Permit CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00691
t 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/10/03
PARCEL: 2S102AD -02400
SITE ADDRESS: 08950 SW BURNHAM ST 100
SUBDIVISION: BURNHAM TRACTS ZONING: CBD
BLOCK: LOT: 005 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: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: 24,600 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: 2 GAS OUTLETS:
> 10000 cfm:
Remarks: Tenant Improvement - Install GRD's, ductwork & (1) AC unit
Valuation $8700
Owner: FEES
NW PREFERRED FEDERAL CREDIT UNION Description Date Amount
13333 SW 68TH PARKWAY
TIGARD, OR 97223 [MECH] Permit Fee 12/10/03 $208.10
[MECPLN] Plan Rev 12/10/03 $52.03
[TAX] 8% State Surcharl 12/10/03 $16.65
Phone: 503 403 - 6210 Total $276.78
Contractor:
ARCTIC SHEET METAL
2310 NE COLUMBIA BLVD.
PORTLAND, OR 97211 REQUIRED INSPECTIONS
Phone: 5039288 Mechanical lnsp
Cooling Unt lnsp
Reg #: LIC 17095 Duct Inspection
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 -00
Issued By: , Permittee Signat „AM � ■ ,pa % ,
Call (503) 639 -4175 by 7:00 P.M. for inspections nee•ed the ext bus ne 'may
Ap RLo /2- -0 5
Mechanical Permit Application
Date received: f - /1_6 ? Permit no.ill,?c w3"G87tr,97
_, j;' ,_ _ - City of Tigard Project/appl. no.: Expire date:
CitynfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: BUP2003 - 00664
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family O Tenant improvement
❑ New construction a Addition /alteration/replacement ❑ Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 8950 SW B Street — Sui tP 1 nn Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ 8, 700.00 .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: NW Preferred Credit Union jurisdiction's fee schedule for residential permit fee.
City /county: Tigard I ZIP: 97273 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: Firm Gh anri AND COMMERICAL JINDUSTRIALEQUIPMENTSCHEDULE
Installing: GRD's, Ductwork, & (1) Ar TIni Fee(ea.) Total
Est. date of completion/inspection: 2 weeks Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned`) Yes ❑ No Air conditioning (site plan required)
Is existing space insulated ?(Yes ❑ No Alteration of existing HVAC system
• MECHANICAL CONTRACTOR . - Boiler /compressors
State boiler permit no.:
• Business name:
Arctic Sheet Metal HP Tons BTU/H
• Address: 2310 NE Columbia Blvd. Fire /smokedampers/duct smoke detectors
City: Portland I State: OR I ZIP: 97211 Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 1 7095 InstalUreplace /relocate heaters — suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): G. L. M • own Vent for appliance other than furnace
- Refrigeration:
CONTACT PERSON
Absorption units BTU/H
Name: Ron Hebdon • Chillers HP
Address: 2310 NE Columbia Blvd.
Compressors HP
Environmental nvironmental exhaust and ventilation:
City:. Portland I State: OR I ZIP: 97211 Appliance vent
Phone 503 288 -58 ' 4ax: E -mail: Dryer exhaust ,
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
- hood fire suppression system
Name: NW Preferret Credit Union Exhaust fan with single duct (bath fans)
Mailing address: 13333 SW 68th Parkway Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: Tigard I State: OR ZIP: 97223 Type: LPG NG Oil
Phone: Fax: E - mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type .
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other: •
Applicant's si_nat -. I Date: �' Other:
Name • • r_ �,��� r7
�i �j
-
Not all ' 4 i cti: 'acce. redit cards, p call jurisdiction for more information. Permit fee $ .2 a /0
J Notice: This permit app Minimum fee $
O Visa O MasterCard
expires if a permit is not obtained Plan review (at L> %) $ • b
Credit card number: / / w ithin 180 days after it has been
Expires Y State surcharge (8 %) .... $ / 6
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 2 ' 7 • j8
$
Cardholder signature Amount 440 -4617 (6i00/COM)
. , �. .
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
a _v:: Description r - ' , , Price .Total
$1.00 to $5,000.00 Minimum fee $72.50
TOTAL' "�VALUATION:. . ..PERMIT;:FEE:,,, ... - _ T =�� 3� t � - `'
Tablle;lA?Me'dhari icalCbd'e' - ''''":=2,1 ;,::.: °gig ^'. "` „,, 'y 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 including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 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 Furnace
$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 including 6) Repair units
$50,000.00. 12.15
Boiled`; kieat' A' , "'=u `:
$742.00 for the first $50,000.00 and r .Checkyal {;that app y , . � „� � ! i'° ' " < °� �.�=
$50,001.00 and up $ $ . v ': k• 1,` a t'
$1.20 for each additional $100.00 or N� '"�qr4:, R Pum Contl
$ For Ite 1, ms 7 11 see pit �4• `� ' '..1,M;$,,- u,. ,,..,��
fraction thereof. • :f oo ^'a i cO; P+ < _ 3 , f ii �, g i
i a u. �» _y�i a � > ' �� ,.- .�.�,, ;as:L"�,':.. ..
�.. .. ,.,� �?`...�;ss*°t „ H'�� x� �. e..,::'� k�- z':e; �:tv. :.x � a.
.:'.. 'yea:_ ?fib.' =.,4�::1 . ., >. �,;= ^e'x �`.�'; ;�..r r. G' T:...;; >'r."*.r:;.i� -'n:�
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
•
11) >50HP; absorb
unit >1.75 mil BTU 87.20
- •,___ 12) Air handling unit to 10 CFM
ASSU.MEDuALUATIONS PER, °APPLIANC;E`. - 10.00
Value Total 13y Air handling unit 10,000 CFM+ -
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 •
16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955
to 100k BTU 19) Commercial or industrial type incinerator
69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) • 1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 ;, ` $
>1.75 mil. BTU Minimum Permit Fee $72.50 SUBTOTAL: ...; �; f ..
Air handling unit to 10,000 cfm 656 8% State Surcharge ; f ,,- ?, ` ; ° ' � - �"`
-: $
Air handling unit >10,000 cfm 1,170 1- ` r - : " " " " > '° ; 1°`
Non - portable evaporate cooler 656 $
Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: . . sties 1'
Vent system not included in 656 -
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1
$62.50 per hour.
Commercial or industrial incinerator 4,590 - 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge - one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ ** Residential A/C requires site plan showing placement of unit.
VALUATION: `, 1 - • All New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech - fees.doc 02/11/02
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received / // -3 Date Requested / a / Z � /OIAM PM BUP
Location g9. 5 0 Au...it/I/1-k 0_4 Suite / ()7) CECL - C� Co L
Contact Person Ph ( ))) 3/ 3 - A PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: I SIT
(
Post & Beam f
Shear Anchors � V
Ext Sheath /Shear t S� L O 1/V1 0
Int Sheath /Shear
Framing po
Insulation Drywall Nailing
Firewall 6VA/6/1 /�
tJ 74
Fire Sprinkler ,, /� ��j
Fire Alarm G 4 i. t' V 6<
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING /11P4/ /1a Alt -
Post & Beam
Under Slab
Rough -In
- Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
IIECHANICA9
Post& Beam
ou -
Gas Line nL
Sm — Dampers W'
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: 111 Unable to inspect – no access
Fire Supply Line 2'-( l�
ADA V
Approach /Sidewalk Date I nspector '� / Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL