #: MEC2004 -00774
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/2004
PARCEL: 2S 113AB -00101
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200
SUBDIVISION: ZONING: IP
BLOCK: LOT: 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Upper level relocate (8) diffusers - (7) return grille.
Lower level relocate (1) return air & (5) supply air diffusers.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 12/1/200z $84.00
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 12/1/2002 $6.72
Phone: 503 624 - 6300 Total $90.72
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: Misc. Inspection
hone: 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.
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 � /�
1 S Tigard RECE' V Date/By: / 2 -/ - 0 y' I/2-/ Permit No.�1 .. 20 */ -,/ 7 i q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
y'tiy I P1 Date/
Inspection Line: 503.639.4175 DEC I L' I
Int rnet: www.ci.tigard.or.us NJ ® " Date Ready/By: et Supplemental See Page l Information
Gal( tO �1 F TIGAR� Notified/Method: Supplemental Information
TYPE .0 NG . •'`. '. : 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.
- • .t • `. , - CATEG ORY OF CONSTRUCTION . Value: $ 2 6 0 a _ o,J
❑ 1- and 2-family dwelling Co mmerciaUindustrial RE EQUIPMENT / SYSTEMS FEES*
y g ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. I Ea. 1 Total
,i. 7.:,,;.:,,•.:: rt', JOB. SITE INFORMATION'ANDl LOCATION :. y-° ,!: Heating/cooling
Job site address: / 0 ) S co 7Z ,9 V Air conditioning
fires plan or heat pump
/ , (requires site lan showin placement) 14.00
City/State/ZIP: -71 5/1/t. , o A. Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU ( ducts/vents) 17.90
Q{ i,4LC/9ni 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
;.;y r i. Y Water heater 10.00
,. a? d `DESCRII'°);IOpi' QI 7 `WO ` ' * ` ..., ��." "'�' . ,.
Gas fireplace 10.00
(fp e,"-- 2--P_ ,o a- L G,y Aj) _ J $ - - 7 7i Flue vent for water heater or gas
t fireplace 10.00
G, Lt! Log lighter (gas) 10.00
Uey... 4Cid4 f &ZOcasT / /Qt )AA) 4J /Ai /4- b - Wood/pellet stove 10.00
i
Sts Wood fireplace /insert 10.00
�4i q" r/� ,rGu�r ` r Chimney/liner /flue /vent 10.00
,: { -.4" '33 t❑❑PROPERTY.OWIYEito " , ; J: ti. ! +': T E N ANT _ .. . :.;
Other: 10.00
Name: 00/1640,,, Environmental exhaust and ventilation
Address: Range hood /other kitchen
,) t t f4-t .¢.(jp equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
k 4. ;sn 0 ELI *N'IY t ,`` /CONTkC'T PERSON ` ` ',, ^` Attic /crawlspace fans 10.00
.i Other: 10.00
� •
Business name: PR a id,,7 A.SGC_,, f f Fuel piping
/� P i p g
Contact name: U /4 V 4 C Q L/ f „ve ^„ 55.40 for first four; $1.00 for each additional
Address: �f7� g' Cr ! / - 4v-1..._ Furnace, etc.
Gas heat pump
City/State/ZIP: fr j L J 0 G,n1 97L2. Wall/suspended/unit heater
( 5U) ,S7 $ -6/9 (S G2 , � , ja` Q 76? Water heater
Phone: Fax:: /
_Fireplace
E-mail: Range
x - •. r- :IY Y
tl , ,�xk ; .,. s.. , s ti '' o-� ;CINTRARCTOi�s I S / ; x 1 f �. t . �• Barbecue
:�T ". � �`� �t�.a_i�r, pi-= ,c� �•_. ..Z. � ':,*•:=,`-.,, wa: -.•vt ...- s�^ �..,.xl... r•_ h-t, � . , . . . . IT
Business name: S'�M 4Q �v�- Clothes dryer (gas)
Other:
Address: . *
f ' 6 :' - f - ',' -' MECHANICAL.:PERM_ITTEES: .
City/ State/ZIP: Subtotal gy, w
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB 1ic.: tr 702...., 3 ffe State surcharge (8% of permit fee) (' . �
TOTAL PERMIT FEE 5 . 7u2.--
•
•
Authorized signature:gz� This permit application expires if a permit is not obtained within 180
WWWWWW h
days after it has been accepted as complete.
mplete.
Print name: 8k ff [ g t i AJcLJZ Date: /2_,-/ -py • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permit, \MEC- PemtitApp.doc 12/03 440- 4617T(II /02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested /' _ AM PM BUP
Location r e i n( 7A Suite f"" a- MEC. 7 " d O 779
Contact Person Ph ( ) 5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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 m/ ; Vito •
PASS PART FAIL '- —
PLUMBING
k.
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 . 'ne
;; pampers
4 P r
PART FAIL
raj RICAL
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 ❑ Please . I for reinspe tion RE: 0 Unable to inspect — no access
Fire Supply Line 7 -1,
ADA Approach/Sidewalk Date v , Inspecto ,��,�� Ext
Other:
Final DO NOT REMOVE this Inspe on record from the Job site.
PASS PART FAIL