Permit C ITY OF TIGARD MECHANICAL PERMIT
ter DEVELOPMENT SERVICES PERMIT #: MEC2004 -00459
c�'J� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 7/14/2004
PARCEL: 1S136AD-04000
SITE ADDRESS: 11507 SW PACIFIC HWY D
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
ELE 3 - 15 HP: COMML.INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install exhaust fan in new restroom.
Owner: FEES
SMITH, EDITA M Description Date Amount
833 NW 170TH DR [TAX] 8% State Surcharl 7/14/200 $5.80
BEAVERTON, OR 97006 [MECH] Permit Fee 7/14/200 $72.50
Phone: Total $78.30
Contractor:
INTEGRA SERVICE CO
201 S HARRISON
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone: 503 - 554 - 1714 Mechanical Insp
Final Inspection
Reg #: LIC 135441
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.
Issued By: J Permittee Signat )/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the • xt business d
Mechanical,Permit Application FOR OFFICE USE ONLY
City of Tigard RDac�ed per mit No..
Date/By: 7 iy - Oy ,� Cc42i0 9/_670v5--9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 /i,,n \ Date/By:
Inspection Line: 503.639.4175 "1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us g Notified/Method: T;3 Supplemental Information
TYPE OF WORK - _ , - COMMERCIAL FEE *, SCHEDULE =- ,IISE,CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY OF CONSTRUCTION ,
Value: $ • ZOCD ££
- - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
- JOB SITE INFORMATION AND LOCATION Heating/cooling ,
Job site address: Air conditioning or heat pump
1/ j 02 /0'1 C // )/(A7 (99,j
(requires site plan showing placement) 14.00
City/State/ZIP: "7` r , 19 O / — Furnace 100,000 BTU ( ducts/vents) 14.00
/ / Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 4D Project name: Gas heat pump 14.00
Cross street/directions to job site:
ikeib Zitr P46,ceeLcS Duct work I4.00
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: 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
Gas fireplace 10.00
S
'4' T4 1/ 6 ci, is F 59 >✓ / L) /Y/° k/ Flue vent for water heater or gas
n S '2p� �,
fireplace 10.00
1`Cr° .� Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑TENANT Chimney liner /flue /vent 10.00
Other: 10.00
Name: t r/9 / 77--/- Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: j3 ) Fax: ( ) • toilet compartments, utility rooms) / 6.80
f , APPLICANT CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00
Business name: /
4D /) 4 , S� f ', r G e- ev, Fuel piping
Contact name: ,C4A v i JAn / $5.40 for first four; $1.00 for each additional
' i s~
Furnace, etc.
Address: 2 0/ S ,/-,/ ,q >2 f S D ,N' Gas heat pump
City/State/ZIP: /1/ /ca 5 Q4 9,7 /3 e Wall/suspended/unit heater
`� ,- / 7
Phone: (Sn) � 7 / / C/` Fax: : ( ) Water heater
/ Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: `S,� h./ Clothes dryer (gas)
Other:
Address: • MECHANICAL PERMIT FEES *. ' :- ' '
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7Z. CO
Plan review (25% of permit fee)
CCB lic.: 1 L j State surcharge (8% of permi t fee) j 4�
/ I / TOTAL PERMIT FEE '�
Authorized signatu / - This permit appli expires if a permit is rot obtained wit 180
days after it has been accepted as complete.
Print name;�,� e £ / { I Date:pfi `• v • Fee methodology set by Tri- County Building Industry Service Board
B.B uildinePermits \MEC- PernitApp.doc 12/03 440.4617T(11/02/4M/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 24 -Hour
BUILDING. Inspection Line: (503) 639 -4175
INSPECTICJ DNISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 -73
AM PM BUP
Location / Suite C. D ME r0 " •
Contact Person Ph ( ) 8'a — ?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 4% _.
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab AIM i
Rough -In MAE
Water Service I I) Wr _
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Ss Dampers
4
PART FAIL
RICAL
Service Lk 111Lie
Rough -In N �� ,%'
UG /Slab t ap A17 - ' *WW1
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El 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