Permit CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00698
f� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD 200 ZONING: MUE
SUBDIVISION: CLARKE BUILDING LOT: 017 JURISDICTION: TIG
Project Description: Install (3) furnaces. Valuation: $12,000.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
TOM CLARKE Description Date Amount
7357 SW BEVELAND STE. 100 [MECH] Permit Fee 10/19/20C $258.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/19/20C $20.68
Phone: 503 793 - 2621 Total $279.18
Contractor:
SURE FLOW HVAC INC.
16209 SE WEBSTER RD REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone: 503 653 - 1636
Reg #: LIC 109777
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 QAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct qu stio toNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: L►'!, Permittee Signature:
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.
Mechanical Permit Application _ �_. FOR OFFICE _USE ONLY
____
City of Tigard 13125 SW Hall Blvd., Tigard, Oklt d7 �� Date/By: D /9 �r Permit No.. r i - �� • J
." Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4,1, .a. , Date/By. Other Permit:
Inspection Line: 503.639.4175 y . sl I Y
p Dat ReadyBy: la • ® See Page 2 for
Internet: www.ci.tigard.or.us OCT 1 ' 2005 Notified/Method: 71 ( Supplemental Information
he{ I ' COMMERCIAL FEE* SCHEDULE -- "USE CHECKLIST
6 1 .111 }G JI SY
• ❑ New construction U 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 tier: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION " Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. Ea. I Total
. • , 'JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: -'2,5 i S ca ) �TZI ) J o -`
Air conditioning
ite plan ng or heat p pump placement) (requires site lan showin lacement 14.00
City /State /ZIP: -1- 1(; /1-N o2 q'7 2 z 3 Furnace 100,000 BTU ( ducts/vents) 3 14.00
t � Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 7 I Project name: WF 111/t =55 c.E,v1 {t Gas heat pump 14.00
• Cross street/directions to job site: `7 Z r\--0-- 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
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace ( 10.00
\ 1/19t,s/ 1 3 f (- AI(Lt1(- c. S 4. Flue vent for water heater or gas
fireplace 10.00
GA-5 - C -1,q -S ?1'- t ) 4)pr,4 c( 1✓lSTfILi1_f7 Log lighter (gas) 10.00
ck `uL°> j � C -l r Wood /pellet stove 10.00
Wood fireplace /insert . 10.00
ROPERTY OWNER. . -TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: C 7CNAA C‘Alf6C. `
Environmental exhaust and ventilation
• Address: vt Range hood/other kitchen
2 .L / c, � w 2 Z J4t / equipment 10.00
City /State /ZIP: IC - L 'lZ SIC) CJ2 - Clothes dryer exhaust 10.00
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) Z 6.80
,• f PPLICANT • - CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
• Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: � Furnace, etc.
I Gas heat pump •
City /State /ZIP: Wall /suspended/unit heater
Phone: (c `79 2c Fax: : (c63) � C Water heater
E -mail: t Range
CONTRACTOR ' Barbecue
Business name: cut w �-' I O� Clothes dryer (gas)
Other:
Address: t ZFF � q s G ) 27 k 1 1 ' A v • MECHANICAL PERMIT FEES*
• City /State /ZIP: )L1pL o --632 293 1s3� Subtotal
) Z Fax: 3 ) Minimum permit fee ($72.50)
Phone: (
�� Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: 0 / / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name M C M.,.c___ Date: /O/( 02 J 65 - * Fee methodology set by Td- County Building Industry Service Board
i:\Building\Permits\MEC-PermitApp.doc 12/03 440.46I7T (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 A ..„
BUILDING DIVISION PERMIT #: mi:c20
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639-4171 ARINIAll'il'
Inspection Requests (24 Hrs.): (503) 639-4175 „4.191- n.
INSPECTION WORKSHEET FOR DATE: 1/17/2006 TIME: 7: 05Arvi PAGE: 6
SITE ADDRESS: 07357 SW BEVELAND RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: oi 7 TYPE OF USE:
PROJECT NAME: BEVELAND WELLNESS CENTER
DESCRIPTION: install (3) furnaces. Valuation: $12,000.
OWNER: CLARKE, TOM PHONE #: 603.793.262 i
CONTRACTOR: SURE FLOW HVAC INC. PHONE #: 503-653-1636
Inspection Request Scheduled For: Date: 1/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact #. Message
699 Mechanical final 025085-01 503-793-2621 N
C5) P&)eC--e- S.
Corrections /Comments/ Instructions:
C v c' ,Q. '13
-----
Ar._jN ( Q Y
ElP"
4F
r PASS 0 PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
-..
I I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
V(A GIL- Date: ilk -- VP
Inspector: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -0069L3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639- 4171�u�INu p
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7 :12AM PAGE: 161
SITE ADDRESS: 07357 SW BEVELAND RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: 017 TYPE OF USE:
PROJECT NAME: BEVELAND WELLNESS CENTER
DESCRIPTION: Install (3) furnaces. Valuation: $12,000.
OWNER: CLARKE, TOM PHONE #: 503-793-2621
CONTRACTOR: SURE FLOW HVAC INC. PHONE #: 503 - 653 -1636
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
695 Misc. inspection 021035 -01 503- 793 -2621 N
•
Corrections /Comments /Instructions:
4110,
F l to &J f__&euE.sS e
•
PASS ✓PARTIAL APPROVAL CANCEL El NO ACCESS
FAIL CALL FQR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ((//4/Phone #: (503) 718-
I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005.00698
13125 SW Haii Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639 -4171 , A 1�4piii ili
Inspection Requests (24 Hrs.): (503) 639 -4175 =�.
INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 7
SITE ADDRESS: 07357 SW BEVELAND RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: 017 TYPE OF USE:
PROJECT NAME: BEVELAND WELLNESS CENTER
DESCRIPTION: install (3) furnaces. Valuation: $12,000.
OWNER: CLARKE, TOM PHONE #: 503-793 -2621
CONTRACTOR: SURE FLOW HVAC INC. PHONE #: 503- 653 -1636
Inspection Request Scheduled For: Date: 10/2012005 Pour Time:
Code # Inspection Description Confirm # Contact.# Message
615 Mechanical rough -in 018862-01 603-793-2621 N
Corrections /Comments /Instructions:
1 tad / 1 i I-
V
Teo an p. % IF • r/% Mr/ IF
PASS C
PARTIAL APPROVAL ❑CAN ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITI4NAL FEES ASSESSED
Inspector:
ilk' Date: �, Phone #: (503) 718 -
-I