Permit iT
A lb CITY OF TIGARD MECHANICAL PERMIT
�Ar DEVELOPMENT SERVICES PERMIT #: MEC2003 -00576
4• I II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/2/03
PARCEL: 1 S134BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 100
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 9
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanincal tenant improvement. Relocate supply & returns, install (1) new vent fan. Project Value: $6,000
Owner: FEES
SISTERS OF PROVIDENCE IN OR Description Date Amount"
BY STEVE FOSTER
PO O BOX 13993
[MECH] Permit Fee 10/2/03 $159.50
PORTLAND, OR 97213 [TAX] 8% StateTax 10/2/03 $12.76
Phone: Total $172.26
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202
Phone: 239 -4600 Mechanical Insp
Duct Inspection
Reg #: LIC 33135 Final Inspection
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 • arlA / � r Permittee Si natur ~ w"
ssued • y• ,� _ �r�` g e�
(503) • 9-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application . FOR OFFICE USE ONLY
Received a �J Mechanical
Date/By: / J 3 Permit No.: /Y 3 - 610 5
CI of Ti and Planning Approval Building
`J g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: /O - L .O / ' f, Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use
Aftl a Date/By: Case No.:
Internet: www.ci.tigard.or.us dl
�1 Contact Juris. • ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
• TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ 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, abor, overhead and profit.
❑ 1 & 2- Family dwelling IA Commercial/Industrial Value: $ 6OOO ' See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling _
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning** 14.00
Job site address: / - y y z 5 4' SGm c t 5 fe/tit Y /to_ Gas heat pump 14.00
Suite #: / 00 Bldg. /Apt. #: Duct work Z., 14.00
Project Name: i , e - 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: I Lot #: Repair units 12.15 Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/Q 6L Q C A 7 C y(f PPL', 0►I¢51701.1 Flue vent (water heater /gas fireplace) 10.00
I +�.�Av , 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: 1 10.00
Name: f et p if 7- e vC r "ewe >y g ys i _ Environmental Exhaust & Ventilation
Address: y , 0 G / v r le T S1N� Range hood/other kitchen equipment 10.00
Clothes dryer exhaust 10.00
City /State /Zip: i f d /t 7 le ~, i 0/1 Single duct exhaust
Phone: 2 /s -?,,'9-- Fax: 2 /5"- ft aZ (bathrooms, toilet compartments,
la APPLICANT ❑ CONTACT PERSON utility rooms) / 6.80
Name: Attic /crawl space fans 10.00
Other: 10.00
Address: -
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. •*
Gas heat pump **
E -mail: WalUsuspended/unit heater *•
CONTRACTOR Water heater *5
Business Name: if M - /I Z C,¢,✓ //Ci¢ </ Fireplace •*
Address: / 3 399 Se' G ;,Re•' - ',' 5 -rte Range ••
BBQ *•
City /State /Zip: f D/1.- te.,¢'v 9 - 1 7 7-02 - Clothes dryer (gas) ••
Phone: )- 3 9- yG 00 Fax: 2 3 9- 70 35, Other: **
CCB Lic. #: Total:
Authorized A� / Mechanical Permit Fees*
Signature: ��2/ y ®< - - 7 Date: 7/2.-4---- Subtotal: $ q
Tn�tum Permit Fee $72 $ /j ! •
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ / a • 74
TOTAL PERMIT FEE $ /7A • P4
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
r
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.
•
is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line; (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ' L
J BUP
Received `�' , / % O la Date Requested /5105 ' AM PM : UP
Location Z suite 2 3 -0057
Contact Persons Ph ( 0 PLM
Contractor 6271 Ph ( )) SWR
BUILDING Tenant/Owner 1v — / /Zed • ELC
Footing
ELC
Foundation
Access:
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
(
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole rx,
Storm Drain
Shower Pan
Other:
Final
PA T FAIL
ECHANIC
eam
Rough -In
Gas Line
ii • - Dampers
Final .
PART 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 ,1
Approach/Sidewalk Date / , Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL