Permit CITY TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2002 -00080
-- 11 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/02
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L -4
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: Duct and drops, registers and grills.
Owner: FEES
PPR WASHINGTON SQUARE LLC Type By Date Amount Receipt
P.O.BOX 21545 PRMT CTR 2/26/02 $72.50 2720020000
SEATTLE, WA 98111 5PCT CTR 2/26/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Phone: 233 -6911
Reg #: LIC 38868
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. Y.0 may obtain •pies of these rules or direct questions to OUNC by calling
Mr1117dR -A 9 Re
Issue By: / Permittee Signatu0
Call (503) 639 -4175 by 7:00 P.M. for inspections need d the next business day
Mechanical Permit Application _
Date received: 6 Z Permit no.: nil e( U,9- -oa
'"� i i City of Tigard Pro;ecdappl. no.: Expire date:
Add 13125 SW Hall BI;':',' t�.�d I?'_: VE City of Tigard Date issued: Bce,?) I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Fig 2 6 2002 Case file no.: Payment type:
Land use approval: Building permit no.:
Cu Y Uhl tJE4 "
11'PrC 01.. f' :RMIT '
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ,enant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION ._ ' - COMMERCIAL VALUATION SCHEDULE
Job address: vl e. 9 5, a . i v.4b 5:I /ie/l. ro xJ SU.Br.L AI. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: L - ix/ value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ nc t 'SO C
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: Pc; p- 4 y B A / jurisdiction's fee schedule for residential permit fee.
City /county: T9.�-yem I Z IP: 97a g / 1 & 2 FAMILY DWELLING PERMIT FIT SCHEDULE
Description and location of work on premises: pi5Ta;Burm J AND COMMERICAL /INDUSTRIALEQU IPMENTSCIIEDULE
.O i AA./,t) Sp r2r LGC'S Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use:
HVAC:
Air handling unit CFM
Is existing space heated or conditionedVarYes ❑ No Air conditioning (site plan required)
Is existing space insulated ?'Yes ❑ No Alteration of existing HVAC system /
1\'IECI - I AN I CAL CONTRACTOR Boiler /compressors
Business name: State boiler permit no.:
�K ATFMP �55o& .. t cat' . HP Tons BTU/H
Address i n 7 AJ G B Fire/smoke dampers/duct smoke detectors
City: / �I Z72.A../D I State) I ZIP: 97x3 a Heat pump (site plan required)
Phone:a _// I Fax:g, c, E - mail: Install/replace furnace/burner BTU /H
' Including ductwork/vent liner CI Yes U No
CCB no.: '''3.- G' Install/replace/relocate heaters
City /metro lic. no.: ySs-- wall, or floor mounted
Name (please print): J6.." — / , i Vent for appliance other than furnace
Refrigeration:
Absorption units BTU/H
Name: .' A2c/►7 �) ,44_,A,7 Chillers HP
Address: 7 Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone3 ..e,9/ ) F. ; ; •97G E -mail: Dryer exhaust
OWNER Hoods, Type 1/ 11/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: I State: 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 -
ess piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove
A Applicant's si nature ,, , Other:
pp g ,/������ � Dateo7 � s_. Other.
Name (print): , E - 4 L t
Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ '7<a. .-70
Notice: This permit application
❑ Visa ❑ MasterCard Minimum fee $
ex if a permit is not obtained
Credit card number. / / Plan review (at %) $
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 (600/COM)
----- - c
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) Fumace 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 Co d
fraction thereof. footnotes below. Com
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 applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 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 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1 170 1 Inspections outside of normal business hours (minimum charge -two hours)
$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 per 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 Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL ' • $ "Residential NC requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:\dstsVorms\mech- fees.doc 12/26/01
CITY OFTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 c� g
INSPECTION''®IVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ( t o AM PM BUPA
Location � L(J So D, Suite 016
Contact Person D Ph ( ) � 9 6 /n PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 0L..d41 � . , __ 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:
Final
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 PART FAIL
CHAN
I Beam
Rough -In
Gas Line
•
Smoke Dampers
1 V\
A 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 reinsp tion RE: Unable to inspect — no access
Fire Supply Line
ADA • Il /)
Approach/Sidewalk Date v (_inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST •
BUP 200 / 4 6 7
Received Date Requested - - AM PM — f )UP e — 61° 0 4?
Location 9(.0/ F (1)/i . SC2 . D Suite � -- MEC . O
Contact Person 77; Ph ( )P- j - PLM
Con x {' 29 2 $ AV-6)14--v Pi Ph( ) SWR
UILDI • Tenant/Owner , �!I_J are/ 1 ELC
•.ting ELC
Foundation 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:
a PART FAIL
• ING - ? i
• Post & Beam /
Under Slab - �
Rough -In
Water Service
Sanitary Sewer ----�,
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P,. =��_ •:� FAIL
(1Ixa :r:nI1.411 ��
Rough -In
Gas Line
Smoke Dampers
inal
SS PART FAIL
E 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 �l
ADA
Approach/Sidewalk Date V Inspector \ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
- - — - —