Permit C ITY OF TIGARD MECHANICAL PERMIT
�I�
r� I DEVELOPMENT SERVICES PERMIT #: MEC2005 -00391
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/28/2005
PARCEL: 1 S136CD -00100
SITE ADDRESS: 11705 SW PACIFIC HWY J ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT: JURISDICTION: TIG
Project Description: Restroom exhaust & gas piping. Valuation: $2000.00
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: DOMES. INCIN:
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:
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Description Date Amount
BY WYSE INVESTMENT SERVICES CO [MECH] Permit Fee 6/28/200 $72.50
200 SW MARKET ST STE 345 [TAX] 8% State Surchar€ 6/28/200f $5.80
PORTLAND, OR 97201
Phone: Total $78.30
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
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
or 1- 800 - 332 -2344. '7
Issued By: ,vZif� Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,�idZE c hanical Permit Application FOR OFFICE USE ONLY
City of Tigard y Permit No. = O ` U IT i
13125 SW Hall Blvd., Tigard, OR 91722 1, u I .J Receiv
Date
;ll'
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / /yrx \ Date/By: Other Permit:
Inspection Line: 503.639.4175 - 1' "vP :)�I
JUN 2 2005 —A+i __ Date Ready/By: MI H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information •
• . C!TY OF Tim n
�(j1P �ORK. COMMERCIAL FEE* SCHEDULE = USE CHECKLIST
1:1 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: $ Z-000
:;RESIDENTIAL EQUIPMENT' /SYSTEMS FEES * - :
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi ❑ Master builder ❑ Other:
Description Qty. I Ea. I Total
JOB..SITE INFORMATION "AND LOCATION . - Heating /cooling
q 4 Air conditioning or heat pump
Job site address:
I I ' ( 05 tc cf ) pck.e , +j C H (.0 y 4 CS (requires site plan showing placement) 14.00
City /State /ZIP: T 'I n� ((_ q r7 ^+ _1 L ^ _ / Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 4 Project name:
.S(-Acc )--' ` C y \O. 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
/y n 4 I /� 4 Oo n � xla1 U / f -7i-- A , S !p / �� Gas fireplace vent 10.00
/"' ' r (�.. `/ Flue vent foor 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
� , . 5 'PROPERTY ; OWNER , TENAN _' Other: 10.00
Name: to S 1 - 1 Environmental exhaust and ventilation
/� 1 ^� Range hood/other kitchen
Address:
1 ' 1 Q c , Lc Li) RC► �t c. 1...1u3..../ . \I . equipment 10.00
City /State /ZIP: T'.1-0,)-01 2 G� Z2S Clothes dryer exhaust 10.00
l Single -duct exhaust (bathrooms,
Phone: (SO ) , —arc Fax: ( ) toilet compartments, utility rooms) 1 6.80
. " , - ' " _ APP_ L'ICANT , Jul CONTACT PERSON - . Attic/crawlspace fans 10.00
' Other: 10.00
Business name: cS(Aic H 1 H 6, V\ .
Fuel piping
Contact name: V G $5.40 for first four; $1.00 for each additional
Fuace, etc.
Address: (t /) V ,id ai.ei c I -( u a-J '3 Gas heat pump
City /State /ZIP: T� o- -r i ((Q Q l 1....„1,9 1....„1,9 Wall /suspended/unit heater .
Phone: (50Z)_ 9 _ 4Gtr Fax: ( )
Water heater
CUUI
Fireplace
E - mail:
Range
- CONTRACTORb' . * - , ' Barbecue
•
Business name: ,c/9/11-: 4$ L,uA& Clothes dryer (gas)
Other:
Address: ' MECHANICAL-PERMIT FEES *' '
City /State /ZIP: Subtotal
,_Minitrlitm er ee $72.50
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: --■1111 W_ State surcharge (8% of permit fee)
• ��� TOTAL PERMIT FEE
Authorized signature: -'. ' This permit application expires if a permit is not obtained within 180
�.= -- days after it has been accepted as complete.
Print name: 1 C___ , Date: * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Pemiits \MEC- PennitApp.doc 12/03 440-4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard'
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valu ation: 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 TIGARD
B
1 UILDING DIVISION PERMIT #: MEC200S -00391
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2005
����
Phone: (503) 639 -4171 i'Ufivi illy
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/7/2005 TIME: 7:10AM PAGE: 10
SITE ADDRESS: 11705 SW PACIFIC HWY J CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: Restroom exhaust & gas piping. Valuation: $2000.00 • ,
OWNER: PACIFIC CROSSROADS PROPERTIES, I PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 7/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010941 -01 503. 9834 -6655 N
Corrections /Comments /Instructions:
•
itillnirA
'Ii
v
F PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
► ,
Inspector: i4 ' Date: 7/7 Phone #: (503) 718 -
I