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Permit 'CITY OF TIGARD MECHANICAL PERMIT k DEVELOPMENT SERVICES PERMIT #: MEC2003 -00695 ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/5/03 PARCEL: 1S136CD-00100 SITE ADDRESS: 11705 SW PACIFIC HWY N SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1 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: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Install exhaust fan. Owner: FEES PACIFIC CROSSROADS PROPERTIES, I Description Date Amount BY WYSE INVESTMENT SERVICES CO 200 SW MARKET ST STE 345 [MECH] Permit Fee 12/5/03 $72.50 PORTLAND, OR 97201 [TAX] 8% State Surchar€ 12/5/03 $5.80 Phone: Total $78.30 Contractor: MK CONSTRUCTION & TRADING 6633 NE SANDY PORTLAND, OR 97213 REQUIRED INSPECTIONS Phone: 503 Misc. Inspection Final Inspection Reg #: LIC 133894 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 -00 Issued By: , Permittee Signature: A.. 1 Call (503) 639 -4175 by 7:00 P.M. for inspections needed -the rie tx business day • • Mec " niCal Permit Application Received FOR OFFICE USE ONLY N / J MechanicitNioal (�, Building RECEIVED Date/By:1�/ �/ V. fl Perm.: 4 �,2, 3 2 O L - N �11k of Tigard Planning Ap rova Y g Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 DEC 5 2 A i Date/By: Permit No.: //�n" Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use w Internet: www.ci.tigard.or.us CITY OF TI : O Dat Case No.: � Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 503- 6BMINNG II '' "" W Name /Method: Supplemental Information. ,.,,; t`,, : k „. s�'. : V" f. ; a '' lei" " ' f'es y ' ",. ,;q - T }`p`c` " 'ii.,: re- :r 3ti .!!! Sx § ":• „ t It �,_`�,��. `..�_.,...•,� < .:,TYPE'OF,WORK ,�z.: ..• ".,x- � rY =;� -x �.,_�COMIVIERCIA I�E.,.SCHEDUi�,E� USE�CIIECKI;IST�.:.��. El New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all = s " . '.Fe rii.:1EGORY OEylCONSTRul TION 'ryR ' ),: r: , mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family : a; RESIDENTI °AI EQUIPMENT /SYSTEMS'FEE *; SCHEDULE° Description Qty Fee(ea.) Total ❑ Master Builder ['Other: Heating/Cooling .. ' ±�= 4:JOB" SITE - `INFORMATION= iind1LO`CATIONF'« ,'" : Furnace - add - air conditioning ** 14.00 Job site address: .447 O.," S u) j>aci Fie_ `i-f W `j Gas heat pump 14.00 Suite #: itJ Bldg. /Apt. #: Duct work 14.00 Project Name: P/2_e 1-/tl N 1 (_. ' Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) . 10.00 Subdivision: Lot #: Repair units 12.15 Tax map/ parcel #: Other Fuel Appliances ax ma P P Water heater 10.00 ".G ; ` ._; : I= DESO:d04TIOWOEAWiti . ' , Y. ': ` ' `' , ;- Gas fireplace 10.00 X g- L- /1, 4 Co C F M Flue vent (water heater /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 T OPERTY.O WNER' "`� H` ' TEA M , y a :,g vF`: , ,. Other: I ❑. O �- ;,�..�.. E . x NAN:T�.,�ry. >� �:.,:�, .- ..,Y 0.00 • Environmental Exhaust & Ventilation Name: NA4 N-N p.t A-Ltil gt- U y -E/U Ventilation, Range hood/other kitchen equipment 10.00 Address: nil 7 o g SW -P I ` e_ -kW C/ 4cLi it- N Clothes dryer exhaust 10.00 City /State /Zip: ° ` D l ot ci 7 22 3 Single duct exhaust Phone( --p 3) t.7, - AS3 j Fax: (bathrooms, toilet compartments, ®•:APPLICANT 77 !" '' - Y.: a' ISI ONTACT PERSONW : °.` ,utility rooms) 6.80 Name: ,a- ©: (.44_6„,i Attic /crawl space fans • 10.00 Address: 6,A. 3 : Nr Aa P`P g L LI) Other: 10.00 Fuel Piping City /State /Zip: pcp i 017, -1 , GP-- Ci "7 2.1..P * *($5.40 for first 4, $1.00 each additional) Phone: Sb 3 3 .s 3 ?2Q Fax: Sb 3 760 -7g' 23 Furnace, etc. ** Gas heat pump ** E -mail: Wall /suspended/unit heater ** '..,` ': , h - _ >_.2?i'OCONTRA'GT.OR` l _ . _x `.;ID ..... ' `V t ;. ���� `� � =F.. - Water heater ** Business Name: iut l.G e1.‘ gfi/UAetl..c 1- :712A - oher LLC Fireplace ** Address: 663 3 xi Dy 8l. U D Range ** BBQ ** City /State /Zip: poet (A-m -Q 6 172 13 C � o Clothes dryer (gas) ** Phone: o3 33,c 372t, Fax: t7) 3) 7&O Other: ** CCB,Lic. #: ,l 3 3 8t/ 4 Total: Authorized ,D�( f Mechan Permit Fees* Signature: (�" — Date: (2f �1 Q ? Subtotal: S - Minimum Pet al. F ee $72.50 $ 7d2 -5,0 V-i- A j` }. { -1 ,.0 11-0 1 L4 ( Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ 5 ..k TOTAL PERMIT FEE $ '7 . 3 0 Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. is \Dsts \Permit Forms\MecPermitApp.doc 01/03 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. $100,001.00 and up $1 ,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction I thereof. All New Commercial Buildings require 2 sets of plans. is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date quested / } Z_ AM PM BUP c Location // - 7®.� ��� _G Suite • 3 'O 6 ��'� Contact Person Ph ( ) 72-6 — 0(Y/ % PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner 1) — d V I. /_5 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 r Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: ( Final PASS PART FAIL yiL PLUMBING , ...-J Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL 1 4A/11‘ =earn Rough -In Gas Line e Dampers � rn PART FAIL 2 - ° 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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 5/ �� 6 y Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL