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Permit A - CITY OF TIGARD MECHANICAL PERMIT ri+� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00478 ,. I I 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/7/03 PARCEL: 2S112DA -00300 SITE ADDRESS: 15230 SW SEQUOIA PKWY 190 SUBDIVISION: ZONING: I -P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 2 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: Replace ductwork on (1) existing unit and add (2) vent fans. Project value: $4,500 Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount 15350 SW SEQUOIA PKWY #300 -WMI PORTLAND, OR 97224 [MECH] Permit Fee 8/7/03 $72.50 [TAX] 8% StateTax 8/7/03 $5.80 Phone: Total $78.30 Contractor: PROTEMP ASSOCIATES INC 9788 SE 17TH AVE PORTLAND, OR 97222 REQUIRED INSPECTIONS Mechanical lnsp Phone: 233 - 6911 Duct Inspection Reg #: LIC 38868 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 Issue By: ,1$ I A, • Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections needed he next usiness day FOR OFFICE USE ONLY Meeha Mechanical Permit Application Received A 1 Mechanical, J ' s "` Date/By: 7 D ', k '" i Permit No ` , f 7 0 - City of Tigard Date/ By: Appr Building DateBy: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 =1960 Post Land Use UyaM ��i" (� Date/By: Case No.: Internet: www.ci.tigard.or.us Contact __leis.: ® See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 -- Name/Method: I / i'as. Supplemental Information. TYPE OFWORK , _. 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 mat ials, equipment, labor, overhead and profit. O 1 & 2- Family dwelling III Commercial/Industrial Value: $ V See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family RESIDE AL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description 1 Qty 1 Fee(ea.) 1 Total p Master Builder ❑ Other: ,_ Heating/Cooling , • • ' JOB SITE INFORMATION and LOCATION, Furnace - add - air conditioning ** 14.00 Job site address: /tea 3 p 51.4" .5C O'd tS a ivy Gas heat pump 14.00 Suite #: /q a Bldg. /Apt. #: Duct work 14.00 Project Name: //VS - 5T A?E. Air: Hydron t 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 ipL�fG6 D . i.1/ a OA 1 ^ , sr-vSo Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 r ∎,∎/ _ T ad"A.D Ann Retre/ F4.s/3 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 • Chimney/liner /flue /vent 10.00 PROPERTY OWNER J ❑ TENANT Other: 10.00 Name: � y0 r- (/51 Environmental Exhaust &Ventilation • y �. Range hood/other kitchen equipment 10.00 Address: Clothes dryer exhaust 10.00 City /State /Zip: Single duct exhaust Phone: G y • (_, ©e' Fax: (bathrooms, toilet compartments, �� ❑ APPLICANT : : ❑ CONTACT PERSON utility rooms) A 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) Furnace, etc. ** Phone: Fax: Gas heat pump ** E -mail: Wall/suspended/unit heater r ** 'CONTRACTOR - Water heater ** Business Name: 2?, a7 r 455m. _A . Fireplace ** ** Address: 7 785 5 6- 7 77-9,1 A)7 Rang ** City /State /Zip: ,./ , °17 2- Clothes dryer (gas) ** Phone: ' 3_ G,9 /J I Fax: a 3Tr 9 767 Other: ** CCB Lic. #: Total: 38e6� Mechan Permit Fees* Authorized I Subtotal: $ Signature: ��L (/ Date: �[/ 7/ Minimum Permit Fee $72.50 $ ag. 7 .) J P4 M/ 4/ j Plan Review Fee (25% of Permit Fee) $ ( Please print name) State Surcharge (8% of Permit Fee) $ ,q. $U TOTAL PERMIT FEE $ p Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Indust S ervice Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPennitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information • Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 CITY- OF TIGARD - . 24 -Hour BUILDING % Inspection Line: (503) 639 -4175 MST INSPECTION•DIVISION Business Line: (503) 639 -4171 // BUP Received Date Requested 1 f 4 AM PM BUP Location /5 2 3 n 6 f.C_Qi a efatY Suite daa 3 =no eiZ9 Contact Person .J �d 4 W� Ph ( 5 3-7 9 -b1.97 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation ' Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - Insulation - Drywall Nailing Fi rewal I Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In • i Water Service Sanitary Sewer Rain Drains Catch Basin I. Manhole Storm Drain Shower Pan Other: Final • PASS PART FAIL ECHANICAL Post Bea Rough -In Gas Line - Sm• - - 'Dampers in- i -)) 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 /0 ! / // (oi Inspector \ Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL