Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00227
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: /3
PARCEL: 1S135AA-01400
SITE ADDRESS: 10215 SW HALL BLVD
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 5
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 4 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 100,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: L 50 + HP:
FURN < 100K BTU: 4 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: q
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: New 2 -story dermatology clinic.Valuation $9870,
Owner: FEES
INTEGUMEND LLC BY SCOTT COLLINS MD Description Date Amount
& MARIA ROSS MD [MECH] Permit Fee 9/30/03 $146.98
9495 SW LOCUST STREET
PORTLAND, OR 97223 [MECPLN] Plan Rev 9/30/03 $36.75
[TAX] 8% StateTax 9/30/03 $11.76
Phone:
Total $195.49
Contractor:
OREGON HEATING + NC INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 538
Mechanical Insp
Reg #: LIC 125815 Mechanical Insp
Heating Unt Insp
Cooling Unt Insp
Final Inspection
/6/V1°3 / ' °L6Lf--
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 ques . ons to OUNC by calling
(503)246 -6699
Issued By: /,-(..-411121--
,-L4 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
F
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00227
°711- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
PARCEL: 1S135AA-01400
SITE ADDRESS: 10215 SW HALL BLVD
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 5
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 4 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 100,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: L 50 + HP:
FURN < 100K BTU: 4 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 0
Remarks: New 2 - story dermatology clinic.Valuation $9870, NO GAS PIPING
Owner: FEES
INTEGUMEND LLC BY SCOTT COLLINS MD Description Date Amount
& MARIA ROSS MD
9495 SW LOCUST STREET [MECH] Permit Fee 9/30/03 $146.98
PORTLAND, OR 97223 [MECPLN] Plan Rev 9/30/03 $36.75
[TAX] 8% StateTax 9/30/03 $11.76
Phone: Total $195.49
Contractor:
OREGON HEATING +A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 538
Mechanical Insp
Reg #: LIC 125815 Heating Unt Insp
Cooling Unt Insp
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 B.: • s i .y Pe rmittee Signature: �
Y __ ' g �� (-
Call (503) •39 -4175 by 7:00 P.M. for inspections needed th- ext busin- -s day
F F is
• .
i /
/
tMech • FOR OFFICE USE al Permit Application Received ;7 - / Mechanical ONLY
\I ED ,
El, Date/By: •0/67 c d .P.- 3/4/. Permit No.: n red ( 941,5 - 60?.,9.7
City of Tigard r , EG _ Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd.
S 2.N3 Plan Review V7 0 1, Other
C\
Tigard, Oregon 97223 W ._, Date/By: 9 4.3 ip,,, _...Berm-Ti •
Phone: 503-639-4171 Fax: 503 A ,,, Post-Review Land Usee L _u on3„..er:40 ._., I
""/Otimat I & --/ Date/By: Case No.:40
Internet: www.ci.tigard.oCtiri ° r L i IS‘ON, . ,p,
-' . • '
e 10.. = I.ji v - • 1 ,. I Contact Juris.: Ei See Page 2 for
24-hour Inspection RequEs05,06L69
. -4175 -"'" ' Name/Method:
- 0
- ,:teNROMMILVITTMTOPKOMMArarZatil ATIMOmmtlirel • .,
y r New construction 1111 Demolition Mechanical permit fees* are based on the total value of the work ,..,
0 Addition/alteration/replacement 0 Other: performed. Indicate the value (rounded to the nearest dollar) of all
Satanala-MOVOTIC*Wijit..70.010M11-Wal& mechanical materials, equipment, labor, overhead and profit. t,
0 1 & 2-Family dwelling ri Commercial/Industrial Value: $ , See Page 2 for Fee Schedule '....
0 Accessory Building • Multi-Family InWatiMINOMMaMSYSTERSIMMSICIMOOMR
Description I Qty I Fee(ea.) I Total s `•
El Master Builder Ei Other: ::T':.
'4WarnalgiarekeigiMiMSW Furnace - add-on air conditioning** 14.00
Job site address:. 0 A/ 5 Iv) 4141. t;,1.)1./D. Gas heat pump 14.00
_
Suite #: Bldg./Apt.#: --es. Duct work 14.00
Project Name: (Nri L.L..c, . Hydronic hot water system 14.00 •
Residential boiler
Cross street/Directions to job site: cf
• (for radiator or hydronic system) 14.00
'ti HALL- )3A--\j P. e_ `SW CZ Unit heaters (fuel, not electric) C..
st-) Loc-u -err. 4 437•n4 AV-5 (in wall, in-duct, suspended, etc.) 14.00 1°
- . Flue/vent (for any of above) 10.00
Subdivision: Lot i..ZSc Repair units 12.15
Ctilief.),FietWOlifiiiVel?AMt:CSANNI1.,
Tax map/parcel #: - Mx (....or ( • a Water heater 10.00
. , MMUSEliSartatS:MarOWI:),FM.all Gas fireplace 10.00
N pi.) Acc '. / I -- z, - 773 - Pr tnAsptc4.11- Flue vent (water heater/gas fireplace) 10.00
• ' GU VNFIC (jci, coo s. ) IN/ 5eM Kreg • Log lighter (gas) 10.00
Wood/Pellet Stove 10.00
Wood fireplace/insert 10.00 . .
Chimney/liner/flue/vent 10.00
it , TRTMMUMWTOTifehlritt; 5!:4 itESTWISif-Z-23ifitiVk Other 10.00
ame: 1 t4MU1fA,MN/17 1--1- :-i-5-fztzElVE:ttfitifivii0eirtitfilitatkUtiiiiWiirtaiiiWEV
Range hood/other lcitchen equipment 10.00
Address: 949s s4N Loc. uvr e-L-r: Clothes dryer exhaust ' W.00
City/State/Zip: pcgt-LAND 1 OR cv-729, . Single duct exhaust
Phi ne: 6;, •245 • 24(g Fax . 24 4 . 516,3 (bathrooms, toilet compartments,
t 7 0 ri*OrfirgOTIMMINAN utility rooms) 6.80
Name: DAIAD A- Fitle.015rr Attic/crawl space fans 10.00
Address: 72 , 1.1, 5-n+. Ave. 4 ) Other: - • • • 10.00
P.::'Nita.IA18'.iMn26ZrMOef,iP:ifiiii
City/State/Zip: I\ 4/ i Cle- - 9 7209 **($5.40 for first 4, $1.00 each additional)
Phone: 5■A . 224 Fax: 5f) • 224 . 21 I Fumace, ** etc. **
Gas heat pump
E-mail: dlotte- 4y46inef..• Ccito Wall/suspended/unit heater **
INENitX:IditAteg150:01.1M7.0TORMANWINZIMIN Water heater **
Business Name: ' Fireplace **
Address: v s, Range , **
- - 1 BBQ **
City/S tate / Zip / 7 ,; j **
• Clothes dryer (gas)
_ -
Phone . . I Fax: Other: **
CCB Lic. #: A . Aq_5:: - Ar
...::1;',:-F,''::::.
Authorized liAlWff%Fff/ff. - - , . . - . , Subtotal: $
Signature: livor 7 *2 *0
Minimum Permit Fee $72.50 $
didirffiNgin i "AI/ Plan Review Fee (25% of Permit Fee) $
(Ple
v e pri 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\MecPermitApp.doe 01/03
. .
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information •
4
Commercial Fee Schedule:
; T,otalLValua ion ; Permit;EFee ; i _ .: y-
$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 6
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. •
•_ iiiif ed Valuaii :!- Per
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955 3 V ( b
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 f 0
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 s 446 22_3 0
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 -044 0,5: $
- VALUATION:
•
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
•
CITY OF TIOAR �' 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION i Business Line: (503) 639 -4171 VIA
BUP
Received 1 2-(2-3 3 -31 ate Requested / 2 24 / 3 AM PM BUP
Location Suite 4 3 `00 Z ?
Contact Person ;d29_P iiZ (),l.P. a14 ) 0 / -- (D 2_,5( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 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
9
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P. . - •. FAIL
ECHANICAL
=os . -. -_
Rough -In
Gas Line
' �_ e Dampers
-.PART FAIL
E 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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date t2-/ 2 "1 0 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL