Permit CITY OF TIGARD MECHANICAL PERMIT
,Yr� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00074
� � I � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/24/2005
PARCEL: 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
> GAS OUTLETS:
10000 cfm:
Remarks: Relocate existing HVAC grilles. Valuation: $900.
Owner: FEES
BENENSON 68TH PARKWAY Description Date Amount
KEY LLC, THE [MECH] Permit Fee 2/24/200f. $72.50
BY FIRST AMERICAN TAX VALUATIO [TAX] 8% State Surchar€ 2/24/200E $5.80
WORCESTER, MA 01615
Total $78.30
Phone:
Contractor:
HUNTER DAVISSON INC
1800 SW PERSHING REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Phone: 503 234 - 0477
Reg #: LIC 01612
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calli - 13)246 -6699.
Issued By: ,j._cf_,77,;" Permittee Signatur: -111111111° f
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the xt business day
Mechanical Permit Application r()li orrl(. r list.: `I:
City Of T /$' ill`- EC E \i ; Received Permit No.: `� C IN J �D 7c. 13125 SW Hail Blvd., Tigard, OR 97223 V 's^ _ : . Plan Review
Phone: 503.639.4171 "-fax: 503.598.1960 4c, ! ,, ; i ' , Date/By. Other Permit:
Inspection Line: 503.639.4175 1,1- =•_I_i D ate ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us FEB 24 1; J Notified/Method: Supplemental Information
• j l �F �� � �� � �� gR k 1 CIAR1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction . M • . i Iff�alt�� } ji N Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 7 1)0 a —
❑ 1 - and 2 family dwelling , 21Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: t 1 �/ ' Air conditioning or heat pump
b �W \ `� (requires site plan showing placement) 14.00
City /State/ZIP: --1-2,4g..0 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/ ce- f lsri 1/W c //-5 Gas fireplace for 10.00
,
U � / Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I )2 TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: I prCoN1 t 113(71•-) (.pf' OA Environmental exhaust and ventilation /�- Range hood/other kitchen
Address: t t3 6) S(_,..) (0 equipment 10.00
City / State/ZIP: TI Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
$APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
���/ �� �/ tSS Q Fuel t io -
PP g
Contact name: D� /Y3 MC(-U ( 55.40 for first four; Sl.00 for each a dditional
Address: , 6 0 S E ,, Cr Furnace, etc.
� Gas heat pump
City /State/ZIP: 00 2 \ u G2 ' ^/ )L2 o Wall/suspended/unit heater
Phone: (3 ) Q3 lit O \07 Fax: :9)3 )p.,. 6 ' 6 Water heater
Fireplace
E -mail: Range
I �/CONTRRAAC -TOR Barbecue
Business name:
�J �� �(Jf/� V w jh) Clothes dryer (gas)
Other:
Address: )EC) 0 Se f f MECHANICAL PERMIT FEES*
City /State/ZIP: I ✓Q `L, „,,0 Subtotal
Phone: (3) g8 -! 7 I Fax: 613) d 3 6 / 6 3 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: l6 /g State surcharge (8% of permit fee)
TOTAL PERMIT FEE
afar= / This permit application expires if a permit is not obtained within 180
Authorized Si
1t days after it has been accepted as complete.
I Print name: 0 • („1-1-2. I Date: oC - pCy Ces • Fee methodology set by Tri- County Building industry Service Board
i:\ Buitding\Permits \MEC- PermitApp.doc 12/03 440-4617T(11 /02/COM/WFB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Permits \NEC- PermitApp.doc 12/03 2
CITY OF
BUILDING; DIV1SION PERMIT #: MEC2005-00074
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/12/2005
Phone: (503) 639 -4171 a ji I Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 5/6/2005 TIME: 7 :10AM PAGE: 77
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: Relocate existing HVAC grilles. Valuation: $900.
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: HUNTER DAVISSON INC PHONE #: 503-234 -0477
Inspection Request Scheduled For: Date: 5/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 006248.01 503-849-7891 Y
Corrections /Comments /Instructions:
6
\ -4 r \-1 ,'-'------. ( 1
\ -....(..„...
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL II CALL FOR INSPECTION ❑ ADDITIO AL FE= ASSESSED
L i
Inspector: • 1 ' Date: 0# if ' Phone #: (503) 718 -