Permit • - tt
CITY TIGARD MECHANICAL PERMIT
PERMIT #: MEC2004 -00032
r'II
- 13125 DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 1/27/04
PARCEL: 2S 102 B D -00100
SITE ADDRESS: 12645 SW PACIFIC HWY
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12
BLOCK: LOT: 052 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: El VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 2 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace (2) gas furnaces.
Owner: FEES
ROMAN CATHOLIC ARCHBISHOP OF Description Date Amount
PORTLAND IN OREGON
2838 E BURNSIDE [MECH] Permit Fee 1/27/04 $72.50
PORTLAND, OR 97214 [TAX] 8% State Surchart 1/27/04 $5.80
Phone:
Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223
Phone: 503 624 - 2704 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
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: � _ - � , _
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day ' \
Mechanical Pe Application FOR OFFICE USE ONLY
S Received Mechanical
Date/By: / — ,0 2 7 -- ' ° `/M., Permit No.: LG0/001- -CZ233 "D—
City of Tigard Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Ocher
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503 - 598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us ' Date/By: Case No.:
wt�'!�'�I
Contact ,.ups ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: / t--r Supplemental Information.
TYPE OF WORK_ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ ew construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
ddition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
El Master Builder ❑ Other: Heating/Coolin
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning•• 14.00
Job site address: / 4 5 S uJ - W/}l -( P[ C_ - Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: 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
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/) LID /es c +e.. q Q s - ..4,,r>'-e+ 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
0 PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: Environmental Exhaust & Ventilation
Address:
Range hood/other kitchen equipment 10.00
Clothes dryer exhaust 10.00
City/State /Zip: Single duct exhaust
Phone: Fax:
❑ APPLICANT (bathrooms, toilet compartments,
❑ CONTACT PERSON utility rooms) 6.80
Name: �-tA, vvy-t CA " " ` Attic /crawl space fans 10.00
Address: g O .5 S I. ineJ e 1 / ` ) 9 Other: 10.00
Z/Gr Fuel Piping
City/State /Zip: - 771 v g t p "($5.40 for first 4, $1.00 each additional)
Phone: L a y ft/7 9 I Fax: Furnace, etc. ••
Gas heat pump +•
E-mail: WalUsuspended/unit heater ••
CONTRACTOR Water heater
+•
Business Name: Cd (a b, a 1+44. Co. i.../ ? Fireplace
Address: pp Q d 3 O 31 7 Range +•
City/State/Zip: BBQ ••
Ci
ty p: 77 a PA— 97 aI 3 Clothes dryer (gas) ••
Phone: G y a 70 v I Fax: .5'9 P' D 290 Other: ••
CCB Lic. #: 7 3 $ 9 Total:
Authorized Mechanical Permit Fees*
Signature: (_7":0•22 Date: /-4 7•0y Subtotal: $ '7.2 • �Z
Minimum Permit Fee $72.50 $
,,Q t G9 ,9. .44.-/AV Plan Review Fee (25% of Permit Fee) $
(Please print name) ' State Surcharge (8% of Permit Fee) $ S , k0
TOTAL PERMIT FEE $ 7y , ao
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\Perrnit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard I _ A, •- �•
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 $1 0,000.00 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 •
c. • 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
thereof.
All New Commercial Buildings require 2 sets of plans.
Vii? . �:. :�
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is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 175
INSPECTION DIVISION • - ' Business Line: 9 -4171 MST
BUP
Received 6 34/ F>e Date Requested 2 / a 0 C PM BUP
Location / 2 6o ei Suite eat DC's a 2.
Contact Person ` l Ph ( O ) lv W - 2 ? d VPLM
Contractor CC. PPA ) �� SWR
BUILDING Tenant/Owner T�iT 1 IG71(11 "`�a ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear non (, / y C
Framing CY�t� cam`'
Insulation „ Q J , / /
Drywall Nailing (�C C_ vc rL�{'
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
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
PASS PART FAIL
MECHANICAL f ��►
Post & Beam � f111i1• tj
Rough -In ((�� ==�� -
Gas Line 2' (t),Ns �`�
• .e Dampers
final
• �" - ART FAIL
ICAL
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 ()? Date `�' ` Inspector L? Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL