Permit C'
CITY OF TIGARD
MECHANICAL PERMIT
�xl DEVELOPMENT SERVICES PERMIT #: MEC2003 -00574
��f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 3/1/04
PARCEL: 1 S135AB -00100
SITE ADDRESS: 10350 SW LINCOLN ST
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 6 VENT FANS: 11
OCCUPANCY GRP: El VENTS W/O APPL: VENT SYSTEMS: 2
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: 2 COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: Y 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: L 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 5 <= 10000 cfm: 69 OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical work for new school, $800,000 valuation
Owner: FEES
WASHINGTON CLACKAMAS CO Description Date Amount
SCHOOL DIST 23J [MECH] Permit Fee 3/1/04 $9,096.50
6960 SW SANDBURG STREET
TIGARD, OR 97223 [MECPLN] Plan Rev 3/1/04 $2,274.13
[TAX] 8% State Surchar€ 3/1/04 $727.72
Phone: Total $12,098.35
Contractor:
ROBERT LLOYD SHEETMETAL INC
PO BOX 307
INDEPENDENCE, OR 97351 REQUIRED INSPECTIONS
Mechanical Insp Final Inspection
Phone: Mechanical Insp
Reg #: LIC 62476 Heating Unt Insp
Heating Unt Insp
Cooling Unt Insp
Cooling Unt Insp
Duct Inspection
Duct Inspection
Fire Damper Insp
Fire Damper Insp
S.D. Shut -down inspection
S.D. Shut -down 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 ifi.ction Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
95 - 001- 0100. may obtain copies of these rules or direct quest' C by calling
( 03)246 -6.99. /
Is ued By: /, 01 , Permittee Signature: ,
- Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit �l ion Fok OFFICE USE ONLY
Received g O Mechanical / ife ODs
• Date/By: Permit No.:'
City of Ti and Planning Approval Building
g 2003 Date /By: Permit No.:
SEP `�
13125 SW Hall Blvd. ' Plan Review n Other
Tigard, Oregon 97223 Date/By: 1 -/7 -OY/42 Permit No.:
Phone: 503- 639 -4171 Fax: 5dh49 irl (1AR p Post- Review �/ Land Use
\' Date/By : /il /07 Case No.:
Internet: www.ci.tigard.or.us BUILDING DIVIS ... J �. 11 Contact w/ pp Jr. See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Meth (1,...K, G• / i a Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
IL New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling IN. Commercial/Industrial Value: $ Vd& Ott See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) Total
❑ Master Builder ❑ Other:
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning** 5 _ 14.00
Job site address /0 5i v L /NGOLM„'i Gas heat pump • 14.00
Suite #: Bldg. /A t.#: Duct work 14.00
H • _ - r system 14.00
o ect Name:A.sz,.\z t0 � �` —
Residents I boi er
Cross to job site: (for radiato or ydronic system) 14.00
\ Unit heaters (fuel, not electric) t
�W-�} �-'` �
� (in wall, in -duct, suspended, etc.) 6 14.00
Flue/vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
Tax map /parcel #: Ilea
Fuel Appliances
t 1 10.00
Water
DESCRIPTION OF WORK A. c c - I 1 10.00
M \ \ .\ I a'r cAw OL64n..A ay. tK Flue vent (water heater /gas fireplace) 10.00
1 ``mi -� t
9 Log lighter (gas) 10.00
`.4 1''^� Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent / 10.00
El PROPERTY OWNER I ❑ TENANT Other: TiP (p t MAC. UN t?f 11 10.00
Name: S, t o�4 \ Q P Environmental Exhaust & Ventilation
} Range hood/other kitchen equipment 10.00
Address: (,q f„.. St4 S O.v,Sv.f� Clothes dryer exhaust 10.00
City /State /Zip: 71. 0 (Z q-1.2,23 Single duct exhaust
Phone: X13 \, .4,961 r Fax: �3 k , 446 11 (bathrooms, toilet compartments, I l
f
APPLICANT f ❑ CONTACT PERSON utility rooms) 6.80
Name: �..es.,\ar�\.tvAQ �, Na �`�fi. J � Attic /crawl space fans 10.00
Address: Sv.l /�( AvA sly_ Other: 10.00
r i� �b Fuel Pipi g
City /State /Zip: 1)ae4.\t,.n. f bIR ci'72..3C * *($5.40 for first 4, $1.00 each additio al
Phone: q3 F . mace, etc. **
c�. �q�2 Fax: 2ys ([� as heat pump •*
E -mail: or o. r c ,Q CpM,ps-s,\.,,u,m2_,,,46. Wall/suspended/unit heater **
CONTRACTOR n Water heater .. d ** •
Business Name: 6f42:1- LLDft pi/ft-rat/7u_ WC,. Fire .lace r / t/ 10 *•
Address: ktf,/ Sp 7 Ran:e
��
City/State /Zip:1,.ID£Pi/Jb f,�C,� O' 9735/ Clothes dryer (gas) 1 0 01111v
Phone: 613.b!g 3031 Fa . , Other:
/499 **
CCB Lic. #: // g A7 Total:
rr Mechanical Permit Fees*
Signature: Date: �( 2t/l
Authorized 1u 3 Subtotal: $ p 0 qt . So
Minimum Permit Fee 572.50 $
t rw.v. l.9k a‘" qL Plan Review Fee (25% of Permit Fee) $ 2. Z4 - y . 13
(Please print name) V State Surcharge (8% of Permit Fee) $ .2 .2
TOTAL PERMIT FEE $ / 2 o?g. 35
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.doc 01/03
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 $10.00 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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and - •
$1.10 for each additional $100.00 or fraction
thereof. �. r
•
All New Commercial Buildings require 2 sets of plans.
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is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639-4171 - MST
/ BUP
Received Date Re uested 7 �( AM +'q/// PM BUP
Location 0 7 5 Z C� c'_-Qm Suite MEC •o-3 - 7
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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 ��
sc = or
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
T FAIL
` MECHANICAL
- ---Post &Beam
Rough -In
G -s Line
0 • _�Dampers
S PART FAIL
ICAL / , .
Service
Rough -In 41111M1I�.1111i i' A /�_.�
UG/Slab MEW' 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: D Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL