Permit C ITY OF TIGARD MECHANICAL PERMIT
�& DEVELOPMENT SERVICES PERMIT #: MEC2004 -00587
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/31/2004
PAARR E CELL : 1 1 S13 S136AD -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: 2 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: 2
> 10000 cfm: GAS OUTLETS:
Remarks: Replace HVAC unit and duct work.
Valuation $16,000.
Owner: FEES
SMITH, EDITA M Description Date Amount
833 NW 170TH DR [MECH] Permit Fee 8/31/200 $312.50
BEAVERTON, OR 97006 [TAX] 8% State Surchart 8/31/200 $25.00
Phone: 503- 245 -1864 Total $337.50
Contractor:
WILLAMETTE HVAC SERVICE
PO BOX 23334
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone: 628 - 6841 Mechanical Insp
Cooling Unt Insp
Reg #: LIC 56951 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 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct quest ► s to OUNC by calling
(503)246 -6699.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By : 5 31 '0 ' tDG/Z- Permit No \ c... ...2 / , ��
Aw 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
\ DateBy: 3 �d7 Di Other Permit
Inspection Line: 503.639.4175 F•' I Date Ready/Sy: NM ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF . WORK COMMERCIAL FEE* SCHEDULE' =- USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
_ Value: $ / CC
4' Q� �
RESIDENTIAL EQUIPMENT /SYSTEMS. FEES*
❑ 1 - and 2- family dwelling XCommercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty l Ea. Total
. • JOB SITE INFORMATION .AND LOCATION • :, . Heating/cooling
.// r7 //�� Air conditioning or heat pump
Job site address:
3 S Sl / o►Ct-e. I4" r �/ (requires site plan showing placement) 14.00
City/ State/ZIP: / Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: 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: 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
��dda. C e.. A 1440 (._j,,,,.` c .t.ei / 7 v e iwpf 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
Chimney/liner/flue/vent 10.00
❑ PROPERTY OWNER I ❑N,
Other: 10.00
Name: 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: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
• ❑ APPLICANT • ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: / ... c...., 2 , fle,‘,...., ` � G j4 C Fuel piping
Contact name: / `.(k n t - G.. ���� $5.40 for first four; $1.00 for each additional
r J
Furnace, etc.
Address: •
�G J3 0 Y 4=, 3 3 3 Y Gas heat pump
City/State/ZIP: T �0_,e C. ? al Wall/suspended/unit heater
Phone: (sG 3 ) G 13 — c 9 4 Fax: : Q cr & `f e 07 S-'4 "?.. Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: - . .. ,
, MECHANICAL PERMIT FEES* .
City/ State/ZIP: Subtotal 3/ L ,
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: • J Q 5 State surcharge (8% of permit fee) 2 S
TOTAL PERMIT FEE $3 _ SD
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
is\ Building \Permiu\MEC•PemtitApp.doc 12/03 440. 46171(11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard n `
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\Penmts\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ' Date Requested / _ y AM PM BUP
•
Location � �' '_ Suite MEC Ado V- 4 ' 6 3
Contact Person Ph ( ) 6 a R/( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing •
Insulation - �- = $$t,
Drywall Nailing ■ 1 I, ��
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: i vAr
F;
PART FAIL
ING
Post & Beam
Under Slab r 1 _
Rough -In
Water Service ,����
Sani Sewer AV/ Ip W ,I/1/` Rain Drains ir
Catch Basin / Manhole
Storm Drain
Shower Pan •
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PAS PART FAIL
LEC RICAL
ice
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: ❑ 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