Permit ,. ,
41 OF TIGARD
CITY MECHANICAL PERMIT
CIA DEVELOPMENT SERVICES PERMIT #: MEC2003 -00715
:„Li -• II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/16/03
PARCEL: 2S112DA -00800
SITE ADDRESS: 15055 SW SEQUOIA PKWY 140
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:
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Split out existing gas line to two separate tenants. Project value: $2,000
Owner:. FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WM I
PORTLAND, OR 97224 [MECH] Permit Fee 12/16/03 $72.50
[TAX] 8% State Surcharl 12/16/03 $5.80
Phone: Total $78.30,
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 Gas Line 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 -00
Issu d By: , ti . r(: «, j . Permittee Signature: A 0 _ I A i
Call (503 639 -4175 by 7:00 P.M. for inspections needed t ..next busi ss day
Mechanical Permit Application FOR OF US ONLY
Received Mechanical
1 Date/By: /s // &A 4 0 i• Permit No.: // (/i0° —0o 7/
City of Tigard Planning Approval Building
`J g DateBy: Permit No.:
13125 SW Hall Blvd. Plan Revi Other
Tigard, Oregon 97223 Date/By: /2 /G ' 0 1/13 5 P Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
e ms u' 1 ; \ Date/By: Case No.:
Internet: www.ci.tigard.or.us L .' I � Contact � ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: //a Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
p 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.
❑ I & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty l Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning** 14.00
Job site address: /50 6 Se jtna PK`Y Gas heat pump 14.00
Suite #: / y (j Bldg. /Apt. #: Duct work 14.00
Project Name: 3 AS 1./4)E Hydronic hot water system 14.00
Cross street/Directions " to job site: (for boiler
(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
Repair units 12.15
Subdivision: Lot #: Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
9A S ? I p ! IV ce Flue vent (water heater /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: iD/ , . us) Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address:
City /State /Zip: Clothes dryer exhaust 10.00
Single duct exhaust
Phone:Gay - 63 DO Fax: (bathrooms, toilet compartments,
❑ 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 ••
Business Name: / Ass QG .2 c, Fireplace ••
Address: 7 Range ••
9 FSE Sc 17*''`'� ✓c' BBQ ••
City /State /Zip: / e7 L. ,,,D
Ir./ Clothes C lothes drryyer ga ••
Phone: a 3 3 - h91/ � F ax: x38.976.7 Other: d Li-- ••
CCB Lic. #: Total:
Authorized Mechanical Permit Fees*
Signature: Date: Subtotal: $
/ L
f Minimum Permit Fee $72.50 $
J F.�� /7 )1O LV LA/ I Plan Review Fee (25% of Permit Fee) $
(Tease 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.
is \Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard r
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. / # 1 , • 39 -4175 MST
INSPECTION 011��N Business Line: f � ��• -4171 '
BUP
Received 12/1 -- Tx - Date Requested / a// 270 3 AM PM /(// 9' BUP
Location /56 5S � " a P uite /4 3 -007/5
Contact Person $ eVV L � Ph �St e i "' / 9 PLM
Contractor i� Ph ) SWR
8
_ BUILDING Tenant/Owner _ VC0 s ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Ins Notes: SIT
Post & Beam (9 / V LJ1r`�'t. -cer-
Shear Anchors / , q<s
r Ext Sheath/Shear C/ J�
Int Sheath/Shear b I 2476
Framing —
Insulation
Drywall Nailing
Firewall ) 5,25
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 6e4 w�
Other:
Final
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
Post & Beam
-In
`Gas Lin 5av"e.
Smoke Dampers
Fin -
PART FAIL
CTRICAL
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
Approach/Sidewalk Date (2 (■ ( Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL