Permit . A CITY OF TIGARD MECHANICAL PERMIT
Ij DEVELOPMENT SERVICES PERMIT #: MEC2006 -00354
l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/1/2006
PARCEL: 1 S 135BD -00300
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace rooftop HVAC. Access on third floor mechanical room. Value: $5500.00
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:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
HAZEL INTERNATIONAL, INC AND Description Date Amount
HIGASHIYAMA HIGHLANDS CO, LTD
BY NORRIS + STEVENS REALTORS [MECH] Permit Fee 8/1/2006 $150.00
PORTLAND, OR 97204 [TAX] 8% State Surcha 8/1/2006 $12.04
Phone: Total $162.04
Contractor:
WILLAMETTE HVAC SERVICE
PO BOX 23334
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: PRI 628 -6841
FAX 503- 848 -2597
Reg #: LIC 56951
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 or 1- 800 - 332 -2344.
Issued By:
/MI / 1 _ Permittee Signature
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard MUG 1 i- 2006 Received G
j
11 A "� g Date/BY. O t • 4, 8 Permit No.: ' I. . .• I — CO
13125 SW Hall Blvd., Tigard, OR 97223 II • Phone: 503.639.4171 Fax t 5434p9f it6yr ilutie01) Plan Review
Dare/BY Other Permit:
T I G A R D Inspection Line: 503.639 n T Date Ready/By:
Mill ® See Page 2 for
Internet: www.tigard -or: D IN � ! y ." Notified/Method Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction %Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
Value: $ .'fiC'
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2 family dwelling Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Q > S S&L) , l �� q� / Q t.-- (requires site plan showing placement) 14.00
Air conditioning or heat pump
3 y I"
City /State /ZIP: / ' / A Furnace 100,000 BTU (ducts/vents) 14.00
.. - VC. IA OW
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no Project name: 1C1C a ✓o 4. �Gci(,
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
J , w r Gas fireplace 10.00
�c� l C. C. G J1 f 7i L,t t- C� t 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 I ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: 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: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans _ 10.00
Other: 10.00
Business name: 7 Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: -
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
/ / J /JI SA C. Clothes dryer (gas)
Business name: I C J !` �c �T(/
Other:
Address: /V Q )'3 O X 42 3 3 3 V MECHANICAL PERMIT FEES*
City/State/ZIP: -4---
v , q 72 S l Subtotal l OD
Phone: ( ) 6 ' a s - 69 l-/ 1 Fax: ( ) 84 9 - s-.9 J Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 57S- 9 —/ State surcharge (8% of permit fee) I? p
TOTAL PERMIT FEE i. &
Authorized signature: This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: Date: e -/ - U ri • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Pamits\MEC- PennitApp.doc 04/06106 440- 4617T(11 /O2/COM/WEB) tC13.°19'
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information g
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.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC200G-00354
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0/1/2006
Phone: (503) 639 -4171 Atro- 'u, +�
Inspection Requests (24 Hrs.): (503) 639 -4175 p.
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7 :05AM PAGE: 11
SITE ADDRESS: 09735 SW SHADY LN A= CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL MALL
DESCRIPTION: Replace rooftop HVAC. Access on third floor mechanical room. Value: $5500.00
OWNER: HAZEL INTERNATIONAL INC AND, PHONE #:
CONTRACTOR: WILL AMETTE HVAC SERVICE PHONE #: 628-6841
Inspection Request Scheduled For: Date: 8/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 035082 -01 503- 752 -4985 N
Corrections /C• -- - s /Inst uctions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONA FEES ASSESSED
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Inspector: g •' •
Date: • vi Phone #: (503) 718