Permit l..
CITY TIGARD MECHANICAL PERMIT
A-tow ik DEVELOPMENT SERVICES PERMIT #: MEC2004 -00392
"'• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/21/2004
PARCEL: 1S134DC-00700
SITE ADDRESS: 11365 SW TIGARD ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A2.1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 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:
FURN < 100K BTU:. AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 2 OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of condensing unit and cooling coil.
Project Value: $3,600
Owner: FEES
BAPS TEMPLE Description Date Amount
PO BOX 41160 [MECH] Permit Fee 6/21/200 $109.30
SAN JOSE, CA 95160 [TAX] 8% State Surcharl 6/21/200 $8.75
Phone: 408 - 453 - 6464 Total $118.05
Contractor:
ROYAL COMMERCIAL EQUIPMENT LTD
2736 SE 15TH AVENUE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 68375
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATT NTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rul: s - /. t forth in OAR
952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or • (e• ( .P stions to OUNC by calling
(503) 6699. i j
LW ; / -�
Issu d By: L , . c�� / / I ,,,. 1 Permittee Signature: ,
Call (503) 6 . • -4175 by 7:00 P.M. for inspections needed t e l % siness day
Mmhanical Permit � t�pM OED FOR OFFICE USE ONLY
City of Tigard tJ cLo E # 1./ c � `_ _ , 7 / �3 / Permit No G 13125 SW Hall Bvd , Tigard, OR 97223 � Other Permit
Phone 503 639 4171 Fax 503.598 196$ 1 % � A Date/By
Inspection Line 503.639.4175 ' • ' 1
.TIGA �.. Date edfly Ready/By aura S See Page for
Internet: www ci.tigard.or us
Girt OF DIVISION
Notified/Method l C Supplemental Information
- - . pUII� p►i\I r;. ..
•' _ -' _ , ; _ -_,.`" „ .TYPE OF WORK: - ' ., .. - " COMMERCIAL 'F.EE *- 'SCHEDULE — USE •CHECKLIST
❑ New construction ddition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the v. . - . . . . . e nea . .. • of all
❑ Demolition ❑ Other mechanical maten. , equipment, labor, overhead, and profit
Value $
'= • - ` ; OF•' CONSTRUCTION _• - U�
[1:I 1 and 2-family dwelling olnmerclalhndustnal ; `: ,;'' 1 RES I DENC • Q / SYSTEMS FEES*
y g ❑ A building
❑ Multi- family ❑ Master builder ❑ Other For special information use checklist
Description I Qty I Ea Total
JOB SITE INFORMATION- =A'ND ''LOCATION ;µ ,'.r` :;. Heating/cooling
Job site address. `/ 3 s 1,0 ` • —� I �� Air conditioning or heat pump
W • 1 S / (requires site plan showing placement) 14.00
City/State/ZIP: • — rd j cfc c-772,22› Furnace 100,000 BTU (ducts/vents) 14 00
Suite/bldg. /apt. no.: Project name: '7 �p S Furnace 100,000+ BTU (ducts/vents) 17 90
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 "OP WORK -i' Water heater 10 00
p � . Gas fireplace 10.00
/J /` �/O!Z .?• --f A ` Flue vent for water heater or gas
SY, ; � fireplace 10 00
Log lighter (gas) 10 00
Wood /pellet stove 10 00
Wood fireplace /insert 10 00
'''' • -0P ROPERTY_OWNER \• " ' - • - .
Chimney/liner/flue/vent 10 00
❑TENANT. ,
Other 10 00
Name: a ;d „P S . — EC - 7 - 71))-& Environmental exhaust and ventilation
Address ) i h@7 S S LJ '_ ,-p zo . j Range hood /other kitchen
equipment 10 00
City/State/ZIP: 9 l rJ Ort- 9 7223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone (yog) 4 /53 — J _ 4 1 4,1_ Fax: ( ) toilet compartments, utility rooms) 6 80
lA / .' ' Atuc /crawls P ace fans 10.00
- , ❑: APPLICANT ❑CONTACT PERSON
Business name: Other: 10 00
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
Clot
Business name: (i — i A N. C�7 eiRk F (D )--�j ') Othehes dryer (gas)
Address: I 9 S • £ • ) 5 AVE ' - , M_ ECH ANICAL PERMIT FEES!
City/ State/ZIP: PO /- rJ CA' 97 2 Subtotal
/ l rm permit fee (5 83 /09 . be
Phone: (503 � t7 1�7 Fa • (5 6 d9 77 Plan review (25% of permit fee)
CCB lic : d S 3 7S i // ' State surcharge (8% of permit fee) 8. 7
TOTAL PERMIT FEE Adiurnellt
Authorized signature
for' / / Thi perm app lication expires if a permit is n obtained within 180 days after it has been accepted as complete. itg Q Print name: / A J i1 r Date —2/-0 ` Fee methodology set by Tri- County Building Industry Service oard
i \Buiiding\Pcmuu \MEC- PenmiApp doc 12/03 440 -4617T (I I /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation : ti
$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. 7a
$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. ?" 30
$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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7;7
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i:\Building\Permits\MEC-PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DI"ON Business Line: (503) 639 -4171 MST
BUP
•
Received - ( Date Requested 7 j AM PM BUP
Location / ] 3 CP S i Suite daNa)zZ
Contact Person r' Ph ( ) — 41Z 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
Susp'd Ceiling ``''
Roof
Other: _jam .-
Final �, ri'ysy
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 •ART FAIL _
;R AL
Post & Beam
Rough -In
Gas Line
Sm. ,e Dampers
S PART FAIL
CTRICAL
Service _
Rough -In Alb\, ,tt / ,
UG /Slab ay - `T/ - i 406 ∎' W
Low Voltage
Fire Alarm •
Final 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