Permit ,
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00130
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/19/04
PARCEL: 1S12600-00300
SITE ADDRESS: 09644 SW WASHINGTON SQUARE RD G -13
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: •
FURN <100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate ducts, grilles & (1) VAV box.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY [MECH] Permit Fee 3/19/04 $146.98
9585 SW WASHINGTON SQ. RD.
PORTLAND, OR 97223 [TAX] 8% State Surcharl 3/19/04 $11.76
Phone: Total $158.74
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 692 - 1565 Mechanical Insp
Final Inspection
Reg #: LIC 5193
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
requi - you to . •w rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
I - ued By: j 4,•!:mm, ric4/ - Permittee Signature: ,
Call ( • .39 -4175 by 7:00 P.M. for inspections n- • ded the next business day
Mechanical' Permit Application Received lication FOR OFFICE USE ONLY Mechanical / ['CAW / ' /30
Date/By: ( 4 I C/7 Permit No.: "
Planning Approval Building .
City of Tigard Date/By. Permit No.
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By. Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 � Post - Review Land Use
nWdl�°tf I & Date/By Case N.
Internet: www.ci.tigard.or.us `^ - ' , y,. e� ' Contact s : El , Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name/Method. I WO, Supplemental Information.
6
, TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Fa Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATrEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ® Commercial/Industrial Value: $_ 1 q Zf) r See Page 2 for Fee Schedule
❑ Accessory Building I=1 Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: t. $' .S NW vAfp - )- sm6.- 1 SC Gas heat pump 14.00
Suite #: 6- 13 I Bldg. /Apt. #: Duct work 14.00
Project Name: 13 a TO CO uoc 'r4 m t. (s Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
09) N (C'.: .) VA V 6o c ) 0 -5) Ne* 60 61 A ce3 Flue vent (water heater /gas fireplace) 10.00
(C.-- Log lighter (gas) 10.00
U CT
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
❑ PROPERTY OWNER I ty TENANT Other: 10.00
Name: g a s G /4 1- d �'0 I ((� c `r-,9 6 L (',� Environmental Exhaust & Ventilation
Range hood /other kitchen equipment 10.00
Address: 9 s W vv/w4)Ne,,.r®,n/ S 6- l 3 Clothes dryer exhaust 10.00
City /State /Zip: T j 6 EZ P) d Oa_ 1 7 72 _3 Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT ® CONTACT PERSON utility rooms) 6.80
Name: AZT -T- c 14 A a. el Attic /crawl space fans 10.00
Other: 10.00
Address: ;0330 $i„ 7
/ 1 , �p il & ? / Fuel Piping
City /State /Zip L-t 4 i i; „ O'Z 9 ?6 ( Z * *($5.40 for first 4, $1.00 each additional)
Phone: 3 / / I Fax: D3 6 9 q - / y 79 Furnace, etc. **
M Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: r9 /20 0 Pte AN (-- Fireplace **
�
Address: / 0 3 D �D T Q� t. /� `!�s „v( Range **
BBQ
City /State /Zip: 'r(0_ t_ - TJji j t ii 9 706 F.. Clothes dryer (gas) **
Phone: 50 6 97 — is 65 Fax: 9)3 G , /-/ '77 Other: **
CCB Lic. #: ®5- 1 q Total:
Authorized Mechanical Permit Fees*
? /
� d
'Signature: Date: l q` Subtotal: $ Minimum Permit Fee $72.50 $
J•40401. A ���� �!✓L f -- P Review Fee (25% of Permit Fee) $
• (Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. "Site plan required for exterior A/C units.
i:\Dsts\Permit Fornms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000 00 Minimum fee $72 50 7a.57)
$5,001.00 to $10,000.00 $72.50 for the first $5,000 00 and $1.52
for each additional $100 00 or fraction �J
thereof, to and including $10,000 00. ` "(
$10,001.00 to $25,000.00 $148.50 for the first $10,000 00 and
$1.54 for each additional $100.00 or n O
fraction thereof, to and including
$25,000 00.
$25,001 00 to $50,000.00 $379 50 for the . rst $25,000 00 and
$1.45 for each additional $100.00 or 6
fraction thereof, to d including '
$50,000 00.
$50,001.00 and up $742 00 for the first $' 1,000.00 and
$1.20 for each addition.' $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description. Qty (Ea) A ount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil BTU
>50 hp; absorb. unit, 25
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in applia• e 656
permit
Hood served by mechanical haust 656
Domestic incinerator 1,170
Commercial or Indus :.I,incinerator 4,590
Other unit, includi • ood stoves, 656
inserts, etc.
Gas piping 1-4 outlets - 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24- Hour , -
BUILDING Inspection Line: (503 � 75
INSPECTION DIVISION Business Line: (50 a, MST
BUP
Received / ' 3 5 Date Requested 9' 4Z AM PM BUP
Location q (O 4 ,1V WA— - Suite G / ' J o Or) / 3 6
Contact Person Ph ( ) to 9 2 /670 0 S PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner [;lLe, ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A C- C/71
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 'L
Post & Beam �'
Under Slab �
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P' ' RT FAIL
i AL
!p ,
Gas Line 410 Le
Su = Dampers V
Fin•.
PART FAIL
EL TRICAL
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 Y , / ' 2' v `� � � Inspector \ v" Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL