Permit I IA
C ITY OF TIGARD MECHANICAL PERMIT
,l.. r, DEVELOPMENT SERVICES PERMIT #: MEC2001 -00162
�' ��- 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/16/01
PARCEL: 2S 113AA -00400
SITE ADDRESS: 16290 SW 72ND AVE B -02
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 018 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: 1
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: 0
> 10000 cfm:
Remarks: Mechanical tenant improvement, relocating grilles and ducts.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 5/16/01 $72.50 2720010000
PORTLAND, OR 97224 5PCT CTR 5/16/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911 Duct Inspection
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You m • • opies ofi -se rules or direct questions to OUNC by c ing (503)246 -9189.
Issue ._ , - C.-C Ak _,, Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t e next b siness day
Mechanical Permit Application
4,,
Date received: ,5 //& /p/ Permit no.: /~ffCv',40/'04,/6,„R
'Y:� City of Tigard Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt
Phone: (503) 639 -4171
Fax: (503) 598 -1960 711 , Case file no.: Payment type:
Land use approval: 1 Building permit no.:
TYPE OF IrERAIIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family Afenant improvement
CI New construction XAddition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COi\9AIERCIAL VALUATION SCHEDULE
Job address: / Q90 51,t./ �^i° A UG Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: ,j �p7- Suite no.: value of all mechanical materials, equipment., labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name,,, p7i= rU,2 -1 /77 OE jurisdiction's fee schedule for residential permit fee.
City/county:77 >7 ZIP: 1 & 2 FAMILY DWELLING PERMIT FIX SCHEDULE
Description and I6cation of work on premises: AND COAIAIERIC.kL /INDUSTR EQUIPMENTSCUEDULE
,( ) ?A./ Z7 /S %921 $t�TIO.J 0 0 er Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? es CI No Air conditioning (site plan required)
Is existing space insulated? e s CI No Alteration of existing HVAC system f
1\l CIIANICAL CONTRACTOR Boiler /compressors
: State boiler permit no.:
Business name
�,Q�JI 91..ip /l & 0 HP Tons BTU/H
Address: •p7 „c-, -- "tty," Fire/smoke dampers/duct smoke detectors
City: P-7- LID I State I ZIP: g7.7 3 a Heat pump (site plan required)
Phone:a ..e_ I Fax93 i f ...p/ I E-mail:
InstaWreplacefurnace/butner BTU/H
Including ductwork/vent liner ❑ Yes O No -
CCB no.:3g Install/replace/relocate heaters -suspended,
City/metro lic. no.: , ./.5" -- 67,- wall, or floor mounted
Name (please print): J 6m L Vent for a ]lance other than furnace
e on:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Rs4C % - US j Exhaust fan with single duct (bath fans)
Mailin g address: D S Sc+ n - F e 00 Exhaust system a art from heating or AC
S tate . ZIP: ue p p g an on up to out ets
City: 7 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: ax: 1 E -mail: Woodstovelpelletstove
Other:
Applicant's signatur I Date: S� s /p/ — Tib er: —
Name (print): J - ✓ /1, -A; t -
Not all jurisdictions accept credit cards, please call jurisdiction for more informat Permit fee $
CI Visa ❑MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount ■ 440-4617 (6R10/COM)
MECHANICAL PERMIT FEES T • ..
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or induding 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 induding 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
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty _ (Ea) Amount 9) 15 -30 HP; absorb
Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace induding vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not induded in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU .
17) Hood served by mechanical exhaust
30-50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 dm 656 69.95
Air handling unit >10,000 cfrrt 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not induded in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc. ,
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one -half hour) $72.50 per hour
* State Contractor Boiler CertlflcaUon required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
i:\dsts\forms\rnech- fees.doc 10/11/00 .
ii . CITY OF TIGARD BUILDING INSPECTION DIVISION er
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 , --� _ y
f --- j
Date Requested (0// AM PM BLD
Location *it) i - 724D iiSit 'Z.^ - E 420 SIN ^ &
Contact Person , Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: i-7�
Slab �� SIT
Post & Beam — � e ms - f ��
Ext Sheath /Shear J
Int Sheath /Shear
Framing
Insulation
Drywall Nailing 11/y_c") ,Q 1.) Firewall ,, -Q- Fire Sprinkler 4- �--L /v ‘` w \ 1 o
Fire Alarm i l
Susp'd.Ceiling 0/1-- L " - ''v' 12--). `-' � 2 'S
Roof .
Misc:
Final ` ��� p / P ASS PART FAIL -� 1
PLUMBING ' � L ,
Post & Beam
Under Slab
Top Out •
Water Service
Sanitary Sewer -j'
ti
Rain Drains , i
Final • 1,
PASS FAIL •
Post & Beam
Rough In L .'
Gas D �
Smoke e Dampers
ASS' PART FAIL •
lir iv
V TRICAL �
�,
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 //��
Otheoach /Sidewalk Date "vl t O 1 1 Inspector 9 /( � ( 9
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.