Permit 1 .
v CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00239
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/4/2004
PARCEL: 1S126BC-01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RDA
SUBDIVISION: 5 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: AC unit. Value: $2500.00
Owner: FEES
PORTLAND OFFICE ASSOCIATES Description Date Amount
BY TC PORTLAND, INC [MECH] Permit Fee 5/4/2004 $84.00
8930 SW GEMINI DR [TAX] 8% State Surchart 5/4/2004 $6.72
BEAVERTON, OR 97008
Phone: Total $90.72
Contractor:
WILLAMETTE HVAC SERVICE
PO BOX 23334
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone: 628 Mechanical Insp
Cooling Unt Insp
Reg #: LIC 56951 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 O I R
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to 0 , � C by calling
(503)246 -6699.
Issued By: _-: _ , __ Permittee Signature: , Or;
Call (503) 639 -4175 by 7:00 P.M. for inspections neede. the next day
Mechanical Permit Application Vid FOR OFFICE USE ONLY
City of'Tigard 679 06 Permit No. j7) Reeived
Other Peimit: - , if ...sr! 13125 SW Hall Blvd., Tigard, OR 97223
Phone. 503.639.4171 Fax: 503 598 1960 / ���,�,� Plan Review
"""" "Pi �' R I DateBy
Inspection Line: 503.639 4175 ,.a' I Date Ready/By Jura 0 See Page 2 for
Internet www ci.h ard.or.us y y g
g Notified/Method ?� �, Supplemental Information
- l', =0- " - .n ,TYPE, OF. WORI{, • . , =„ . . - - COMMERCIAL 'FEE. _SCHEDULE- - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 2 V Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical matenals, equipment, labor, overhead, and profit
; GATE GORY:OFZtONSTRUCTION -'- i ' Value. $a S O i
' " E ' :RESIDENTIAL UIPMENT / SYSTEMS FEES*
❑ 1- and 2 family dwelling Commercial /industrial ❑ Accessory building
-; Q
For special information use checklist
❑ Multi - family Master builder ❑ Other
Description Qty Ea Total
B SITE INFORM _ _ ,
JO _ ti _ ATION � I,OCATIi* .'.` < Hea _ ..
Job , it condttionin • .r heat pump
ob site address:
9��Q v' (,�,) �o s(A , ., Ffo... S z I .- ' - . an showing placement) 14 00
City/State /ZIP: dd Furnace 100,000 BTU (ducts /vents) 14 00
Furnace 100,000+ BTU (ducts /vents) 1 7 90
Suite/bldg. /apt. no.: Sui'F , 0 Project name:7A „A Gas heat pump 14 00
Cross street/directions to job site: / MCl/ C ` 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
Flue/vent for any of above 10 00
Subdivision. Lot no.: Other. 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION °- =; � f : _�fS Water heater 10.00
'i' ; 'WOR ... — - ° Gas fireplace 10 00
71./e...c.r ei 4■�" -67.,... r: ,, Ipv'Eev 1,0 c ' Flue vent for water heater or gas
/ /// fireplace 10 00
fJC l'e- s s .51,0/1t S / l i S�� Log lighter (gas) 10 00
.- "'r0 /%1 stove 10 00
Wood fireplace /insert 10 00
Chimney /liner /flue /vent 10 00
. . PROPERTY) ': .• .. - 0 TE NANT ; z . ;'
r. • 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
'r� 0 APPLICANT ! '° ; - •i❑ "• PER r: I.;m Attic /crawlspace fans 10.00
Business name: Other: 10 00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
#` =<t - - CONTRACTOR a = s F % "•' Barbecue
Business name: Le j, t t ta•. -t-�� RvA C Clothes dryer (gas)
Other
Address: )' r n 1( ,.,Z 3 3 - ` z,,,i,, . •MECHAN I CAL ; •PERVHT FEE * y ', `
City /State/ZIP: - D . ' g ` Subtotal
Phone: ( ) Minimum permit fee ($72 50)
4..2 e - G 8 , 4 Fax Ri ( ) Pee - a .� L Plan review (25% of permit fee)
CCB lid, S C t, , S I State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: `/,... e_ s1.nF wTN Date: S_ 4_1 _ 0 el * Fee methodology set by Tn- County Building Industry Service Board
I \ Building \Perrruts \MEC- PerrrutApp doc 12/03 440 -4617T (I I /02/COM/WEB)
j
Mechanical Permit Application - City of Tigard
Page 2 - Supplementalinformation
Commercial Fee Schedule:
b.T'otalValuatio ` < _ 'e-ntiY r °Y "' Y�
$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.
i \Buildmg\Permits\MEC- PermitApp doc 12/03 2
CITY OF TIGARD 24 -Hour
BUSLDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP
Received l Date Req es ed � "f AM PM BUP
Location I . 3 , 'W _ • • Suite � '`'� � MEC aZv� Ob 9
Contact Person Ph ( ) �5�1 � PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner , �(.��,(.C� 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 ^ 1
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof n
Other:
Final
P ASS PART FAIL 4111i ,
PLUMBING
Post & Beam
Under Slab 11 �� wdo
Rough -In � MI SP _
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole ■
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
ME
Po
Roug -
Gas Line
Smoke Dampers
•1- PART FAIL
RICAL
Service
Rough -In
UG/Slab
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