Permit CITY TI GA R D MECHANICAL PERMIT
I re DEVELOPMENT SERVICES PERMIT #: MEC2005 -00203
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/2/2005
PARCEL: 2S 102AC - 01704
SITE ADDRESS: 12720 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace (2) roof heat pumps. Valuation $6000.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: UNK 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: 2 OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
SPRINGER, JERRY C Description Date Amount
7400 SW FAIRWAY DR
WILSONVILLE, OR 97070 [MECH] Permit Fee 5/2/2005 $159.50
[TAX] 8% State Surcha 5/2/2005 $12.76
Total $172.26
Phone:
Contractor:
ACE RESTURANT EQUIPMENT
9955 SW BEAVERTON - HILLSDALE HY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Phone: 503- 644 -1806
Reg #: LIC 128907
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.
Issued By: 12_f r_. 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.
r
Mechanical Perini b'El V E ® Received FOR OFFICE USE ONLY
�`++ - �y
City of Tigard
Plan :,2-45- � Permit No.MEC2 ^u1 - -aVey
SIM 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review \\ `` �/l!
Phone: 503.639.4171 Fax: 503.598.1 1/ / D
0 2005 Other Permit:
Inspection Line: 503.639.4175 •J W Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: e. �
• � V r Supplemental Information
(211Y Or i1u.0 19
.13 UltifitiNe 1 14SJON COMMERCIAT .FEE* SCHEDULE = :.1(JSE CHECKLIST:
itildi 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.
CATEG, RY OF CONSTRUCTION Value: $ ////''
J op O
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwellingommercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: j 2-72-0 S( poek(•ic 1.4 1.,4)y Air conditioning or heat pump
' (requires site plan showing placement) 14.00
City/State/ZIP: �3nrd t pg, Ri � . Furnace 100,000 BTU (ducts/vents) 14.00
� Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: #'Z tr , 1 Project name: FtAbj is . p vi,(ce tdottifort. 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: I 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
f �ePiar,P. roof- Itp boa (tamp. 02- Gas fireplace foe 10.00
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
ID PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: S o 8 er, :ferry C Environmental exhaust and ventilation
Address: --/q.00 ( equipment 10.00
Range hood /other kitchen
S� �QII i1)a1� Q1
City/State/ZIP: wi1SC{/IUl ((Q , or 910 a Clothes dryer exhaust 10.00
Phone: Single -duct exhaust (bathrooms,
( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON ' ' Attic /crawlspace fans 10.00
Business name: Other: 10.00
e2�� LI�'( w 14 1 itpi te1/1-{ Fuel piping
Contact name: On nn9, Tae. $5.40 for first four; $1.00 for each additional
Address: /3880 3 Foriyl(Y19 G as hea etc
li � Y (at Gas heat pump
&!1!
City/State/ZIP: UG r 4-OM, nR (1100/L n Wall/suspended/unit heater
Phone: ( ) 641 - 14.00 Fax: : (3) 6 Water heater
- (R�6' Fireplace
E -mail: Serve e s) t g .- a pp p t 1 L,lce . corn .
t -" Range
'CONTRACTOR Barbecue
L Clothes dryer (gas)
Business name: Ace 1K P C - 1 - )r v1 �it DtiiplA&QUT - i/ Other:
Address: ��t s ij Pp(U e r +o,1- H i j i sc 4e joy MECHANICAL PERMIT FEES* : -
City/State/ZIP: Bea v Q r+00, 0? A 400- Subtotal
Phone: (56 ) 6'1-4-C806. Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 1 2,.g 40 . e.›..;' b "A State surcharge (8% of permit fee)
i 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/ t 1 Date: 5/._70 � I • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \PemutANIEC- PermitApp.doc 12/03 4404617T (11 /02/COM/WEB)
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.
$100,000.01 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 OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005-00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2/2005
Phone: (503) 639 -4171 i�
Inspection Requests (24 Hrs.): (503) 639 -4175 ° __..
INSPECTION WORKSHEET FOR DATE: 6121/2005 TIME: 7:11AM PAGE: 103
SITE ADDRESS: 12720 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PUBLIC SERVICE LABRATORY
DESCRIPTION: Replace (2) roof heat pumps. Valuation $6000.
OWNER: SPRINGER, JERRY C. PHONE #:
CONTRACTOR: ACE RESTURANT EQUIPMENT PHONE #: 503- 644 -1806
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009725 -01 503.5 -9811 Y
Corrections /Comments /Instructions: lAZ-
C lal '
-11—. )---# \ Xjf
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ' CALL FOR INSPECTION ❑ ADDITI NAL FEES ASSESSED
Inspector: /��/1% _ Date: Z( (IS-Phone #: (503) 718 -
NV