Permit C ITY OF TI G D MECHANICAL PERMIT
4I � DEVELOPMENT SERVICES PERMIT #: MEC2002 -00195
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/02
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09714 SW WASHINGTON SQUARE RD F -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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of some new grills
Owner: FEES
PPR WASHINGTON SQUARE LLC Type By Date Amount Receipt
P.O.BOX 21545 PRMT CTR 6/10/02 $72.50 2720020000
SEATTLE, WA 98111 5PCT CTR 6/10/02 $5.80 2720020000
PLCK CTR 6/10/02 $18.13 2720020000
Phone: Total $96.43
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 692 -1565
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 - 010 thr. u! OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by al ' ,03)246-9189.
Issue By: Permittee Signature:.
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the ext business day
- , Mechanical Permit Application
mislifriemmiim 49-
ih ,, Date received: Permit no.:
)I j
�''!..L City of Tigard i ° Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall B1vi 9 Date issued: By'. I Receipt no.:
- Phone: (503) - 639 -4171 - - v I
Fax: (503) 598 - 1960 Case file no.: Payment type:
MAY 10 20P7
Land use approval: Building permit no.:
CI A X vir A AkIY
I11E OF PERMIT
0 1 & 2 family dwelling or accessory latommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE
Job address: Of/ I I 5 a S try h Sq, • indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: y i value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ . E.
Lot: (Block: ISubdivision: *See checklist for important application information and
Project name: A-I d v jurisdiction's fee schedule for residential permit fee.
City /county: 17 civ d I ZIP: 1 S. 2 FAMILY DWELLING PERMIT FIX SCHEDULE
Description and l c lion of work on premises: 1 AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE'
Fee(ea) Total
Est. date of completion/inspection: Description Qty. Res. only Res.only
Tenant improvement or change of use: 13VAC:
Air handling unit CFM
Is existing space heated or conditioned ?1a zes 0 No _ Air conditioning (site plan required)
- - "Is existin s ace insulated ? = es - CI - No — — - - -- — - - - - - -
g P Alteration of existing HVAC system
MEClIAN CONTRACTOR Boiler /compressors
�� .� '` , ` - / State boiler permit no.:
put HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
TQ `I City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
G1 CCB no Install/replace/relocate heaters - 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: NI6 ( V 1 ( k Chillers HP
1-3'7- pas v< s fc 4--1 Com ressors HP
Address: T Environmental exhaust and ventilation:
City: a C. State: ZIP: d 5- O 1 Appliance vent _
Phone: smiinfiranamize E -mail: Dryer exhaust
OWNER Hoods, Type 1/lures. kitchen/hazmat
hood fire suppression system
Name: A b \b 0 r y Exhaust fan with single duct (bath fans)
Mailing address: I•3 z -( P°51": j\vt Exhaust system apart from heating or AC
City: Tor 1� Cr C I State: C I ZIP: 0 . F-1 Fael piping and dishibation (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel pi I ing each additional over 4 outlets
ENGINEER ' + esspp ,g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: ax: E -mail: ' Woodstove/pellet stove
Applicant's signature: /WA/i ' /diilrlf.'iii�r , der
M/�'/>�/ :
Name (print): C h o MC (4 (J - V
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application
❑ Visa ❑ MasterCard 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 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
` Cardholder signature Amount 440-4617 (6/00tCOM)
MECHANICAL PERMIT FEES ' k
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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 Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 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 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 to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicants 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cirn 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour
2 Inspections for which no fee is specifically indicated (minimum charge -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.
hdsts\forms\rnech- fees.doc 10/11/00
CITY F.TIGARD 24 -Hour
"BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 • M,ST
BUP
• �.
Received Date Requested AM PM BUPI
/
Location ' / w SO- ' Suite P — MEC c / 95--
Contact Person �//'l Ad -/-7 Ph ( ) 9.2 iC � ,S PLM
Contractor 0000 Ph (� ) SWR
. BUILDING Tenant/Owner ELC
Footing 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:
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
• '.ART FAIL
L
•;•rg
Gas Line
Smoke Dampers
F . -
. PART FAIL
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 iC) 7 Approach/Sidewalk Date 2--- Ext -
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY 24 -Hour
B UILDING Inspection Line: (503):639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 M ST aiak
/ %33 � s Bu — � ° / ?.;\ Received Date Requested F` AM PM O / 6
Location : - 0 r i/ Suite G� g1fylkS 4 0 c — GO /9,
Contact Person �'J.r .r>, Ph ( S� /) � I — 7/ / O PLM
Contractor ti Ph ( ) SWR
in BUILDING Tenant/Owner Q ELC �,
Footing ELC > &i AM
Foundation Access: • V
Ftg Drain • . ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear AV
Int Sheath/Shear n,, at- _ Ov /C S " _ ,9 ��_
Framing Y ►' \
Insulation
Drywall Nailing
Firewall Q .- -06 /Gj O c l
Fire Sprinkler
Fire Alarm / 4� t _ f-n S s-e--e.Q.
Susp'd Ceiling J jQ (� � �) S 4 o ./ ) 1,,.. / � Cl Al oJ'
7 ` ZL < /� (A-1 -i _S r k 1 4 . �� c-�
ASS PART 440/
PLUMBING L j /' / �/ .
�� 5���� C 1
Post & Beam t� \ /J/� ,� lo-{K /�� . ' _
• Under Slab / 1 u� •
Rough -In
Water Service
Sanitary Sewer 6 .�/�`" (-
2 - Q d / � ( T2'
Rain Drains `
Catch Basin / Manhole / 1 V S u 5 s-S ( .s-4 c-e-fQs .
Storm Drain
Shower Pan lj C� / J ��` -y ' p
— r--e
Other: �.
Final - = �, -
PASS PART FAIL r i " —`
MECHANICAL - : •
Post & Beam x C� •
Rough -In 1�
Gas Line Q 1 \ pN✓
Smoke Dampers
• PART FAIL
RICAL: :,
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 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: 0 Unable to inspect - no access
Fire Supply Line �p
ADA Approach/Sidewalk � Insp ector /�` Y ?
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL