Permit ri i
4►, CITY OF TIGARD
�' MECHANICAL PERMIT
u: "I'� DEVELOPMENT SERVICES PERMIT #: MEC2002 -00289
..� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/02
PARCEL: 1 S136DB -02500
SITE ADDRESS: 11636 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 0
OCCUPANCY GRP: B VENTS WIO APPL: 2 VENT SYSTEMS: 1
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 100,000 BTU 15 - 30 HP:
FIRE DAMPERS ?: N 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: L 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: 2 <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical tenant improvement.
Owner: FEES
NACHTIGAL, FRED C SUC PERS REP Type By Date Amount Receipt
KESSLER, JULES E PRMT CTR 8/30/02 $62.50 2720020000
101 SW WASHINGTON ST PLCK CTR 8/30/02 $18.13 2720020000
HILLSBORO, OR 97123 5PCT CTR 8/30/02 $5.80 2720020000
Phone: Total $86.43
Contractor:
BEWLEY MECHANICAL
5591 SW ARCTIC DR
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 626 -8986 Mechanical lnsp
Reg #: LIC 63582 Mechanical lnsp
Duct Inspection
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 • les adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 c •, through OAR
952 -001 -0 You may obtain copies of these rules or direct questi • . t 0 NC by calling
tw4194. -Q RQ
Issue Permittee Si natu. f+•— 1 �
9 1� ►�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the ne ` bu ' - ss day
t , 7,_... oz..--
Mechanical Permit Application OFFICE USE ONLY
( n 1 / � h , � 65,4 ` .
Date received: 0 Permit no.: fL
"t' City of Tigard `J Projectappt. no.: date:
Ciq of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ByLk Receipt no.:
Phone: (503) 639 -4171 _
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
J 1 & 2 family dwelling or accessory J Commercial /industrial LI Multi - family Tenant improvement
J New construction J Addition /alteration/replacement LI Other:
JOB SITE INFORiMA LION COMMERCIAL VALUATION SCHEDULE
Job address: i J (. 3 6 S (,t, Pa � I' (,� Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: — l Suite no.: — J value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: 15 13 6 B -{-arc 1 )$7)8 profit. Value $ 1 0� DO 0
Lot: -5 t 7 Block: — I Subdivision: — 1 *See checklist for important application information and
Project name: .l �� N Tt a r�l jurisdiction's fee schedule for residential permit fee.
City /county: -J
a . /i. uj / IZIP q 4.).) 33 I & 2 FAMILY l)WEIII:NG PERMIT FEE: SCHEDULE
De cation of work on premises: I F' AAN DC OMIVI ERICAL /INDUSTRLALE:QElPMENTSC1IEDULE
I'vy% a✓O ✓'P tee..+ 4-0 (�h-1 ye. bt.t t' I at A-1 Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? kYes Li No Air handling unit �U - I %.) CFM 1600
space insulated? : - Yes Cl No Air conditioning (site plan required)
Is existing O
g P Alteration of existing HVAC system a
Boiler /compressors 0
Business name: I v Q - State boiler permit no.:
HP Tons BTU /I
Address: ' Fire/smoke dampers/duct smoke detectors Q
City: I State: I ZIP: Heat pump (site plan required) Q
Phone: I Fax: I E - mail: Install/replace furnace /burner$DODOBTU /H
CCB no.: Including ductwork/vent liner Xl Yes No
install/replace /relocate heaters - suspended,
City/metro lic. no.: wall, or floor mounted 0
Name (please print): Vent for appliance other than furnace 1
CONTA(T PERSON Refrigera on:
p Absorption units BTU/H 0
Name: ,yyta p.d a 0 - Feeitiei'Td go I Chillers HP 0
Address: 1094 - v F . 3� " t' k � Oa Compressors HP b
w Environmental exhaust and ventilation:
City: B 1 a ✓1.«_. State:W/q - I ZIP: q$Z) 3 ? Appliance vent lilt
Phone. 5 -, ). 7.., CO Fax: }% - Mq E - mail: Dryer exhaust •
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system O
Name: rL ,Uk.3 � Exhaust fan with single duct (bath fans)
Mailing address: a t{-a i (A h t2t/Zn, E xhaust system apart from heating or AC 0
City: fitte.- I State: kill I ZIP: CM i 3 it" Fuel piping and distribution (up to 4 outlets)
Type: LPG X _ NG Oil
Phone:
.31S, / Fa x: E - mail: Fuel piping each additional over 4 outlets
Process piping (schematic required) 0
Number of outlets tQ
Name: Au to I h 4.--.5 ,^ Other listed appliance or equipment:
Address: ,i S ►'r^ owa Decorative fireplace O
City: t ' e - Iu 1 q n State: l4/ ZIP: R3 Insert - type 0
Phone:N..C. 7 3'', (, C 1 Fax: 7.31, 736.11E-mail: DI eramoi � 'oodsto ve /pellet stove 0
Other: (')
Applicant's signature: Date: (p • t Q .C-0 Other: 0
Name (print): ' I c) - / Fer.t 'Ho /4bri& .
Not all jurisdictions accept credit cards, please call jun 1 for more information Notice: This permit "pp 1LCdtiOn Permit fee $
LI Visa u MasterCard Minimum fee $ �- • So
Credit card number: / / expires if a permit is not obtained Plan review (at o Z T $ 1 $ . 1 3
Expires within 180 days after it has been State surcharge (8 %) .... $ 5. $t)
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $ c i 4.. It 3
Cardholder signature Amount 440-4617 (6 U(UCOM)
, CITY. OF TIGARD 24-Hour -
. . BUILDIN I Inspection Line: (503) 639 -4175
C " MST
INSPECTION DIVISION Business Line: (503)-639 -4171 BUP oZ — d
, r
Received Date Requested l 1 ( / AM PM BUP
Location 1 / 3 Z � . c c , Suite , r M jy2Jvz - o 0 1
Contact Person Ph ' 70/..= /0 q
Contractor Ph ( ) SWR
BUILDING _ Tenant/Owner ELC
Footing
Foundation - -- - - - ELC
Acees
Ftg Drain % _ �� a ; ' " °'�,� ELR
Crawl Drain - �� IT
Slab
pre'ionl ..
Post & Beam
Shear Anchors ' �' �l tit' ,� ,
Ext Sheath/Shear p l C �� ! �_ c "/ I� .�. I
Int Sheath/Shear ( ii I � -
Framing �'
Insulation 00
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm _ �'
Susp'd Ceiling _
Roof
Other
i _ ....-AMMIIIIMP • a BING AMU a I I r -
Post & Beam Myll t :KW '
Under Slab V Ii -
Rough -In
Water Service
Sanitary Sewer 1
Rain Drains '
Catch Basin / Manhole
Storm Drain •
Shower Pan
Other: • 4 a?, Z`
, ;r ;;, j PART FAIL
•
I "' ANICAL
Post & Beam .
Rough -In ,
Gas Line
Smoke Dampers
Final '!
PASS PART FAIL •
ELECTRICAL
Service
Rough -In
UG/Slab _ �,
Low Voltage • i
Fire Alarm '
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 1 ` 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line /
ADA Date ///1.) /d Inspector r) Ci7 Ext
Approach/Sidewalk
Other: ,
Final ` DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL