Permit � ? CITY OF TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00674
,. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/25/03
PARCEL: 1S134BC-00300
SITE ADDRESS: 12282 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Mechanical gas piping for new pizza oven. Project Value:
Owner: FEES
BPP RETAIL LLC Description Date Amount
BY BURNHAM PACIFIC PROPERTIES
ATTN: JOHN WATERS [MECH] Permit Fee 11/25/03 $72.50
SAN DIEGO, CA 92101 [MECPLN] Plan Rev 11/25/03 $18.13
[TAX] 8% State Surchari 11/25/03 $5.80
Phone: Total $96.43
Contractor:
KSM PLUMBING
DBA SUNSET PLUMBING
PO BOX 628 REQUIRED INSPECTIONS
WEST LINN, OR 97068
Phone: 503 - 570 - 3427 Gas Line
Final Inspection
Reg #: LIC 14154
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 da ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those r - s are set forth in OAR 952 -001 -00
Issue By: i;Sy ► Permittee Signature: A . �/1
�`" '" Call (50 .39-4175 by 7:00 P.M. for inspections neede • the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
Date/By: 45 03 Permit No.: CC c)l77S
Ci a Tigard of Tigard Planning Approv. Building
Date/By: Pemtit No .:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No .:
Phone: 503 - 639 -4171 Fax: 503-598-1960 Post- Review Land Use
1 Date/By: Case No.:
Internet: www.ci.tigard.or.us �� II y
24 -hour Ins ection Request: 503 -639 -4175 Na � Su pee Pa for
P Q Name/Method: / /fQ Supplementalnformation.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling 2.
ommercial/Industrial Value: $ 5b See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
❑ Master Builder El Other: Description I Qty I Fee(ea.) I Total
Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: /'a 2g _5,,J . h I/; Arm t2? Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Hydronic hot water system 14.00
Project Name: pt 2.2.42.- Sc.L.,...r /224.— 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: I Lot #: Repair units ' 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
ilckci Qj S f '45 7 4 '2_2_9.- � Flue vent (water heater /gas fireplace) 10.00
�c 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 & Ventilation
Address: Range hood/other kitchen equipment 10.00 •
City/State /Zip: Clothes dryer exhaust 10.00
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT 0 CONTACT PERSON utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 1 0.00
Fuel Piping
City /State /Zip: *•($5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. *•
Gas heat pump **
E -mail: Wall/suspended/unit heater *•
CONTRACTOR Water heater •*
Business Name: (Pk 4,, Fireplace **
Address: . , 6,2- Y Range *4. BBQ ••
City/State/X: Lr/61- X /ti--v O✓\- Clothes dryer (gas) *•
Phone: cb3 -S2 f 029 Fax: S7o - 373s Other: ?)d£it **
CCB Lic. #: / ' /(5" Total:
Authorized �/ Mechanical Permit Fees*
Signature: ,f / Date: / /r/ 'a3 Subtotal: $
Minimum Permit Fee $72.50 $
.5z;>4 �C � v /1/ Plan Review Fee (25% of Permit Fee) $
" (Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
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.
i:\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
thereof.
All New Commercial Buildings require 2 sets of plans.
•
1
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— _ J, +ditio,1,-A y Approved - - • - - -- l ] -
-Pr only the w.< as described in:
- - - - --- - -- ...._...._._ _.____... .._ - -- '.c Q
EG2003 - O kyr 7 - - - -- - - - - -
S::e I.ette. to: Follow l I
Attach -
Job Aric'ress: / .$74.1 SCA/az riwgr RD
OFFICE COPY ..... i hrileld.N.. 9. !E Dater / / - 2X - -__ _
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 639 -4175
MST •
INSPECTION DIVISION Business Line -4171
BUP
•
Received /7--(((o / -U(t Date Requested / D AM �/� PM BUP
Location Z . Z S W _ ,, J J *0 i i te Gip — nQ ro 744
Contact Person 6 Ph (" 03 70 -3 4 1Z7 PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner �, � 42t • ELC
Footing
Foundation ELC
Ftg Drain Access: • ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 1119 /, _ kJ rf _
Framing u�� v't�- -
Insulation
Drywall Nailing
Firewall -Z) L n ��
Fire Sprinkler t
Fire Alarm
Sus 'd Ceiling g C04 S `-- t..,1.A \ S "Z__ \ � 2—� 6
Other: (�, /
Final �Q S l l A S l 2445
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 i
Post & Beam
,
Rou h -In ��
as Line
Smoke
Dampers
in
PASS PAR 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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA \l /(t
Approach/Sidewalk Date ✓ 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL