Permit A CITY OF TI GA R D MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2001 -00116
� I � 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/10/01
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09455 SW WASHINGTON SQUARE RD A -15
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: 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
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
>
GAS OUTLETS:
10000 cfm:
Remarks: Tenant Improvement - HVACNAV
Owner: FEES
MACERICH NORTHWESTERN ASSC. Type By Date Amount Receipt
401 WILSHIRE BLVD - STE 700 PRMT CTR 4/10/01 $72.50 2720010000
SANTA MONICA, CA 90401 5PCT CTR 4/10/01 $5.80 2720010000
Total $78.30
Phone: 800 - 421 -7237
Contractor:
INDEPENDENT SERVICE
935 SE 12TH
PORTLAND, OR 97214 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 266 -7594 Duct Inspection
Reg #: LIC 125154 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 -0080.
You may obtain copies of these rules or direct questions to OUNC' by calling (503)246 -9 :9.
Issue By: / Permittee Signature: ir
Call (5 639 -4175 by 7:00 P.M. for inspections needed the next business day
r
A r___ Mechanical Permit Application
Date received: - D —0 I Permit MQ(j21 00
1 ''''J J 1 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: ov / - 1)120 oZ 7 Building permit no.:
❑ I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 9L ( d ' . 0 , (R p, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBlock: 'Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: I & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and location of work on premises: Abu ✓P 46,i/7 AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
Ni ■.. ' / Pt c/,,--/ OF - Slog e Fee(ea.) Total
Est. date of completion/inspection: pUon Res. only Res. only
Tenant improvement or change of use: HVAC: opU
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit (� C a
g p Air Condidon nlan r n�rrrL��
Is existing space insulated? ❑ Yes 0 No Alteration of existing HVAC system
NIECIIANICAL CONTRACTOR Boiler /compressors
Business name: ' d p p tA a,e tA-4 e ( J j L State boiler permit no.:
' HP Tons BTU/H
Address: 9 3s se 1 2 1 ' Fire /smoke dampers/duct smoke detectors
City: o 4-) e J I State: c9 - f j ZIP: ? 7z I I- / Heat pump (site plan required)
Phone: Z 3 &_076 6 I Fax: z q ,- , p4 E - mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.:
/, C / , Install/replace/relocateheaters- suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT' PERSON Refrigeration:
- Absorption units BTU/H
Name: Chillers HP
Com ressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
I Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: 15tate; I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel i ing each additional over 4 outlets
ass p p (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert-type
Phone: I Fax: E- 'l: Woodstove/pellet stove
Applicant's signature: 4&y 4f I Date: y/ Or
/ d /ao
Name (print): 3 V G/Q h ir -yr
Not all jurisdictions accept credit cards, please can n jurisdiction for more information. Permit fee $ / IX /
l] Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $ r
Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ W , .3
Cardholder signature Amount 440 -4617 (6N0/COM)
MECHANICAL PERMIT FEES '
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLIN? FEE SCHEDULE:
TOTAL VALUATION: FEE: \ Desc Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
• $1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including '2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or i cluding vent 14.00
fraction thereof, to and including 4) S pended heater, wall he- er
$25,000.00. or or mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Ve not included in app ance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repai units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that pply: B'filer Heat Air
$1.20 for each additional $100.00 or For items 7 -11 see or Pump Cond
fraction thereof. footnotes belo . • .mp * "
7) <3HP;absorb it
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k B 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU i 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit t. 10,060 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 0,000 C' +
permit 17.20
Repair units 805 14) Non - portable ev- porate cool:
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan tonne; ed to a single , uct
3 -15 hp; absorb. unit, 1,700 r 6.80
101k to 500k BTU 16) Ventilation sys m not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance pe it 10.00
mil. BTU 17) Hood served y mechanical exhau
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic inci erators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial r industrial type incinerator
Air handling unit to 10,000 cfrtt 656 69.95
Air handling unit >10,000 cfrn 1,170 20) Other units, ncluding wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping ne to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Pe it Fee $72.50 SUBTOT • L: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surchare' $
inserts, etc.
Gas piping 14 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Re uired for ALL commercial permits only
TOTAL COMMERCIAL $ ` TOTA RESIDENTIAL PERMIT FEE: $
VALUATION: (? .
Other Inspections and Fees:
1 Inspections outside of normal business hours (minimum charg- -two hours)
$72.50 per hour.
2 Inspections for which no fee is specifically indicated (minimum Marge -half hour)
$72.50 per hour
3 Additional plan review required by changes, additions or revisions to plans (minimum
charge-one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
i:\dsts\formsknech- fees.doc 10/11/00
y 0
CITY OF,TIGARD BUILDING INSPECTION DIVISION
24- Hourinspection Line: 639 -4175 Business Line: 639 -4171 MST
,�' BUP
Date Requested U -/ 3 AM PM BLD
Location Q ys5 S r.✓ L4 5k $ f Suite / i. MEC 2G / - / / �o
Contact Person • G ; 1J u 6Itar Ph 7? 3 q t y U PLM
Contractor Ph SWR
BUILDING Tenant/Owner 72/1 6 4 44 S ? ELC
Retaining Wall _ ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final •
PASS PART FAIL
PLUMBING
Post &'Beam
Under Slab
TO Out -
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL •
19rECUANI A
Post & Beam /
Rough In piR �%►Sfz
- Gas Line - • - -
Smoke Dampers
•
(' ) PART FAIL
J " RICAL
Service_
Rough In
UG /Slab
Low Voltage
. Fire Alarm
Final
PASS . PART . FAIL •
SITE
Backfill/Grading '
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinfection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk /�� a
Other Date I Inspector / -1 . Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION ( i' b
24- Hour.inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
A6 , a ) Date Requested 1/12-e AM PM ' BLD
Location q', (,d,_ .C4 _ Suite MEC ZB4! 1 f,
Contact Person ? Ph S PLM
Contractor & & Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation , / / / � � !Ai Sic
Drywall Nailing .� — eeb,fri
Fire wall 1A ^V t 4>r /0/1.( t/G Sys s C1 �
Fire Sprinkler 4
Fire Alarm
Susp'd Ceiling- 64
Roof
. Misc:
Final
• PASS PART FAIL •
PLUMBING
• Posst & Beam
Under Slab
Top Out
Water Service
• Sanitary Sewer
Rain Drains
Final
P R FAIL
ECHAN
ea m
Rough In
Gas Line
Sm• - I -mpers
PART FAIL
ECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm • -
Final
. PASS PART FAIL •
SITE
•
Backfill /Grading -
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA l
Approach /Sidewalk D a t e 'Il / i
Other P InS actor tgi.lA) Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site: