Permit C ITY OF TIGARD MECHANICAL PERMIT
iA DEVELOPMENT SERVICES PERMIT MEC2004 -00549
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/13/2004
PARCEL: 2 S 112 D D -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 150
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: 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate supply grilles.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 8/13/200z $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 8113/200' $5.80
Phone: Total $78.30
Contractor:
AIR RITE CONTROL, INC.
1623 SE 6TH ST
PORTLAND, OR 97214 REQUIRED INSPECTIONS
Phone: 238 - 0388 Mechanical Insp
Final Inspection
Reg #: LIC 63302
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 -6699. /
Issued By: _ � Permittee Signature: 1�`� ,E1,, '�
Call (503) 639 -4175 by 7:00 P.M. for inspections need - d the next b ' nesslr
Mechanical Permit Application FOR OFFICE USE ONLY
Received _ Mechanics C/ _,�yy��
Date/By: if /. e Ad permit No.: D / - arsd 9
City of Tigard' RECEIVED Planning Approval , /�L Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 AUG 13 goo ard.or Date/By_ Permit No.:
Phone: 503 -639 -4171 Fax: 503 -598- Post- Review Land Use
/ / i i.�, r M : id' ; Date/By: Case No.:
Internet: www.ci.ti I
g l l'I Y Q 1 p - a , a` I Contact Juris.• ® See Page 2 for
24 - hour Inspection Requtji89 , 't S ON - Name/Method: T Supplemental Information.
TYPE OF WORK 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 materials, equipment, labor, overhead and profit.
El 1 & 2- Family dwelling Commercial/Industrial Value: $ a F 0 (o '4 See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder LI Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: / s K 9 5 5 w 5 Bpi.) C mi Gas heat pump 14.00
Suite #: / 3 b I Bldg. /Apt. #: Duct work 14.00
Project Name: v F142. I a0A-d Hydronic hot water system 14.00
Cross street/Directions to job site: (for orid radiator boiler
� ( 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
Tax map/parcel #: Other Fuel Appliances
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
12-734,e, cel-r ; c$ tJ p p L° G/2-1 . 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 g TENANT Other: 10.00
Name: . R .. i L-..0 ti w t iz_a sY Environmental Exhaust & Ventilation
Address: / S�9.I' s w g Range hood/other kitchen equipment 10.00
City /State /Zip: 7' is G , � 71.." �� Clothes dryer exhaust 10.00
/ Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: A t (Z A t 7 a c-a C-, Fireplace **
Address: / a, 2 3 $ fl 6 7H 4 V Range **
BBQ *4
City /State /Zip: p d n-7 7/ C.111 C ) 2 Z /'/ Clothes dryer (gas) **
Phone:Sd3 23 ILO 8 g--e? Fax: 603 23e/ Oci1' Other: *4
CCB Lic. #: 6 3 3 U 2 Total:
Authorized Mechanical Permit Fees
�— Subtotal: $
Signature: „iii i / � Date: -d
Minimum Permit Fee $72.50 $ '
TOM S 00 • I gir Plan Review Fee (25% of Permit Fee) $
(Ple. e print name) State Surcharge (8% of Permit Fee) $ r - b
TOTAL PERMIT FEE $ 7 S)
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.
i:\Dsts\Permit Forms \Mec Fermi tApp.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 I 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
BUI 'NNG Inspection Line: (503) 639 -4175
INSPECTIOIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requeste , AM PM BUP
Location 1 S 9 • Suite 4S MEC ZC:C4 d (754 \ 4 1 .
Contact Person Ph ( ) PLM
Contractor Ph ( ) Z �-3 - 9 70 3 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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 I ,
Roo
`'t r II 1� •
SS M PART FAIL , ' ''��
PLUMBING i
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
Rough -In
Gas Line
S. - D..mpers
D,mpers
- A S -ART FAIL
LE ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm •
Final El 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