Permit A CITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00493
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/2004
PARCEL: 2S 112DA -00300
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100
SUBDIVISION: 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: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Abandon 1 rooftop unit and new duct work. Value: $18,000
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 7/26/200L $339.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 7/26/200L $27.16
Phone: Total $366.66
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Duct Inspection
Phone: 233
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) -669•.
Issu d By: � . /i _ / I/GG "" �
Permittee Signature: ■
Call (503) 639 -4175 by 7:00 P.M. for inspections neede. the ne "business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard „ (�'' _ L Received co p3
�J g U � _� �� _ �/ Date/By: / , AP Permit No.: f r t 6 / tt 1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi '
Phone: 503.639.4171 Fax: 503.598.1960 I � //404i I ;\ DateBy: � ? _ 3 „b S/� Other Permit:
Inspection Line: 503.639.4175 djU,� r (� - r .f ((( f/
Internet: www.ci.figard.or.us b ^ ^^ Date ed /Met Supplemental Ready/By: Jars. See Page 2 for
g Notified/Method: S Information
fe. . " YOF - 1i( r,.y - -
TYPE " OF� WORKJ.; ;. 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: $ 00.0
•., RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION _ Heating/cooling
�� Air conditioning or heat pump
Job site address:
/5 n �� vv� $ /. (requires site plan showing placement) 14.00
City/State /ZIP: T94RJ) / Get Furnace 100,000 BTU (ducts /vents) 14.00
Y Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: MoD Project name Amisri F 4eain we% 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
D/ .$T Dc/c7/ e- it P . AS P 1 r i ea Flue vent for water heater or gas
fireplace 10.00
. Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Other:
Chimney/liner/flue/vent 1 0.00
Other: 10.00
Name: .4C ` 1L ,../.57-
JS 1 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: ( ) IoZ.y _ Cry 3tb0 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
Business name: 74 ere" P Clothes dryer (gas)
Other:
Address: 9 7 s � 17'r`\ A MECHANICAL PERMIT FEES*:
City/State/ZIP: /' ire / Ck q 7i m Subtotal 3 jjv
Phone: ( ) F ax: ( ) _23 V� 976, Minimum permit fee ($72.50)
•?33' V� Plan review (25% of permit fee)
CCB lic.: 3 .e 8 3 Ve 86, , State surcharge (8% of permit fee) a i , I i
TOTAL PERMIT FEE 364p,(4p
Authorized signature: �� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: '` -> k , ,, ,1 Date: 03/e./ * Fee methodology set by Tri- County Building Industry Service Board
\m 1:\ Building Pedts\MF,C- PermitApp.doc 12/03 4404617T(I1/02/COM/WEB)
•
Mechanical Permit Application = City - of Tigard •
'Phge.2 - `- Supplemental Information ` - , -_ • '
Comme'rcial'Fee Schedule: • .
'° : ?T6tal3valu'at><on = .- :; a, FS " tfo -_ ' I -�. . r ; =.
•
$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;000.0:C $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 fbf the first $10,000:00 and • •
$1.35 for each additional $100.00 or
fraction thereof, to and . ' '
o d 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 ' - ' i ' ' '
fraction thereof, to and including , , .
- $100,000.00. : •
$100,000.01 and up $1,39650 for theffirst $100,000:00 and . . " '
$1 :10 for each additional $100.00 or
fraction thereof. .
Note: All n commercial' buildings require 2 sets of plans: '
•
•
•
•
•
•
•
is\ Building \Pemuts\MEC- PermitApp.doc 12/03 ' , ., , ,
2'
CITY OF TIGARD 24 -Hour -
BUILDI,NG Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
q BUP
Received / Date Requested / / AM PM BUP
l
Location • S LC Suite /OD MEC , e c("0 (f93
Contact Person .c c�C�. Ph ( ) 233 _C 9 l ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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 tit iv
Roof sp'd Ceiling
Roof I\ , ` f , ,
Other: ai - :,MI ' , �i�,`.
PART FAIL
PLUMBING MB/SIM�� 5!
Post & Beam \ 11W' '
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
Rough -In
Gas Line
Smoke Dampers
PAS PART • FAIL
ELE RICAL
- ice
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 fl 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