Permit 'i
NIL CITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2003 -00440
' J l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/29/03
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09493 SW WASHINGTON SQUARE RD A -3
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: 1
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: Reducting vents, clean existing grilles and replace existing exhaust fan in bath.
Value: $466.00
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY [M> CH] Permit Fee 7/29/03 $72.50
9585 SW WASHINGTON SQ. RD.
PORTLAND, OR 97223 [TAX] 8% StateTax 7/29/03 $5.80
Phone: Total $78.30
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 462
Duct Inspection
Reg #: LIC 50897 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 -00
Issued By: ." � / .� Permittee Signature: (4,100.1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
BuP 2ob3- co t z S
Mechanical Permit
f d "�' ' ° ` Date received: 7 -,24-,0- Permit no.:yyj 7 -,iV0
.4 �. 11 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, O R 97223)
Phone: (503) 639-4171 „_. _ f ..., Date issued: By:? Receipt no.:
Fax: (503) 598-1960 �� ( %� . Case file no.: Payment type:
y - '' � : -
o -
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory dicommerc' ndustrial 0 Multi - family 0 Tenant improvement
0 New construction likAdditio • r ' eplacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 911_m S to GUust, S g g, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I SJe no.: Sp A3 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ Lf 1 -7(t, aO .
Lot: IBlock: I Subdivision: - *See checklist for important application information and
Project name: 0/1p1-to t (ei Ma yr VIA-E1 jurisdiction's fee schedule for residential permit fee.
City /county:` ( s� [P: Q712 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and cation of work on premises: arL _ L&• AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
eh CZNI - YF,Oa Q.. 0/X . • un # roars Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL 'CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name:
\r �� ' .� HP Tons BTU /H
Address: 5s.1 5— r Fire /smoke dampers /duct smoke detectors
City: rk J,t,v a A.Lk t F. Stat : ji,e j ZIP: 97a Heat pump (site plan required)
Phone: y([,a I Fax:((( ?' p E - mail: Install/replace BTU /H
Including ductwork/vent liner ❑ Yes 0 No
CCB noW#Wilt . 7 Install/replace /relocate heaters— suspended,
City /metro lie. no.: D a q I wall, or floor mounted
Name (please print): _ ' . ex r(_ ', • 6,1150 - rN Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ ll/res. kitchen/hazmat
hood fire suppression terg�
Name: Exhaust fan n with with singngle e du (bath fans) /
Mailing address: Exhaust system apart from heating or AC
City: [State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E - mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert-type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signatu •._, i s , „,, Date: ` 36 co Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /r . -56
❑ Visa ❑MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at %) card number: ( ) $
Expires within 180 days after it has been
State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ - -
Cardholder signature Amount 440-4617 (6/00 /C6M).
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: 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 including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15 -
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Conti
fraction thereof. footnotes below. Comp
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14 00
8% State Surcharge $ 8) 3 -15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 -1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52 20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87 20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17 20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10 00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69 95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10 00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct di ( 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1 170 1 Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $62 50 per hour.
Commercial or industrial incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62 50 pet hour
inserts, etc. 3 Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62 50 per hour
Each additional outlet 63 `State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ **Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
..- - 1l d sts \forms\mech- fees.doc 02/1 .
CITY OF TIGARD 24 -Hour • . -
BUILDING Inspection Line: (503) 639 -4175 r .
INSPECTION DIVISION . - Business Line: (503) 639 -4171 MST • - p
BUP 3 — eO /o
Received Date Requested o -a �° AM PM BUP - 60 e/7
Location 9 / /, a) SCE 11" - • 1(� p A
Suite "3 re 3 do WC)
Contact Person Ph ( ) - 3 .- ? y3.5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner �� // ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain R443— DO 1/77
Slab Inspectio 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
V) i
PART • FAIL
P BING . = .
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: • -
Final
PASS PART FAIL .
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA F/a tv / 0
Approach/Sidewalk Date I nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site. -
PASS PART FAIL