Permit CITY TIGARD MECHANICAL PERMIT
' I�+� DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00188
c -- " 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/3/2005
PARCEL: 2S 115AA -OTOOA
SITE ADDRESS: 16055 SW 108TH AVE 100 CLUB HOUSE ZONING: R -25
SUBDIVISION: OAK TREE APARTMENTS LOT: OOA JURISDICTION: TIG
Project Description: Building F - Clubhouse, mechanical work. Project Value: $11,000
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 3
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 2 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 0 <= 10000 cfm: 2 OTHER UNITS:
> 10000 cfm: 0
GAS OUTLETS:
Owner: FEES
OT2 LLC Description Date Amount
5437 ROSALIA WAY SUITE 100 [MECH] Permit Fee 5/3/2005 $245.00
LAKE OSWEGO, OR 97035 [MECPLN] Plan Rev 5/3/2005 $61.25
[TAX] 8% State Surchar€ 5/3/2005 $19.60
Phone: 503- 620 -4373 Total $325.85
Contractor:
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POLYTECH HEATING LLC
2263 SE 85TH AVE SUITE 2A REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97035
Phone: 503 888 - 7999
Reg #: LIC 162238
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
or 1 -80 32-23
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Issu By: I ,iJ�� Permittee Signaturee _
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
7606S 5[,c) /o -
Mechanical Permit Application :--> y . A Pf r - FOR OFFICE USE,ONLY' • _ ,
, , y
Rec e i ved
City of . y . v 9 "/J4/)� Date/By: a / d / I� Permit No ..00rg'g
13 125 SW Hall Blvd., Tigard, OR 't�s Plan Review 71,4
Phone: 503.639.4171 Fax: 503.5 1:.10 � ` tl Date /By: ACV / - a Other Permit:
)l�
Inspection Line: 503.639.4175 � °� i Da Ready /By: 4 7 �! / l luris FA See Page 2 for
Internet: www.ci.tigard.or.us APR 21 2005 a if d/Met od: a
► / ,/ I / 0•• � / �CG.� Su pplemental Information
CCi Id � _ MN C S IERCI is FEE* SCHEDULE - USE CHECKLIST
EA `' � ' ' I er9 tlo n / repl acement Mech permit fees* are based on the value of the work
New construction performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment. labor. overhead, and profit.
Value: S / bb' ,---- CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: / s ---s- Sir 1 p8 "A Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: 7 ok (3 Z 23 Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg./apt. no.: t/� I Project name: 00 ( +6 Furnace 100,000+ BTU (ducts/vents) 17.90
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: I 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
// /7 j r O( A / Gas fireplace Flue vent for 10.00
AA, r > k� ��/ G � � �"�Yf1 C�.Q Gw. % ent or water heater or gas
r
fi
b3DP-� / Q � u3c _v - 6 � Log replace 10.00
/l / Log lighter gas) 10.00 ,
g i - Da 7 o f 2. Wood/pellet stove 10.00
I Wood fireplace /insert 10.00
❑ PROPERTY OWNER I Chimney /liner /flue /vent
Other: 10.00 'e
❑TENANT 10.00
Name: 6 T2 LL' Environmental exhaust and ventilation
�/ 7 , Range hood /other kitchen
Address:
�`7' D �1w iL a: ieU S� fAf0V equipment 10.00
Ciry /State /ZIP: Z�ts-4 C9s o 6 G' 9 7 0 3 i^ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms.
Phone: 1.S 2I ) ‘2- _ ! f� 72 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; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZII': Wall /suspended /unit heater
Phone: ( ) Fax:: ( )
Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
� 4 � /_,( - Clothes dryer (gas)
Business name: 2C ' �� C
, / Other:
Address: 6? fL: ' P ,de- MECHANICAL PERMIT FEES*
City /State /ZIP: J � � 7 ,( r ! 0 R 9 zi c Subtotal y
t " Minimum permit fee (572.50) S,
Phone:1�e ) �.e, A I Fax: (t ) 7 g+ e- .,, f1 Plan review (25% of permit fee) �� 2 5
CCB lie.: l 2_ 2_ �Zg if 24 G q State surcharge (8% of permit fee) /� O
S TOTAL PERMIT FEE 3,25 g-6
Authorized signature: This permit application eepires if a permit is not obtained within 180
days after by it has been accepted as complete.
(cri
Print name: % / ey-/Z /' d Date: ,2-'1 ' Fee methodolocy set Tri- County Builcn Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
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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.
S100,000.01 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.
66 3 S v
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t: \Building \Permits \MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEG2O000188
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/312005
Phone: (503) 639 -4171 AzgA IIUlt llffllt
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_..
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 20
SITE ADDRESS: 16055 SW 108TH AVE 100 CLUB HOUSE CLASS OF WORK:
SUBDIVISION: OAK TREE NO. 2 APARTMENTS LOT #: OOA TYPE OF USE:
PROJECT NAME: OAK TREE II APARTMENTS
DESCRIPTION: Building F - Clubhouse, mechanical work. Project Value: $11,000
OWNER: OT2 LLC, PHONE #: 503-620-4373
CONTRACTOR: POLYTECH HEATING LLC PHONE #: 503888.7999
Inspection Request Scheduled For: Date: 99/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 015181 -01 503-888-2082 N
Corrections /Comments /Instructions:
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. A „, ) , „,,
, .
(11 .
il f `''PASS PARTIAL APPROVAL El CANCEL NO ACCESS
. ❑ FAIL CALLFOR INSPECTION ❑ ADDITI NAL FEES ASSESSED
Inspector: W./
Ins Date: .� Phone #: 503
P g ( ) 718 -