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Permit
a . CITY OF TIGARD MECHANICAL PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00190 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2007 PARCEL: 2S 102C B -02300 SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG PROJECT: PACIFIC MEDICAL Project Description: Install additional HVAC unit and ductwork. Project Value: $6,000 CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: B 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: Owner: FEES PACIFIC PROPERTIES Description Date Amount BY MARTIN JOHNSON 13200 SW PACIFIC HWY [MECH] Permit Fee 4/9/2007 $159.50 TIGARD, OR 97223 . [TAX] 8% State Surcha 4/9/2007 $12.76 [MECPLN] Plan Rev 4/9/2007 $39.88 Phone: Total $212.14 Contractor: WILLAMETTE HVAC SERVICE PO BOX 23334 TIGARD, OR 97281 " REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 628 -6841 • FAX 503- 848 -2597 Reg #: LIC 56951 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 'n the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain ''pies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issu By: 0 /' I / ; Permiftee 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. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Datee/By 9 e9 Permit No.: /_� 1 90 1 4 ill • 13125 SW HaII Blvd., Tigard, OR 97223 Plan Review r✓r L` vaiv/ _ a Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: Inspection Line: 503.639.4175 Date Ready/By: I G A R D Date p ReadyBy: 0 See Page 2 for Internet: www.tigard - or.gov Notified/Method: a Supplementallnformation TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction &ddition/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, ov and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling kirCommercial/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: 4 5 ? y (0 S <) �,� 4 Ai wing placement) 14.00 or heat pump '/ � (requires site plan showing C Furnace 100,000 BTU (ducts/vents) 14.00 no.: Project Furnace 100,000+ BTU (ducts/vents) Suite/bldg./apt. ect name: j / etc Jf vG. 4 z ¢ 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 / , Gas fireplace 10.00 /v e't� !II/� C L.- 0. � ) t...+&le 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 ❑ PROPERTY OWNER I ❑ TENANT ot y/liner /flue/vent 10.00 Other: _ 10.00 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 10.00 City /State/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: _ 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) I Fax :: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue G� ` /� /L / / Clothes dryer (gas) Business name: r l c1( l� Other: Address: )'CJ ,) 3,y e.,? ,3 3 Cl MECHANICAL PERMIT FEES* City/State /ZIP: -7—' P ✓ce C� q ? pr2- e ( Subtotal Minimum permit fee ($72.50) ,r Phone: ( ) L. ,- 6$ �/ Fax: ( ) SY 0- pl S9 j Plan review (25% of permit fee) 3 $$ CCB lic.: .5 4 ,,,5/ State surcharge (8% of permit fee) /A, 7 TOTAL PERMIT FEE A/ f . / si r � - 2...7 �� This permit application expires if a permit is not obtained within 1 Authorized signature: /" — days after it has been accepted as complete. Print name: I Date: • Fee methodology set by Tri -County Building Industry Service Board I :\ Building \Permits \MEC- PemutApp.doc 04 /06/06 440- 4617T(I1 /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. 1:\ Building \Permits\MEC- PermitApp.doc 12/30/05 2 CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2007 -00190 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2007 Phone: (503) 639 -4171 i 1 Inspection Requests (24 Hrs.): (503) 639 -4175 F__ INSPECTION WORKSHEET FOR DATE: 6/28/2007 TIME: 7:01AM PAGE: 90 SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE: PROJECT NAME: PACIFIC MEDICAL DESCRIPTION: Install additional HVAC unit and ductwork Project Value: $6,000 OWNER: PACIFIC PROPERTIES, PHONE #: CONTRACTOR: WILLAMETTE HVAC SERVICE PHONE #: 503.628 -6841 Inspection Request Scheduled For: Date: 6/28/2007 Pour Time: Code # Inspection Description Confirm # Contact # (ag-- 699 Mechanical final 051076 -01 971 -67B 5099 fl Y <<� iiq Corrections /Comments /Instructions: � I� —I Z I#*"' PASS ❑ r' : ' L APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL I CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector Date: C 2e 0 Phone #: (503) 718- Z‘ CITY OF TIGARD BUILDING DIVISION p - PERMIT #: MEC2007 -00190 13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 4/9/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639- 4175jl� INSPECTION WORKSHEET FOR DATE: 5/31/2007 TIME: 7:00AM PAGE: 57 SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE: PROJECT NAME: PACIFIC MEDICAL DESCRIPTION: Install additional HVAC unit and ductwork. Project Value: $6,000 OWNER: PACIFIC PROPERTIES, PHONE #: CONTRACTOR: WILLAMETTE HVAC SERVICE PHONE #: 503. 628 -6841 Inspection Request Scheduled For: late: 5/31/2007 Pour Time: Code # Inspection D- - - i': ion Co firm # Contact # Messa. - 699 Mechanical f. al 191 04' :11 -02 503 - 752 -4985 der PL- f Z0 Cor -ctions /Comments /Instr •. • onl m �l v P11 c fc Z? o J PL4-4 i - D 7-'/ 5k� Pict oeanye___ Z__ � T ©-v r p- f' e 4 S Pe. M_eDV r CD S 7 go i 1 "! Go.'L ❑ PASS 111 PARTIAL APPROVAL 111 CANCEL ` • NO ACC SS FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718 - 7-4