Permit CITY OF
MECHANICAL PERMIT
"��w ��r; DATE ISSUED: 8/21/01
� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00300
-''�'` I-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 13AA -00500
SITE ADDRESS: 16112 SW 72ND AVE B -18
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOA 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:
GAS 3 - 15 HP: 1 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: 1
> 10000 cfm:
Remarks: Installation of 2 ton (new) gas HVAC
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 8/21/01 $72.50 2720010000
PORTLAND, OR 97224 PLCK CTR 8/21/01 $18.13 2720010000
5PCT CTR 8/21/01 $5.80 2720010000
Phone: Total $96.43
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 233 -6911 Mechanical Insp
Reg #: LIC 38868 Final Inspection
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 No ' ' tion Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You y obtain copies of ese rules or direct questions to OUNC b (ling (50 46 -9189.
- Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections neede the nee usiness day
-:..--:.-., (11(-)) ' 41-
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Mechanical Application �J
Datereceived�/ 2d#1 Permit no.:lyl(C - 1_ 1
�'-`' r�'�i City of Tigard ��• ty g Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: l Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: t.
• ` TYPE OF P ]1MlT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family r enant improvement
0 New construction 0 Addition/alteration /replacement Cl Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE '• :, ":
Job address: /e1, // 'R S , 7e2 -vD AelE Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ 45 > •
Lot: IBlock: ISubdivision: *See checklist for important application information and
Project name: /_7,„c_0g jurisdiction's fee schedule for residential permit fee.
City /county: 7 < IZIP: c:97"02 1 & 2 FAMILY DWELLING PERIIITFEE SCHEDULE;"
Description and iodation of work on premises: h///4 G AND COMMERICAL/INDUSTRIAL EQUIPMENT SCI
/e- 077 5•ASA( Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? jd'les 0 No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? % es 0 No Alteration of existing HVAC system
MECIIANICAL CO NTRACTOR Boiler /compressors
State boiler permit no.:
Business name:
1,c47,TLniP • sy nc.. HP Tons BTU /H
Address: f 07 ,tie G Q ,c—H, Fire /smoke dampers/duct smoke detectors
C?
City: , rz 6,u0 iStateet I ZIP: 97 - Heat pump (site plan required)
Phonea3 3-C.9 it 1 Fax:oZ3f-- 9)17 I E - mail: Install/replace / burner BTU /H
Including ductwork/vent liner 0 Yes O No
CCB no.: '3 T g _ Install/replace/relocate heaters -suspended,
City /metro lic. no.: V $ sa. wall, or floor mounted
Name (please print): - G Ar.6s ,,../ t Vent for a • pliance other than furnace
CONTACT PERSON efngerahon:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Fnvuronmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
. � hood fire suppression system
N me: "7" G - f. t:I $ i Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: IZIP: Fue piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E-mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert -type
Phone: Fax: 1 E -mail: Woodstove/pelletstove
Other:
Applicant's signature: I Date: g /Q07/ ` fi e . :
Name (print): , leF.N't v � / .
` . Permit fee $
1 Not all jurisdictions accept credit cards, please call jurisdiction for more information.
O Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at % ) $
Credit card number Expi / within 180 days after it has been (
accepted as complete. State surcharge (8%) .... $
a cre
Name of cardholder as shown on credit card P TOTAL $
Cardholder signature Amount , 440-4617 (6RI0/COM)
MECHANICAL PERMIT FEES -
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
'TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Fumace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Fumace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see . or Pump Cond
fraction thereof. footnotes below. Comp " .
7) <3HP;absorb unit
Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00
8) 3-15 HP; absorb
8% State Surcharge $ unit 100k to 500k BTU 25.60
9) 15-30 HP; absorb
25% Plan Review Fee (of subtotal) $ unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP: absorb
unit >1.75 mil BTU 87.20
12) Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Fumace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Fumace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor fumace including vent 955 , 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30-50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU .
Air handling unit to 10,000 cfm 656 8% State Surcharge • $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
•
appliance permit Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $72.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimun
charge-one-half hour) $72.50 per hour
Gas piping 1 outlets 360
Each additional outlet 63 * State Contractor Boller Certification required for units >200k BTU.
"Residential NC requires site plan showing placement of unit
TOTAL COMMERCIAL $
VALUATION:
i :ldsts\forms\mech- fees.doc 08/06/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639-4175 Business Line: 639 -4171
: Date Requested / — AM PM BLD
Location 1 Co Z Z A/L Suite MEC
Contact Person Ph i- - j ('/( PLM
Contractor Ph SWR
BUILDING i ghigfr t/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
P PART FAIL
C HAN
Post & Beam
Rough In
Gas Line
S is • , e Dampers
- ASS , PART FAIL
EL CTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date (br L ��G( Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.