Permit ;/4-4, CITY OF TIGARD MECHANICAL PERMIT
vw r . DEVELOPMENT SERVICES PERMIT #: MEC2004 -00100
,. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/4/04
PARCEL: 2S1 13AC -00101
SITE ADDRESS: 16655 SW 72ND AVE 500
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P
BLOCK: LOT: 029 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 grilles and add restroom bath fan. Value: $3,000.00
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [MECH] Permit Fee 3/4/04 $118.50
[TAX] 8% State Surchar€ 3/4/04 $9.48
Total $127.98
Phone:
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233
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: ( / y' l GUC �r. �
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t e next day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tig
p . Receiv J��/ /G/ / Permit No.: rn �G�t7s/ -e o/ 0()
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
1\ Date/B
Inspe Line: 503.639.4175 i r'_I I Date Ready/By: 1vris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /j/ G 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: $ 4 000
1
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heatinp/cooling
Job site address: / ( ....-„,c = 5.--6-- 5 A/ 7,21-10 (requires
fires s to plan conditioning or heat p pump
re uires site l showing placement) 14.00
City/ State/ZIP: - , 9„,AK D C Qp Furnace 100,000 BTU (ducts/vents) 14.00
��„ - Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: SOO Project name: ie4Fti 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
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
eCG 0 G cK/L!C'S ADO 841,. q Fla)✓ Flue vent for water heater or gas
fireplace 10.00 •
fdL /r/l 120)0" Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
' �ROPERTY OWNER I ❑ TENANT . Chimney /liner /flue/vent 10.00
Other: 10.00
Name: 1 j `'0 v57 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:
Fuel piping
Contact name: $5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: /' � p . s 't ,. ,G . Clothes dryer (gas)
Other:
Address: ,S$- .SC: / 7 7`" .Vt MECHANICAL PERMIT FEES*
City/ State/ZIP: / ". trje7"G A44) ax , 9) ra Subtotal
1 Minimum permit fee ($72.50)
Phone: (S7j 1) 23 3 - V °,,,, Fax: 4:5D3) 3 7 _ 974 7 Plan review (25% of permit fee)
CCB lic.: ..esr8' v. State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: J� A" r -r Date:/
• Fee methodology set by Tri-County Building Industry Service Board
i:\Building\Pemti is \MEC- PeunitApp.doc 12/03 440-4617T (I I /02/COM/WEB)
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.
$100,000.01 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.
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING InspectionW(50, 5
INSPECTION DIVISION Business Line: (+ ;f 39 -4171 MST
BUP
Received -- Z / Date Requested 3/234,C/ AM PM / 7 BUP
Location A) Suite 5 — Ct)
Contact Person : : • Ph (_ O 57?— 6/97 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: w k k SIT
Post & Beam "
Ext Shear Sheath/Shear
ea t h /Shear
Ext eah/hear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In V
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan +\," /e'
Other:
Final
PASS PART FAIL
MECHANICAL
Post
h -In
Gas Line
Smo.e Dampers
tip
0 PART FAIL
� 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 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 13 Inspector ^ V Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL