Permit .•
C ITY OF TIGARD MECHANICAL PERMIT
4•or DEVELOPMENT SERVICES PERMIT #: MEC2004 -00421
- r - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
PARCEL: 2S1 12 DA -00800
SITE ADDRESS: 15055 SW SEQUOIA PKWY 100
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
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:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate ducts & grilles for TI.
Project Value: $9,000
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 6/29/200 $213.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 6/29/200 $17.08
Phone: Total $230.58
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 -6911 Mechanical Insp
Final Inspection
Reg #: LIC 38868
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 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-., •' /
Issue • By: !i�L Permittee Signature:
Call (5 1 639 -4175 by 7:00 P.M. for inspections needed th ne usiness day
Mechan;al Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: ti eAT M. �
Plan Review Permit ..:' �� t ,
13125 SW Flail Blvd., Tigard, OR 97223 Om�e
Phone: 503.639.4171 Fax: 503.598.1960 .o r Other Permit: ' Date /By: ; D.�I, i..,,,I.i
Inspection Line: 503.639.4175 �' Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: i f 41,,, Supplemental Information
• TYPE OF WORK COMMERCIAL FEE *. SCHEDULE. - -USE CHECKLIST •
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION „• ;
Value: $ 9 U DO ■
❑ 1 - and 2-family dwelling - ' RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
y g [/]�CommercialJindustrial ❑ Ac cessory 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
l.; -
Job site address: DSO Air conditioning or heat pump
Ts $ k QICJ�/ •� P/rW (requires site plan showing placement) 14.00
City/State/ZIP: 7,.410 ((( Furnace 100,000 BTU (ducts/vents) 14.00
/
/ Furnace 100,000+ BTU (ducts/vents) 17.90
dg. /apt. no.: /a 0 Project name: p4 e IF/ Ze s-ri 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
Oz)/Fy /� /�� �JCTW' Pat A.,Z 4/ Flue vent for water heater or gas
)LOS / / Pz ALf fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
P OWNER I ❑ TENANT Other: 10.00
Name: / 7 a . , g ser 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: (b ) Gay - l�3alD 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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR . - Barbecue
Clothes dryer (gas)
Business name: P OTC NIP
Other:
Address: ej ? Rs , 5 ... J 7.7-tt ,4 MECHANICAL PERMIT FEES *: , ' •
City/State/ZIP: nn�7l4rtio/ Ot 9717...72-
Subtotal
Phone: (973 ) .233 1/ I f � . ) a 3� �� 7G 7 Minimum permit fee ($72.50) a „ . 5,50 Plan review (25% of permit fee)
CCB lic.: ...?gg State surcharge (8% of permit fee) 7 D g
TOTAL PERMIT FEE Bp ..5
Authorized signature: • This permit application expires if a permit is not obtained within 180
f days after it has been accepted as complete.
Print name: J4C77Ci„ I� t Date: 44 /�.. ' Fee methodology set by Tri- County Building Industry Service Board
i:\BuildinglPermits\StEC- PermitApp.doc 12/03 440- 4617T(111/02/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 — . po V
for each additional $100.00 or fraction
thereof, to and including $5,000.00. ���� Q /Od _ '�Q
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and 7/
$1.80 for each additional $100.00 or p
fraction thereof, to and including �� x / �Q = ��
$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 /1/ .
fraction thereof, to and including • $50,000.00. o 0
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and 7O •
$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 l
$1.10 for each additional $100.00 or
fraction thereof. / Y
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: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested " ( AM PM BUP
Location / S SS Suite /66) MEC o� C)O c — o d 94P.
Contact Person Ph ( ) 33 6, 9 t t PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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 V W
PLUMBING -
4/
& Beam �� ' r
Under Slab L. 4 ��
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Sm.. z Dampers
ii
PART FAIL
RICAL
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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL