Permit CITY TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00015
:4: 4 4 ,,,A,
-- �,L R�J 1 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/23/04
PARCEL: 2S1 10 D C -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
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: 1 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:
OTHER UNITS:
FURN > =100K BTU: < =10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Refrigeration remodel of 30+ systems $18,000 Valuation
Owner: FEES
TIGARD, CENTER LP Description Date Amount
9777 WILSHIRE BLVD #609
BEVERLY HILL, CA 90212 [MECH] Permit Fee 2/23/04 $339.50
[MECPLN] Plan Rev 2/23/04 $84.88
[TAX] 8% State Surchar€ 2/23/04 $27.16
Phone: Total $451.54
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone: 503 - 652 -0884 Mechanical Insp
Final Inspection
Reg #: LIC 149200
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 - 00,1 =0100>Y may obtain copies of these rules or direct questions to OUNC by calling
(503)46 -6699. \ -Th
Issued By: /\ ,�; Permittee Signaturel��
Call (5 639 -4175 by 7:00 P.M. for inspections needed the next b siness day
/5570 50 Pig glair nCVCI V EU
Mechanical Permit AppliQatiQn1 4 2004. FOR OFFICE USE ONLY
City 'Of Tigard Date/By: i DateB / ` Pem>itNo.: c A'^
OO .,
13125 SW Hall Blvd., Tigard, OR 97223 1960
Phone: 503.639.4171 Fax: 503.598.1960 Plan Revie
. rm
DateBy: 2 — i e o
CITY OF TI ' Other Permit:
N I, l
Inspection Line: 503.639.4175 BUI LDING DIVI Date Ready/By: 3,' '/ / W turfs: S upplemental See Page 2 for
Internet: www.ci.tigard.or.us ( F t Notified/Method: /� , I Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ 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: $ 4, /Jae
• RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling A Commercial/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
Air conditioning or heat pump
Job site address: /557t _5t '' /.t C - /e — Ail / (requires site plan showing placement) 14.00
City/State/ZIP: �-7� y �r," / -
j �/9 33 Furnace 100,000 BTU (ducts/vents) 14.00
e Furnace 100,000+ BTU ( ducts/vents) 17.90
' Suite/bldg. /apt. no.: Project name: J OI. 1ewo ! / tl 78 Gas heat pump 14.00
Cross street/directions to job site: I 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
Flue/vent for any of above 10.00
Subdivision: I Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
/20'1>1--i p --jGy( , -. 01 � � - 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
Chimney/liner /flue/vent 10.00
❑ PROPERTY OWNER I ❑ TENANT Other: 10.00
•
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) • toilet compartments, utility rooms) 6.80
F APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:{ frl�J . // Dlir�� a(� %;i� / ` �f4l 6 ,7....;46- Fuel piping
Contact name: �f .. ,,, e.,,,,,!... $5.40 for first four; $1.00 for each additional
Q Furnace, etc.
Address: S-7 62 Se � ..e.e 1 /CYTOtie lam/ l� . Gas heat pump
City/State/ZIP:14 e m tAA) ,- / 7 9 7d- Wall/suspended/unit heater
Phone: COS) 8 y9 — 63-1 0 I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR ., Barbecue
Business name U C(p , r l ' i jA i s �.� (-AU a 4, y �G Clothes dryer (gas)
` ^ n ' . 1 Other:
Address:s'3 0 6 s ^ 1 C/LY1 it$l r'1`h� W MECHANICAL PERMIT FEES*
City/State/ZIP: /A Ir) k %)2 9' 7��,.-� Subtotal �' 3 SO
/' ' Minimum permit fee ($72.50)
Phone: (g)3 g L/9 .s 6' 45 Fax: ( ) Plan review (25% of permit fee) gt/, g 6
CCB lic.: / y ycaaz:, State surcharge (8% of permit fee) A7.11
�
f TOTAL PERMIT FEE I{ 5 / , 5 t y
Authorized signature j/ / This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: i7A, k F ✓ vj e �- Date: ) — / L, — L1 ' Fee methodology set by Tri- County Building Industry Service Board
is\ Building \ Permits \MEC- PermitApp.doe 12/03 440- 461TT(I1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information 4 - . !
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 24 -Hour
BUILDING Inspection Line: (5Q3) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Date Requested 1 / 1 " -- le ) A(�i` PM BUP
Location I S s 7 v Y , Suite MEC — 6 1 v 0 /5 --
Contact Person -_i1. Ph ( ) g49 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
1 <
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA T FAIL
ECHANI A
Pos
Rough -In
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
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: 0 Unable to inspect — no access
Fire Supply Line
ADA ZtS75
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL