Permit CITY OF TIGARD
MECHANICAL PERMIT
'r'c DEVELOPMENT SERVICES PERMIT #: MEC2005 -00029
'`
-' � II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/18/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09432 SW WASHINGTON SQUARE RD K -2
SUBDIVISION: WASHINGTON SQUARE 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: DOMES. INCIN:
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical TI, relocate ducts & grilles, add (1) VAV box. Project Value: $5,800
Owner: FEES
WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY [MECH] Permit Fee 1/18/200`. $155.90
9585 SW WASHINGTON SQUARE RD [TAX] 8% State Surchari 1/18/200: $12.47
TIGARD, OR 97223
Phone: Total $168.37
Contractor:
ARCTIC SHEET METAL
2310 NE COLUMBIA BLVD.
PORTLAND, OR 97211 REQUIRED INSPECTIONS
Phone: 5039288 - 5844 Mechanical Insp
Final Inspection
Reg #: LIC 17095
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)24 699.
Issue By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application rolz orrice Hsi:: ()Nix
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,, e: ; , !. `' Received i o -' Permit No.: Date/By. Other Permit:
" :"
Inspection Line: 503.639.4175 _ a ( Date Ready/By: 1 0' ® See Page 2 for
Internet: www.citigard.or.us Notified/Method 7/� 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: $
RESWENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2 family dwelling (I Commercial/industrial ❑ Accessory building
1:1 Multi 0 Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
U ' • Air conditioning or heat pump
Job site address: / S W i.,,,3 c, �� . s cd c Yo u 4cA (requires site plan showing placement) 14.00
City / State/ZIP: r I . G - c7 a 2 1 Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: k3 2 X.f. c Gas heat pump 14.00
Cross street/directions to job site: F �-� w e a N e vs..,1 l 1 J ( n _ v, r r 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
Gas fireplace 10.00
Fl v4 L Du as c.--) o (( .d - Ni 4 V .. P .A e v,K4 -, Flue vent for water heater or gas
n fireplace 10.00
I — S k• .9.j , n v (' c Ct e P14. n - 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
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
( ) . toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
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
Business name: A, c 4 t < < s l Clothes dryer (gas)
Other:
Address: • oZ 3 10 N c - ru S . , (3 (vi, MECHANICAL PERMIT FEES*
City /State /ZIP: `'o J ( t vI _ v ) I t Subtotal
/ Minimum permit fee ($72.50)
Phone: (S 3) . 3 e s B , z, Fax: (cc., 3 ) a ,.5 y - I h' 4 5 Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tn County Building Industry Service Board
i:\ Building\Pennib\MEC- PermitApp.doc 17/03 410- 46ITr(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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.
i:\Building\Penmits \NEC- PennitApp.doc 12/03 2