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Permit CITY TI GAR D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC200300379 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/7/03 PARCEL: 1S136DA-00100 SITE ADDRESS: 11308 SW 68TH PKWY 2ND FL SUBDIVISION: ZONING: MUE BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: ELE 3 - 15 HP: 0 COMM. 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: 2 Remarks: Add (2) new cooling units and duct work. Owner: FEES BENENSON 68TH PARKWAY Description Date Amount KEY LLC, THE [MECH] Permit Fee 7/7/03 $72.50 BY FIRST AMERICAN TAX VALUATIO WORCESTER, MA 01615 [MECPLN] Plan Rev 7/7/03 $18.13 [TAX] 8% StateTax 7/7/03 $5.80 Phone: Total $96.43 Contractor: HUNTER DAVISSON INC 1800 SW PERSHING PORTLAND, OR 97202 REQUIRED INSPECTIONS Mechanical lnsp Phone: 503 Duct Inspection Reg #: LIC 01612 Final Inspection 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 ques OUNC by calling (503)246 -669 Issued By: Permittee Signatur . Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day llOn Toll of OF ICE USE ONLY Mec �d�lt• cal lief .I 1 G r Received 97/03 ' Tim Mechanical tl � ' . ' Date/By: Permit No.: � R`aGb3 '00 9 Cl of Tigard Planning Approval Building 0 City g R Date/By: Permit No.: ga/i.ZO Ba3,Pi 13125 SW Hall Blvd. jU1. ZlY�3 Plan Review $ v Other Tigard, Oregon 97223 C I� T Of, T � ( • K U Date/By: � •.7 .3 Permit No.: Phone: 503 - 639- 4171i.r�bi Post Review Land Use B® �'" " �� "il " 1 '� Date/By: Case No.: Internet: www.ci.tigard.or.us II 6 I Contact furls.: 0 See Page 2 for - 24 -hour Inspection Request: 503 -639 -4175 ' Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ ew construction ❑ Demolition Mechanical permit fees* are based on the total value of the work PE ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CO N TRUCTION mechanical materials, equipment, labor, overhead and profit. El & 2- Family dwelling Commercial/Industrial Value: $ ZOO See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE Description 1 Qty 1 Fee(ea.) 1 Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 Job site address: 11 3O6 5c.) (4S-- a '-t f, Gas heat pump 14.00 Suite #: 1 Bldg. /Apt. #: Duct work 14.00 Project Name: i J JEcte. 01- 6-,,. 2 Hydronic hot water system 14.00 job site: Residential radiator boiler Cross street/Directions to 1 (for radiator or hydronic system) 14.00 4 t -SU5 •p 6S N 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 /Ao4 (Q, l_ leric t r /lc c v,./ h j) Flue vent (water heater /gas fireplace) 10.00 Leor.4 r712 y,� Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue/vent 10.00 El +RIROPERTY OWNER 1 ❑ TENANT Other: 10.00 Name: Environmental Exhaust & Ventilation Range hood/other kitchen equipment 10.00 Address: City /State /Zip: Clothes dryer exhaust 10.00 Single duct exhaust Phone: I Fax: (bathrooms, toilet compartments, 0 APPLICANT 14XCONTACT PERSON utility rooms) 6.80 Name: Dkva Anc- bretlL Attic/crawl space fans 10.00 Other: 10.00 Address: c;v14.4- /Y5 04.;:e,(n (a /Are Fuel Piping City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Phone: I Fax: Furnace, etc. *• Gas heat pump • • E -mail: Wall/suspended/unit heater •• CONTRACTOR Water heater •• Business Name: 1�1f1_ 1�,P►.UIiSO,A Fireplace •• Address: ( :O() I (/mom q BQe • * City /State /Zip: tn4ZT1/;s0 t:/L. ! 7e Clothes dryer (gas) •• Phone: 0,'N ()t./ 77 Fax: A1(9 (6Q5 Other: •• CCB Lic. #: l (o Total: Authorized Mechanical Permit Fees* Signature: - a„, Date: 7- ? -03 Subtotal: $ Minimum Permit Fee $72.50 $ 2 . SO P -0 . '-� Plan Review Fee (25% of Permit Fee) $ /P. /3 (Please print name) State Surcharge (8% of Permit Fee) $ .S. Jv TOTAL PERMIT FEE $ 5 `/3 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 Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard .e1-- Y: Page 2 - Supplemental Information Commercial Fee Schedule: To Valuation: Permit Fee: • 51.00 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. • As Valuations:.Per-Appliance: Value Total Description: Qty (Ea) Amount Fumace to 100,000 BTU, including 955 ducts & vents Fumace > 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 161% 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: . i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP ` — Received 2 ` 2 ' 4 Date Requested I /A/ AM PM BUP Location /1 0 G' 0) ( suite. ,,,3 — Do 3 7 ? Contact Person T (oh (6-03) 2 '3- / '237 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain pSl U f/ '17 c 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 \/. Rough -In Gas Line = ' - pers PART FAIL • ICAL 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 111 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA U 3 Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL