Permit ri
C ITY OF T I GA R D MECHANICAL PERMIT
PERMIT #: MEC2003 -00393
"�
DEVELOPMENT BMENg Tigard, SERVICES 6394171
DATE ISSUED: 5/12/2004
13125 SW
PARCEL: 2S110DC -00700
SITE ADDRESS: 11205 SW SUMMERFIELD DR
SUBDIVISION: WILLOW BROOK FARM ZONING: R -25
BLOCK: LOT: 016 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 DOMES. INCIN:
LPG 3 - 15 HP: COMML.INCIN:
MAX INPUT: 190,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 1 <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace (2) 5 -ton rooftop units with (1) 10 -ton unit and replace (1) 7.5 ton unit with new 7.5 ton unit. Project
Value: $18,874.
Owner: FEES
CONGREGATE CARE ASSET V, LTD PTN Description Date Amount
BY FALCON FINANCIAL [MECPLN] Plan Rev 5/4/2004 $18.13
PO BOX 12188 [TAX] 8% State Surcharl 5/4/2004 $5.80
SALEM, OR 97309 [MECH] Investigation Fe 5/4/2004 $72.50
Phone: [MECH] Permit Fee 5/4/2004 $72.50
Contractor: [MECH] Permit Fee 5/4/2004 $214.50
Refund - [MECH] Permit 5/11/20(N - $214.50
JET HEATING INC Total $168.93
1935 SILVERTON RD NE
SALEM, OR 97303 REQUIRED INSPECTIONS
Phone: 363 - 2334 Gas Line Insp
Heating Unt Insp
Reg #: LIC 3944 S.D. Shut -down inspection
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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -. ".
Issued By: i� 1. Permittee Signature.
Call (503 .39 -4175 by 7:00 P.M. for inspections needed the next business day
CITY OF TIGARD
12/22/2003 11:08 FAX 5095981880 c 1 [ 001 i I
� FI_ ►1t irF1'IC�1� l_ 51�: ()NIX
Mechanical Permit Application • Y • 5 ; o N�1N E a) ,3 91
�� Planning Approval ! Building \
City of Tigard c °\1 Date/By: I Perndt No.: p
13125 SW Hari Blvd �e Den R'`w Oma
�0A Darien 3 - D�S) Pemtit No.:
Tigard, Oregon 97223 y • - Post-Review Land Use
Phone: 503-639-4171 Fax: 503- 598.1 i t , DaDate/Br. Case No.:
Internet www.ci.tigard.or.us _. :- i ; Contact I 1O. I Z1 See Page 2 for r
24 -hour Inspection Request: 503 - 639- 417b-i -- - Name/Method: -17 AF ' , supplemental torormatioo.
1l�RCSA'18 7 1l a :i;: tw',i ,y,.:i a:.
... ' ... '• ' ' ':'.. 7�YLs1�'OT.�t�; :`•>` "'""z' i, °� :;. [" - on the total value of the
■ _ Demolition Mechanical permit fees' are based work
New construction performed. Indicate the value (rounded to the nearest dollar) of all
Addition/alterati.. I lac= . El ' Other mechanical materials, equ meet, labor, overhead end profit
� -` y '.,!- • y D : a' : of t? ti no. -3' ;:a:,;:1 =41 • :•v .. � I See Page Schedule
o n e zm�[C Value: S IS � � ' 2 f Fee S ch ul
1 & 2- Family dwelr'ma iaUIndustrial �`:. r't Ly=e ` :�
ter: :riq :A y , '13 . . :�.;>�+ini
I d
Multi-Family .� Fades.) Total
Building Daactlptton Q�'
,, \
Master Builder Other: I ' . -Oa.
% , :!'- , :fi,.0'.5IMIZWORllCk Osy..rer `a lO - e *,!;. Furnace - add-on air condi. ming" 14.00
Job site address: 1 { 2.05 S i,v ` 'ern c 1 (1 O Gas �t pump I I I '2 14.00 •
Suite #: Bldg./Apt.#: Duct work I l 14.00
14ydtonic hot water system! 14.00
Project Name: S m.c.r C. L la C,I t.& 6 lam:•► se.- Residential7roiler ik
Cross street/Directions to job site: (fbr radiator or hydronic system) 14.00
Unit heaters (ftteli not electric)
(iii wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
I Repair units I 1 1 • 12.15 {
Subdivision: Lot #: .per Poet Ap4nanoa
#: Warr heater I 10.00
•
Taut map/parcel r�D& [ t4 $K:' - ": ;;`? ' Gas fireplace I 10.00
•
>.:;,e;; °::. ; tea' :••Y: •• :" ) 10.00
RV irk C s.- +urea S1 40 F to Un . 4.5 Flue vent (water.heste leas place 10.00
P Log tighter (gas)
Imo, +ti► t 1 v b,n l-LrL i' Wood/Pellet stove I 10.00 .
j - _ i . 7„ 5" . tAn: f w ft. A let. ti,-3 wood fireplace/insert 10.00
` Chlmney/linerlfid &Vent 10.00
.� .. - �s.M o I
0 i ::, . ; t. ;1 * "': a ' a�` I; a3:e a , "- / -4... ` :F.tt W. Other: 10.00 vir Anterteai Bsba°etdb YaaBlaftou . .. .
NamC: su m r►r a a rc I C� G� b � �' - M ange h ood/othei kitchen egttipment 10.00
Address: 1 1 2.0 S S Si,trN sw. e F s cid 0 clothes dryer euljauat I 10.00
City /State/Zip: 'T: c • • 1 o rr i - 7 z 2 y ' Single duet oaltaust
ms, toilet compemments,
Phone: Pax: ter -- -.- Utili stns) I I 6.80 •
t0 00 I '
Name: 7e. 4- .e« t,n� Attic/crawl atswl apace tans I
other I I . .
Address: P o 130 x '7 . 6 2 _. Faer r t
City /State/Zip: Spa - U r e_ 113 U 3 "M 4(1 for that 4, 31.00 eaeb additional)
Phone: ub3 -y $S- y LB41 'ax: Oae he p i _ "
E -mail: 6?-4 u C C� • . • ' °n-C . e_ Wawauspended/Unit heater
f :i., ',r. ' ba . • 11! re. :;L y:f�y 1:12;,`1,.% • Water heater 1 ••
Business N ame: i t 4- -ec., -; F� ce � ..
Address: �). o. 130x. - b L >38Q
City /$tateIZ p; I n Ar ri Q'e- 7 2:2 `f Clothes dryer) 1
Phone: •*
� F ax: ocher. Toal
So3- �t�5 - y I 5 �
CCB Lie. #: 39 y ti = okeal Pervde Fee+• ,
t
Authorized ST/ W
' [ DO r G `' S • S o
sigh d � fo � - Dace , mum ' emtit Fee 572.50 �.t
Plan Rovi' Fee % of Permit Fee S/ • / • - rain - Tlt D ✓ t ��1 states ' • . : - 18% of Perna Fee S T .: '
(Please e print name) I T, 'l
•Fee methodology set by •r�i •C000ty Build/lag industry Service Board. ,
Notice: Th1s permit application expires if a permit [e eat obtatocd within "Site p requi (or est A/C units. ,
1 go days after tt bas been accepted ae complete. t
iMsts\Permit PormslMeePermitApp.doe_01/03_-
# I - I ).) , ' ' - - 1
------- '' , 0 ' N
CITY OF TIGARD 24 -Hour ( 55 Sea— 100 '
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
1` _) BUP
Received Date Requested / 6 . " Z AM ` PM BU -
Location ___// 3 D .S -Nc C �'VL
�vVl ' ‘,(1 /4 Suite 119"\-- ®36 — a639. �
Contact Person i�L� Ph ( )485 8s = i-iil g / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
#.1 L L c s- _ ELC
Footing
Foundation ELC
Access: I ( b -70-10 ELR
Ftg Drain
Crawl Drain
Slab Inspection Notes: C1.-) � d o _ SIT
Post & Beam
Shear Anchors — \ S
Ext Sheath/Shear '
Int Sheath/Shear
Framing
Insulation ' � / - / �U S
Drywall Nailing l l V
Firewall
Fire Sprinkler
Fire Alarm i ,
Susp'd Ceiling i
Roof _
Other: 1
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS RT FAIL / 111110‘
CH , AL
Post & Beam
Rough -In
Gas Line
Sm: Dampers
10 PART FAIL
RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for inspect , n RE: 1 u nable to in pect — no access
Fire Supply Line , F ��-
ADA D Ins 1001tO �a__llExt Approach/Sidewalk P
Other:
Final DO NOT REMOVE this ins . ection record from the Job site.
PASS PART FAIL
h 5/11/2004 • Notes For 4:21:33PM
TIDEMARK
Case #: 1VIEC2003 -00393
COMPUTER SYSTEMS, INC.
l' Y - vp ua ' t e d « s j . , , . � : 1.. M:
_ j, 5. ?�f �.7yi : ,s .� � . }. �, ,�� r - ` te ' ` jf „r. > . • r- r.� t.
� a 'te ,., ; . :B }No_te"s , : !: . _ .. _ :'4. - - - -. ,, �" '• - - -- .' s _ A 3 ,4:. ,-
5/11/2004 DLH Fee adjustment for using "old" MEC permit fee schedule per plan submittal date. Original fees were refunded/deleted and
new fees paid using original receipt number. Applicant submitted a second check #18956 in the amount of $221.43 which
was not receipted and was returned to the applicant at permit issuance. A request for refund of $214.50 for the difference
was processed on 05/04/04. DLH
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CASCADES
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P.O. BOX 7362 (503) 363 -2334 18956
1935 SILVERTON RD. N.E.
SALEM, OR 97303
l nl= rr=1
4 a li45fa10 _L, `-• - .": I DOLLARS
PAY
{( sI I '' ', 'a7 ) � _
NET AMOUNT
:) Y + J � i ` . " . •-• DA
TO THE,
r. ,/ V � � V
y o a2 3
OF DER: Impars, , . ��� O G%!! / /�/ %4...vt, /r1.'�rr /
'I'
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1 of 1 CaseNotes..rpt
•
Fees Associated With 4:16:42PM
-� 5/11/2004
Case #: MEC2003 -00393
■ o �1 C r
City of Tigard
Fee Start End Revenue Created
Type Date Date Dept Description Account Number B y Date Amount Due
PLCK 1/1/1990 12/31/2005 [MECPLN] Plan Rev 245- 0000 - 433050 BSB 5/4/2004 18.13 " 0.00
5PCT 1/1/1990 12/31/2005 [TAX] 8% State Surcharge 100- 0000 - 207020 BSB 5/4/2004 5.80 " 0.00
PRM3 7/1/2001 12/31/2005 [MECH] Investigation Fee 245- 0000 - 431010 BSB 5/4/2004 72.50 0.00
PRMT 1/1/1990 12/31/2005 [MECH] Permit Fee 245- 0000 - 431010 DLH 5/11/2004 72.50 0.00
PRMT 1/1/1990 12/31/2005 [MECH] Permit Fee 245- 0000 - 431010 DLH 5/11/2004 214.50 0.00
PRMT 1/1/1990 12/31/2005 Refund - [MECH] Permit Fee 245- 0000 - 431010 DLH 5/11/2004 - 214.50 0.00
Total: $0.00
7 ' c: 74. /e �yCoe -Z/
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Page I of 1 Case Fees .rpt
1 C I OF TIC,ARI) 5/4/2004
:01
--7':'":--7':'":"< 13125 SW Hall Blvd. G 9.14AM
--7' :'":"< Tigard, Oregon 97223 1
((�
- ....- (503) 639 -4171 `� --
L
Receipt #: 27200400000000001839 CJ i ( , , , , 4 _ , . . . _ . .
Date: 05 /04/2004 << /�
Line Items:- - - - - - -- /4 d� K�L / C/ - /
Case,No.. Tran Code Description Revenue Account No Amount Paid
_'_ 1v1EC2003 003'93 i [MECPLN] Plan Rev P:; ; , 245- 0000 - 433050 87.92
Iv1> C2003 -00393 'TAX] 8% State Surcharbe`.` ` . 100-0000-207020 28.14
MEC2003-00393 / [MECH] Permit Fcc 245-0000-431010 267.37
-! Line Item Total: $383.43
Payments: ---
Method Payer User ID /' Acct. /Chec Approva4.No % How Received Amount Paid
Check JET HEATING 17636 By Mail 383.43
! Payment Total: $383.43
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