Permit CI TY OF TIGARD MECHANICAL PERMIT
1. DEVELOPMENT SERVICES PERMIT #: MEC2000 -00010
� � I 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 01/24/2000
PARCEL: 1 S134BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 206
SUBDIVISION: ZONING: C -N
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:
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 OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Grill and Duct relocation
Owner: FEES
SISTERS OF PROVIDENCE IN OR Type By Date Amount Receipt
BY STEVE FOSTER PRMT KJP 01/24/20( $50.00 00- 321349
PO BOX 13993 PLCK KJP 01/24/200 $12.50 00- 321349
PORTLAND, OR 97213 5PCT KJP 01/24/20( $4.00 00- 321349
Phone: Total $66.50
Contractor:
GOHMAN MECHANICAL INC
412 S BEAVERCREEK
602 REQUIRED INSPECTIONS
OREGON CITY, OR 97045 Duct Inspection
Phone: 650 -1588 Final Inspection
•
Reg #: LIC 119952
ORIGINAL
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 - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obta'n , opi- . of these rules or direct questions to OUNC by calli g (503) 46 -• 189.
Issue By: Ai • 0 • Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
CITY OF TIGARD Mechanical Permit Application R B
PP Recd B • ' �
13125 SW HALL BLVD. Commercial and Residential Date Recd • " " ., °;
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 G Date to DST 40-16a Ie
Print or Type `� Permit # "G ° �700O - °cob
Incomplete or illegible applications will not be accepted Lw rali 0, l -/D i- igo
Name of Development/Project Description .
DR. D e 2 it - y - 6' d Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# 6b1p A) Permit Fee 16.00
Address /2 50 �, ^ h of 1 5 Fe rrr C / 1) Furnace to 101 - 0 BTU
Bldg# City /State Zip including ducts & vents 9.65
2) Furnace 100,000 BTU+
TI t,A{Z.0 including ducts & vents 12.00
NspNor name of business)
`j/ 7 S ,p 3) Floor Furnace •
}
Owner Co u 1 e nC �� ) including vent 9.65
Mailing Address 4) Suspended heater, wall heater
Peil Pan )e ' '39 9 J or floor mounted heater 9.65
_ 5) Vent not included in appliance permit 4.75
ftl(ty/State //�� Zip Phone Check all that apply: `Boiler Heat Air
L 3 oQ.977j , For items 6 -10, see or Pump Cond Qty Price Amt
Name (or name of business) footnotes 1,2 Comp
I)STrc 6) Repair units
Y-� 8.40
Occupant Mailing Y-OeC Address 7) <3HP;absorb unit to
Dik 100K BTU • 9.65
City /State Zip Phone 8) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
Contractor Name 9) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
C/OhrY"Ck rneci f It` 10) 30 -50 HP; absorb
Prior to permit Mailing Address // unit 1 -1.75 mil BTU 36.00
issuance, a copy y/ 2 5. &AVC/ere Ce/ r FllrX 11) >50HP; absorb unit >1.75 mil BTU
of all licenses City /State Zi Phone 60.15
are required if ok Toy, ore_ 4 7b 651°4-636
12) Air handling unit to 10,000 CFM
expired in COT Oregon Const. / Cht. Board Lic.# p. Da 7.00
database ii / f c2 IILA To ( 13) Air handling unit 10,000 CFM+
Architect Name 11.85
14) Non - portable evaporate cooler
Or Mailing Address 7.00
15) Vent fan connected to a single duct
• 4.75
Engineer City/State Zip Phone 16) Ventilation system not included in
appliance permit 7.00
Describe work to be done: 17) Hood served by mechanical exhaust
7.00
New 0 Repair 0 Replace with lie kind: Yes ti, ' No 0 18) Domestic incinerators
Residential 0 Commercial Modification 0 12.00
19) Commercial or industrial type incinerator
Additional information or description of work: 48.25
r no d e _ 54Appj y GRILL-ZS , 20) Other units, including wood stoves
7.00
NOTE: For Commercial projects only; Units over 400 lbs., located on the 21) Gas piping one to four outlets
roof, require structural calcs. prepared by licensed engineer. 3.75
Type of fuel: oil 0 natural gas 0 LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL - 5b
I hereby acknowledge that I have read this application, that the information ,
given is correct, that I am the owner or authorized agent of 8 /o SURCHARGE Y `>I
PLAN REVIEW 25% OF SUBTOTAL - ••
the owner, that plans submitted are in compliance with Oregon State laws. R equired for ALL commercial permits only ., t- - l , ' ce
Signs j re of Owner /Age t Date TOTAL 1 ' 7�
7 ei/ / 30 - q 9
Other Inspections and Fees:
Contact Person Name 6 Phone
/ p 1. Inspections outside of normal business hours (minimum charge -two hours) $50.00 per hour
rn X 014 y1/l.lz- N f 6, j �- / s 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Foonotes for commercial projects only: $so
3. Additional o onaal l pour
plan review required by changes, additions or revisions to plans (minimum
1. Provide full schematic of existing and proposed gas line and pressure. charge one - half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical *State Contractor Boiler Certification required
units. "Residential A/C requires site plan showing placement of unit
l:\rnechperm.doc rev 11/1/99
OVER - THE - COUNTER (OTC) PERMIT
COMMERCIAL MECHANICAL PERMIT CHECK LIST
Description of Project: 0 — Pad tP� °4\
Class of Work: Air Floor Furnace: Evap Coolers:
Type of Use: 0,0114 Unit Heaters: Vent Fans:
Occupancy Grp: 0 Vents w/o Appl: Vent Systems:
Stories: Boilers /Comprsrs: Hoods:
Fuel Types - 0 - 3 HP. Repair Units:
3 - 15 HP. Wood Stoves:
Max Input: Btu: Air Handling Units Clo Dryer:
Fire Dampers: _< 10000 cfm: Oth Units: I
Gas Pressure: H / M / L > 10000 cfm: Gas Outlets:
No. Of Units:
Furn < 100k Btu:
Furn >_ 100k Btu:
NOTES:
COMMERCIAL INSPECTION ACTIONS FEE MENU
Gas Line Inspection $ i Permit Fee -
Mechanical Inspection $ trA, Plan Review
Cooling Unit Inspection $ 8% State Surcharge
Shaft Inspection $ Additional Permit Fee
Hood Inspection $ Additional Plan Review Fee
Fire Suppr Inspection $ Inspection Fee
Miscellaneous Fee
Fire Alarm Inspection
REMARKS:
Fire Damper Inspection
Miscellaneous Inspection
Fire Al spection
Final nspect
FOR OFFICE USE ONLY:
TYPE OF USE OPTIONS (COM = commercial; CMS = commercial manufactured structure)
CLASS OF WORK OPTIONS FOR AU. PERMITS (NEW = new; ADD = addition; ALT = alteration; ACS = accessory;
FND = foundation; OTH = other, DEM = demolition; REP = repair FPS = fire protection system. NOTE =USE OTH FOR FENCES, RETAINING
WALL, DETACHED DECKS, SIGNS, AWNINGS, CANOPIES)
I: /dst/forms /otcmech.doc 9/99
is \dsts \ forms \otc- mech.doc9 /99 1
2/16/00 Activities for Case #: MEC20O0 -00010
3:10:18 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECC007 Application received 1/6/00 , DEB RECD No Hold GEO 1/10/00
MECC008 Permit created 1/10/00 GEO DONE No Hold GEO 1/10/00
MECC735 Duct Inspection 2/2/00 RB FAIL No Hold AKJ 2/2/00 unable to view (tile already
placed)
MECC799 Final Inspection - 2/9/00 RB PASS No Hold AKJ 2/9/00
MECC081 Return to pending 1/12/00 DEB PEND No Hold DST 1/12/00 Contractor brought in revised
plans for this project. Found
permit in the READY file,
returned it to pending and
placed in Building mailslot for
re- review.
MECC015 Reviewed Plans Routed to DSTS 1/19/00 RP SENT No Hold GEO 1/19/00
MECC016 DST Post - Review Completed 1/19/00 GEO DONE No Hold GEO 1/19/00
MECCO50 (F) Ready to issue 1/19/00 GEO DONE No Hold GEO 1/19/00
MECC090 (F) Issue permit 1/24/00 KJP DONE No Hold KJP 1/24/00
MECC800 Case Finaled 2/9/00 AKJ DONE No Hold AKJ 2/9/00
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
11.1 7oto-c000ct
Date Requested ai 6 1/00 AM PM Z -COO l30
Location 12 t /3, S - -aiA,/ �
Suit iZj Z } 7ej0 GL`s ICS
Contact Person 61 Ph gl / / Z21,p PLM
Contractor Ph SWR
ILDI Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: I ry t A n 4 SIT
Slab ( / �uC
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing .
Firewall I
ire S rinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
r4.00 PART FAIL
• ' BING (I)/
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
- 'HANIC b
Post & Beam
Rough In
Gas Line
S • e Dampers
in.,
Al ar PART FAIL
CTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other
Date v �6 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.