Permit •
rA R CITY OF TIGARD MECHANICAL PERMIT
i _ DEVELOPMENT SERVICES PERMIT #: MEC2004 -00059
`'� �l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/11 /04
PARCEL: 1S126C0-01107
SITE ADDRESS: 09693 SW WASHINGTON SQUARE RD C -9AB
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: GAS OUTLETS:
> 10000 cfm:
Remarks: Relocate (2) existing grilles, clean grilles, and relocate (2) existing pnuematic thermostats. Value $1200.00
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQ. RD. [MECH] Permit Fee 2/11/04 $72.50
PORTLAND, OR 97223 [TAX] 8% State SurcharE 2/11/04 $5.80
Total $78.30
Phone:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 692 - 1565
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 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 calling
(503)246 -6699.
Issued By j o /1» �c.c A�� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mec �� hanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
- * Date/By; - 1/ "a 1 / Permit No IV\ j. �LOOV- vvo 6?
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 �isaral Post - Review Land Use
Internet: www.ci.tigard.or.us "Ali Date/By: No.:
Contact Jyris.. ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 " " Name/Method / l ck Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
• Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2 - Family dwelling • Commercial /Industrial Value: $ /2.00 See Page 2 for Fee Schedule
❑ Accessory Building ❑ 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: 96 9 3 S W W 1, r`! 1 Jl -TOM Sal 12,D, Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: 5110E, Gil 04.1. 1�� A5, b-1 s a Hydronic hot water system 14.00
t1 °� " 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
26 LOG.-1 6 ( Z -) g.,) IS Tl Al rr c,A f L,L( .5) Flue vent (water heater /gas fireplace) 10.00
a 0 A ( � t2 i f t-E S �� b a 1 o 1-4" W g Wood/Pellet (gas) 10.00
/ Wood/Pellet stove 10.00
OZ) Z) a,)Pl,% (A1 u m i T/ (- 7liC6 0, 1q,i1S Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER I ® TENANT Other: 10.00
Name: S /106 /4 /fie, Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 96,93 S W GLIp„i'J/l.ol llrw .5(1. p na,I Clothes dryer exhaust 10.00
City /State /Zip: T ) & AIL i / ( Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT is CONTACT PERSON utility rooms) 6.80
Name: A i l S G M A (4b Attic /crawl space fans 10.00
Address: 103 3 6 S VV 'ran LA -r / 2011 - Other: Fuel Piping 10.00
City /State /Zip: '1 ( A. im r) N (,2 y 7 0 2 * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: s (,g ?-/&� a��69 -/51, Furnace,
heat pump *1
E -mail: WalUsuspended/unit heater **
CONTRACTOR Water heater **
Business Name: gat2i IJ M a ifl6.1 61- 44 Fireplace **
Address: /63 3 0 .5 w 7piitaTiil 2014 a Range **
City/State/Zip:
BBQ **
Cit
y p� TU �Lr�T / � LG� �. �I 7 �� � Clothes dryer (gas) **
Phone: .5 /3 b. -.I (2 Fax: ..,) 6 9/ sy 79 Other: **
CCB Lic. #: 0 p g 3 Total:
Authorized Mechanical Permit Fees*
/ Subtotal: $
Signature: '" Date: 2404'
Minimum Permit Fee $72.50 $ "7. ,56
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ -80
TOTAL PERMIT FEE $ . 3 (9
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\Peimit Forms\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
$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
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
fraction thereof, to and including
$25,000.00
$25,001.00 to $50,000 00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742 00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Fumace 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, 5,725
>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 appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: . (503) 639 -4171
BUP
Received Date Requested 3 - (cl AM PM BUP q
Location �� 9 w G� • SCE - R D Suite MEC ° 1 1' 6 0 05/
Contact Person Ph ( ) .S 7a - 353/ PLM
Contractor Ph ( —y, ) SWR
-mil" "` s
BUILDING Tenant/Owner a-P 0 )1aJ_ , QJ• 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 r-7 �1 _
Roof 1 $ / GNrG t �4 � / 7 /r /N GX
Other:
.rte! /N D / (.'A i / N G- /ODA. f TO !LE'f1 N Loe /442-.0
PART FAIL
BING DIJiZ //V f /3 vs/ /0E55 I/DU/�S 1)
Post & Beam
Under Slab
Rough -In -
Water Service 0 _
Sanitary Sewer ci ) 1
Rain Drains
Catch Basin / Manhole
• Storm Drain
Shower Pan
Other:
Final I I
P ASS PART FAIL 0
MECHANICAL N V
Post & Beam I A (./
Rough -In - F�
Gas Line ® D
�� • e Dampers
40 ART FAIL
ICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 1=1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd..
PASS PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA ' ` / —0C( ,, / d �/
t1?7 1� /V L3 L✓► L & C (L- E2- %iC
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this inspection record from the job site. •
PASS PART FAIL