Permit CITY OF TIGARD MECHANICAL
� , DEVELOPMENT SERVICES PERMIT
PERMIT # • MEC97 -0313
13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: 09/02/97
PARCEL: 2S1O1AA -09800
SITE ADDRESS...: 12570 SW 69TH AVE #101
SUBDIVISION : MLP95 -0013 ZONING: MUE
BLOCK • LOT •001 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 0 DOMES. INCIN: 0
:GAS 3 -15 HP : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP : 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HP : 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP : 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 1
FURN < 1O0K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 0
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks: Executrain tenant improvement to new cowwercial building
Owner: FEES
JT ROTH JR type amount by date recpt
12600 SW 72ND AVE PRMT $ 25.00 BON 08/13/97 97- 298230
STE 200 PLCK $ 6.25 BON 08/13/97 97- 298230
TIGARD OR 97223 SPCT $ 1.25 BON 08/13/97 97- 298230
Phone #:
Contractor:
TRI— COUNTY TEMP CONTROL /HEATNG
13651 SE AMBLER RD
$ 32.50 TOTAL
CLACKAMAS OR 97015
Phone #: 654 -3115
Reg #..: 000007
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 wore
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-881-0810 through OAR 952-001 -8880. You way
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue By: ' � --d Permittee Signature:`a �l
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + ++
Call 639 -4175 by 6:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
v, . 1 vI 1 vr911w IvuG'.,l lwflvwu IF GI Mil PqJ Jllwar iu11 Rec'd By .5. GArtf -rf/1
13125 SW HALL BLVD. Commercial and Residential . Date Recd `1 - 1 3 - 7 8-
TIGARD, OR 97223 IA A r/ Date to P.E. 'ohs -9-
639 -4171 x304 l Date to DST CJ's
(503)-, 0390
�' � � - Print or Typ Permit e/nr✓c9 � - 0 3i3
i Caned(AsA 4Z
Incomplete or illegible applications will n .t be accepted , /" A jal„
Name of DevelopmentUPropct Description
�* Lt/ R«� - c-r\-o/ Table IA Mechanical Code QTY PRICE AMT
Job Street s Suite# A) Permit Fee -0- -0- 10.00
Address ic2 5 70 cal 69 / 0
Bag# City /State Zip 1.) Fumace to 100,000 BTU 6.00
_77q, / 7 ZZ - S including ducts & vents
Name for name of bu ess) 2.) Furnace 100,000 BTU+ 7.50
Owner , / • 7 • j(z including ducts & vents
Meting Address 3.) Floor Furnace 6.00
/ �'L cJ 7z ,....2 , 26,D including vent
City /State zip Phone 4.) Suspended heater, wall heater 6.00
r qq 9'7223 1 639 Zt, or floor mounted heater
Name (b name of business) 5.) Vent not included in appliance permit 3.00
�X c c{.._7 /zav�
Occupant Maui g Addfe48 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorb unit to 100K BUT"'
City /State zip I Phone 7.) Boiler or comp, heat pump, air cond. 11.00
3-15 HP; absorb unit to 500K BTU"
Contractor Nane r 8.) Boiler or comp, heat pump, air cond. 15.00
(Prior to f (o 7 2:S 7 ( �� o / 15-30 HP absorb unit5-1 mil BTU"
issuance Mating Address 9.) Boiler or comp, heat pump, air cond. 22.50
applicant / 565/ 56 %66-/ 4 30-50 HP; absorb unit 1- 1.75mi1 BTU**
must provide all cayi race /� zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
contractor C cN l O/L c 1 ' i i5 5 37/5 > 50 HP; absorb unit 1.75 mil BTU"
license Oman # Exp. 7e 11.) Air handling unit to 10,000 CFM 4.50 •
information 42 ,
for COT COT Business Tax or Mew # Exp e - 12.) Air handling unit 10,000 CFM 7.50
database). . l /2C., 5
Architect Name 13.) Non - portable evaporate cooler 4.50
or g A ddrea9 14.) Vent fan connected to a single duct 3.00
Engineer 'Scat, Zip Phone �- 15.) Ventilation system not included in 4.50
GY ' 02 _252 O / J appliance permit
Describe work New 0 Addition 0 Alteration 0 Repair 0 16.) Hood served by mechanical exhaust 4.50
to be done Residential 0 Non - residential 0
Additional Description of work _ -4--i r l 17.) Domestic incinerators 7.50
• ao%`- -- oc d'`�_c- Z - v .9 7 L./ s 18.) Commercial or industrial type 30.00
'ID - •=76U,,,S / -/ U! Incinerator
Existing use of / / 19.) Repair units 4.50
budding or property /'lp .., 1 h " Arej - c-- _
20.) Wood stove 4.50
Proposed use of /�1 / 21.) Clothes dryer, etc. 4.50 _
building or property Of - 1 4-e- ( r.2-.. vvc-p1 /cam
22.) Other units 4.50
Type of fuel - oil 0 natural gas A LPG 0 'electric 0 23.) Gas piping one to four outlets 2.00
I hereby acknowledge that I have read this application, that the 24.) More than 4-per outlets (each) .50
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
Signature �oof Owr�/Age Date V.v /y 7 'SUBTOTAL
,
At---v S �v. � .. Z 4,511 3 � (5 /
5% SURCHARGE /
Al
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL ti v r
TOTAL 3 2-�
i:\dstlmechpmtdoc (rev 9 'Minimum permit fee is S25 + 5% surcharge
"Residential A/C requires site plan showing placement of unit.
OVER - THE - COUNTER (OTC)
COMMERCIAL MECHANICAL PERMIT CHECK LIST
Permit #: Date: s- 13--97
Project Name: Eie..44.criz.js
Site Address: 125 $w 4. Su rrE to 1
Description of Project: ....÷ r� # -{a
Class of Work: (Floor Furnace: Evap Coolers:
Type of Use: 414 Unit Heaters: Vent Fans:
Occupancy Grp: Vents w/o Appl: Vent Systems:
Stories: Boilers /Comprsrs: Hoods:
Fuel Types - 0 - 3 HP. Repair Units:
/ / / / 3 - 15 HP. Wood Stoves:
Max Input: Btu: Air Handling Units Clo Dryer:
Fire Dampers:- < = 10000 cfm: Oth Units: ..��
Gas Pressure: H / M / L > 10000 cfm: Gas Outlets:
No. Of Units:
Furn < 100k Btu:
Furn > =100k Btu:
NOTES: H I 02 p L e
Permit Extension � � � Permit Fee
Gas Line Inspection G 2 - Plan Review
Mechanical Inspection 2- 5% State Surcharge
Heating Unit Inspection Supplemental Permit
Cooling Unit Inspection Additional Permit Fee
Shaft Inspection Additional Plan Review Fee
Hood Inspection Inspection Fee
Fire Suppr Inspection Miscellaneous Fee
Duct Inspection
Fire Alarm Inspection
Fire Damper Inspection REMARKS:
Miscellaneous Inspection
Fire Alarm Inspection
/ Final Inspection
:T71.PE OF USE.OFTIONS> .CAM = rc MS =.
comma ai C corruner tr►air
MASS __OF WORK OPTION ALL: PERM#TS: (NEW: = new AADO = addition:: ALT; =_ a atiors .ACS :iaccessa : m; < >:: >: ?::::::::::m » »::> >:: >?: » >: ><::
FND,: =: foundation :OTH othiii;. DEM = demolitions:: REP repair FPS = fue protec syste . =t35E
RETAINING WALL DETACHED DECKS; SIE fS. AWNINGS.
i:lovrcntr.doc (dst) 2/97
1
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: q — 7 7 A.M. P.M. MST:
Location: ) D---570 SO) (0 q Th a,�f BUP:
Tenant: Suite: /0/ Bldg: MEC: C r 7-031 3
Contractor. Phone: Z frill & ,3 q— ,�..6 3 7 PLM:
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING CHANIC ELECTRICAL SITE
Site Post/Beam Post/Beam eam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr/Ahn Crawl/Found Dr Hea P um Low Volt
Approved Approved pproved ' Approved Approved
Appr /Sdwlk Not Approved Not Approved ed Not Approved Not Approved
FINAL FINAL FINAL FINAL
O Call for reinspection 0 Reinspection fee of $ p required before next inspection 0 Unable to inspect
Inspector: -� dL� Date: L °' /CD 9 Page of