Permit A CITY O T I GARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00669
.44. A I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004
PARCEL: 1S136AD-04000
SITE ADDRESS: 11535 SW PACIFIC HWY
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:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 5 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: 5
> 10000 cfm: GAS OUTLETS:
Remarks: (5) refrigeration systems and piping.
Owner: FEES
SMITH, EDITA M Description Date Amount
833 NW 170TH DR [MECH] Permit Fee 10/6/200 $231.50
BEAVERTON, OR 97006 [MECPLN] Plan Rev 10/6/200 $57.88
[TAX] 8% State Surcharl 10/6/200 $18.52
Phone: 503- 245 -1864 Total $307.90
Contractor:
CONSTANT COMFORT INC
PO BOX 4730
SALEM, OR 97302 -8730 REQUIRED INSPECTIONS
Phone: 503 - 588 -7523 Cooling Unt Insp
Final Inspection
Reg #: LIC 73669
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: �r' i . ' Permittee Signature: ,, %/IA_! // .•'
Call (503) 639 -4175 by 7:00 P.M. for inspections n the next business lay
. . ji - ('D /:'''
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
'J g
Date/By: dQ _/I yam^ / .-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �C ",..of
`
Phone: 503.639.4171 Fax: 503.598.1960 A di Other Permit:
es I d� DateBy: � -G -o S W
Inspection Line: 503.639.4175 - ■ (� _I Date Ready/By: 1 fa See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method 40 �� WC.. Supplemental Information
I/ /r�
Ari�i i -' ,
• TYPE OF WORK 1r
C I.( .4 ' S t ■ - US CHECKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* az on the value of the work
performed. Indicate the val •unded to the nearest dollar) of all
❑ atmolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
__vita CATEGORY OF CONSTRUCTION - Value: $1Ci 4 0 0 6,, (,,
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. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
P Air conditioning or heat pump
Job site address:
/ 1 .C3 S" S (4) P5 a / G 14 buy (requires site plan showing placement) 14.00
City/State/ZIP: Tf 6 A-4-9 Q /2, 9 ? a a- 3 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: I Project name: /4�}L 74� Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: }". MWD if)' %2 D 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
Subdivision: I 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
f
f - _ /2.e 41 elf /0/(J 5 S(� S *1( Flue vent for water heater or gas
/ / fireplace 10.00
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: --/1 1--/ Sni / 7 y Environmental exhaust and ventilation
Address: l� Range hood /other kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT 0. CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additiona
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: (ii) pi 57- /9,/l/ t /il � i i }Xi ,� Clothes dryer (gas)
( (/ /"� Other:
Address: (o /A 6-x I/7 30 MECHANICAL PERMIT FEES*
City/ State/ZIP: .5 / ce ryt oler 9 731J� - (7 `f d Subtotal 231 , 0 Phone: ( ..3) 5 6 - 7� a Fax: 57 ) 6o .1 ? 5-1 Minimum permit fee ($72.50)
7 Plan review (25% of permit fee) 57 . &&
CCB lic.: 7 3 c, (0 r State surcharge (8% of permit fee) / g , c',
i I TOTAL PERMIT FEE 09'. 70 Authorized s' a� A r / This p ermit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name. a l°5 L, 44 Date: q ^). Q -O Li
• Fee methodology set by Tri- County Building Industry Service Board
is \Buitding\Perntiu\MEC- PemtitApp.doc 12/03 440.461n (11 /02/CO
Mechanical Permit Application - City of Tigard •
O.
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. aft
$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:\ Bui lding\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63 ' ' 5 MST
INSPECTION DIVISION Business Lin. • , (503) 6 re • 1
BUP
Received Date ' quested Z / t PM BUP
Location Ci U L Suite 6( 0O 66 ''
Contact Person (9 Ph ( ) PLM
•
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain f�� �/
Slab Inspection Notes: (c) 74,k • Lli CiJ S SIT
Post & Beam
Sr Anchors
c s
Ext Sheath/Shear
ear
Int Sheath/Shear
Framing
Insulation 0-29. 5 - /� � 6 0 ` �
Drywall Nailing �� 'C ' — t"
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof \ / / G ,l Other:
Final
Final Cx 0
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
P P _ RT FAIL
CHA L •
0
; 11411filliii;11 I 's
Post & Beam
Rough -In
Gas Line
S i • Dampers
in -
• PART FAIL
= L ' TRICAL
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 ri Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
Approach/Sidewalk Date C / 27 /J Inspector 1
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL