Permit y
4 CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00028
'
--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/03
PARCEL: 2S113B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Remove & replace 3 ton rooftop gas pack, 7.5 condensing unit, roof fan and fan.
Owner: FEES
UNIFIED SEWERAGE AGENCY Description Date Amount
HILLSBORO, L LSBORO O N 1ST AVE
O R 97123
HIL [MECH] Permit Fee 1/27/03 $156.20
[TAX] 8% StateTax 1/27/03 $12.50
Phone: Total $168.70
Contractor:
ANCTIL SHEET METAL CO.
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone: 503 Mechanical lnsp
Final Inspection
Reg #: LIC 8897
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued `/, • / Permittee Signature:
, e
Call (503) :39 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application Received FOR OFFICE USE ONLY
2 Mechanical ,,,y
Date/By: I P gg 7 G 3 Permit No.: tree o' 19 U
Planning Approval Building
City of Tigard Date/By: Planning No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503 -598 -1960 Post Review Land Use
G�iM h hr ' iii ,, i ' � Date/By: Case No.:
Internet: www.ci.tigard.or.us _a_411 - I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
t : :: Vre . � ' t e c A . - _ } - " ` '- .'' s- >; - (, @ r `' a' „'1 ,e t { : 1 ''.' a -`$ s, t iAc h i •,,
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
al • ddition/alteration/re • lacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
€ A mechanical igterials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling 01 Commercial /Industrial Value: $ rh9 0 See Page 2 for Fee Schedule
❑ Accessory Building • Multi- Family = =. °°°° D P.£ Ni li i :`'A' , `' 1 2.41
Description Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
x -- r ;z s : 1 ! ' e ' e I - c. , , ° r Furnace - add -on air conditioning** 14.00
Job site address: /6 �� O Sc.../ es- ' Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Pro ect Name: Hydronic hot water system 14.00
k ” - Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
? Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
Other Nei ; Appliances
Tax ma • / • arcel #: Water heater 10.00
- : ; • i � e- • " "t / 341-, (, ° a .O . 41j 7 ". E „ . a Gas fireplace 10.00
1 ?-4/.2.-,4 ,.. t 3 C. Z 1.• 9I1 ftj Flue vent (water heater /gas fireplace) 10.00
it i Log lighter (gas) 10.00
'� t'"� �"'i�"n L''^ ` Wood/Pellet stove 10.00
*- i i t / , P ., Wood fireplace/insert 10.00
/, t/ Chimney/liner /flue/vent 10.00
Name: cc, vc�s EnvIrOnmenta1 F J a st A;veptilation. ,
Range hood/other kitchen equipment 10.00
Address: 16,1 —c; 0 S w 8.5-'il. Clothes dryer exhaust 10.00
City /State /Zip: rf o K. 9 72Zi( Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
it . .�.': ,, _ . • f It utility rooms) 6.80
Attic /crawl space fans 10.00
'1 _ �` 1,. Other: 10.00
Address: x , pin
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Sa- - 2C! -�/N2I Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall /suspended/unit heater **
: ems Water heater **
Business Name: ' / _ _ IN,IffiliMill Fireplace **
Address: y7 2-0 iv u,.,j s Be
Q **
City /State /Zip: 1 0 e 9 72/ 1 Clothes dryer (gas) **
Phone:�o3 - 2$ /- b7S I Fax: Other: **
Total:
CCB L1C. Mechanical Permit Fees*
Authorized Subtotal: $
Signature: Data! i 2 7 "�� Minimum Permit Fee $72.50 $
t b-Ut c) j c _ Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPemvtApp.doc 01/03 - .
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Li(503) 639 - 4171 MST
BUP
b
Received Date Requested / — ° 23 ' AM PM BUP
Location / to 8) (s` - "-- Suite MEC a 3 — aa41
Contact Person Q Ph ( ) a Yl 'a 75g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner q.S / ELC
Footing
Foundation ELC
Access:
Ftg Drain
Crawl Drain
3D
Slab Inspection Notes:�� Z - — 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
MEMO)
Rough -In
Gas Line
Smoke Dampers
In-
s PART FAIL
ELECTRICAL
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 // 6'/i ADA Date Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL