Permit /�\ CITY OF TIGARD MECHANICAL PERMIT
,' I , DEVELOPMENT SERVICES PERMIT #: MEC2000 -00406
, .� I 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/00
PARCEL: 2S 112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 140
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002" JURISDICTION: TIG
CLASS OF WORK: 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: 1 DOMES. INCIN:
ELE 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical work for commercial TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 10/13/00 $72.50 2720000000
PORTLAND, OR 97224 PLCK CTR 10/13/00 $18.13 2720000000
5PCT CTR 10/13/00 $5.80 2720000000
Phone: Total $96.43
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911 Duct Inspection
•
Reg #: LIC 00038868 Final Inspection
ELE 201JHA
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 ays. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility otification C i ter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0080.
You ay obtain copies oft -se rules or direct questions to OUNC by : 1 ing (50 6-6189.
Issue / `!/_L:.� ,.e Permittee Signature: _ 41 Call (503) 639 -4175 by 7:00 P.M. for inspections needed t next bu /ness day
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Mechanical Permit Application
..• Date received: AoAz z) Permit no.: /W.C2-0dD _DO, (o
_41.11i. 1. ,;11." City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 gu�� 4,w e°0 ?yam Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ►I Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /.x , - S Q / n / A j'''/,./)/ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: a ‘.. Suite no.: lyp / value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ C sr .
Lot: (Block: ISubdivision: *See checklist for important application information and
Project name: Cri 5 it./ 56 jurisdiction's fee schedule for residential permit fee.
City /county: T,30,22 ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and l cation of work on premises: f-!f /AG AND COMMERICAL /INDUSTRIAL EQUIPMENrTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
•
Is existing space heated or conditioned ?Yes ❑ No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated2Yes ❑ No Alteration of existing HVAC system
NI ECI IAN I CAL CONTRACTOR Boiler /compressors
Business name: ,e2177-r../4,77 Ef 0� _rive_ State boiler permit no.:
HP Tons BTU/H
Address: gE7 x. E e - Fire/smoke dampers/duct smoke detectors
City: L, en7 I StatenQ I ZIP: 93 e2. Heat pump (site plan required)
Phone:3 3 - tom` /J I Fax:d3i. E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: e 3FtShg Install/replace/relocate heaters - suspended, _
City /metro lic. no.: 1./5,,C , wall, or floor mounted
Name (please print): 'C ,IE - Vent for ap r liance other than furnace ,
CONTACT PERSON Relrigerahon: -._
Absorption units BTU /H
Name: Chillers HP
Compressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC •
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: E marl: Woodstove/pelletstove
Other:
Applicant's signatu : Date: 1.7 • i a • 0 6 Other.
Name (print): j ///„UT
lal 6e2
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa CI MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $ l b f 3
Expires within 180 days after it has been State surcharge (8 %) .... $ • 6
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE':
TOTAL VALUATION: FEE: Description: Price . Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Fumace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 q 10.00
to 100k BTU I I 7 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU ---
18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
‘ * State Contractor Boiler Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 (1r' ()Os yZ
• Date Requested / c2 / AM PM BLD
Location / S3,S S'& -S'E (/4 /C/ Suite l )»
Contact Person Ph PLM 66
Contractor Ph SWR
y
UILDING Tenant/Owner Sl/ /TL / ELC
Re aining Wall ( 01 Ate ,r ft ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /titCj
Fire Alarm
Susp'd Ceiling
Roof
Misc:
YffT►
V PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL •
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk / �1
Other Date ( ^9 - 0 / Inspecto / t� X1/ E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.