Permit ..
'� CITY OF TIGARD MECHANICAL PERMIT
i� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00359
E � II 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/1/03
PARCEL: 2S101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 150
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
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:
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: Move ducting to accomodate new walls.
Owner: FEES
PACIFIC NW PROPERTIES LTD PTNSHP Description Date Amount
9665 SW ALLEN BLVD STE 115 [MECH] Permit Fee 7/1/03 $72.50
BEAVERTON, OR 97005 [TAX] 8% StateTax 7/1/03 $5.80
Total $78.30
Phone:
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Duct Inspection
Phone: 538
Final Inspection
Reg #: LIC 125815
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 -00
Issued By:
,,,.4..„__
Permittee Signature: _a,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit A • tion FOR OFFICE USE ONLY
Received Mechanical
; -- Date/By: cR Pennit - _ ,c' o 7 om3
City of Tigard *. Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. 11V Plan Review Other
Tigard, Oregon 97223 0- Date/By: Date/By. Permit No.:
Phone: 503- 639 -4171 Fax: 503 - �� VP ,� Post - Review Land Use
,, ,erA � ,/ \ Date/By: Case No.:
Internet: www.ci.tigard.or.us Q NNG,O -. ,,I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 5 - 175 Name/Method: 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
g] 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 a Commercial/Industrial Value: $ 56 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 Fumace - add -on air conditioning ** 14.00
Job site address: 135 51.4.) 12,A4 Gas heat pump 14.00
Suite #:. 1‘b 1 Bldg. /Apt. #: Duct work j 14.00
Project Name: c /IG . - reAr N A 1 ' Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
'1'L .4-- 5 J (in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
A , r . ue "k1 Flue vent (water heater /gas fireplace) 10.00
a � Wa"'`s Log lighter (gas) 10.00
Wood/Pellet stove 10.00
. Wood fireplace/insert 10.00
�( Chimney/liner/flue/vent 10.00
kU PROPERTY OWNER 1 ❑ TEN MT Other: 10.00 .
Name: L4 r. M.., 1 I�J I. , 111:1)
Environmental Exhaust & Ventilation
� Range hood/other kitchen equipment 10.00
Address: C S St A) � S � l�s Clothes dryer exhaust 10.00
City /State /Zip: Ag,00ti Or 1,463S" Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT . $ CONTACT PERSON utility rooms) 6.80
Name: C.-It v ,,-{. / t,t,_...,v-- Attic/crawl space fans 10.00
Address: 0009512.‘ Other: 10.00
1H� ' �'///�� 'r L/ Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phci 4 3) eei
'— f(j1 Fax: Fumace, etc. **
`� Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name' t {-AZ, Fireplace ** Range **
Address: ?O T3 3et7 BBQ **
City /State /Zip: pVmpeo— 1 ' r (7 (L5 Clothes dryer (gas) **
Photre3/y .Z't S f Fax: Other: **
CCB Lic. #: ) Z.SV I Total:
Authorized /G,� Mechanical Permit Fees*
Signature: ( i .it Date Subtotal: $
Minimum Permit Fee $72.50 $ ' , ,
C hid" - L Q l - Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ � g0
TOTAL PERMIT FEE $ ,
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
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,'td'ana 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 t
Description: Qty (Ea) Amount . rt•af -, • o :: • Furnace 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 ,� t • a t� { 1,4 +
101k to 500k BTU R' r 1 _,5 ti ••.) ...'r'. , <•a'r y..
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 • ► `' . ��`'` et,y�• • t'' • •
Air handling unit >10,000 cfm 1,170 s, ,IN
C't •
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
r
permit 3 - '._ A! .. ., _4
Hood served by mechanical exhaust 656
Domestic incinerator 1,170 ' ; .- :r t' — ; •••-‘ , 'fi t
Commercial or industrial incinerator 4,590 1 -
Other unit, including wood stoves, 656 '41'.` •.'� • , ti • ; y � ; �.
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $ • ; . " -s 4 1 07 ,
VALUATION: ° . . •t; _,�;1
+� : ..*' 4 9.. •J - . •
• r .. •
•.r • • t
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY - Of TIGARD 24 -Hour
BtfiLLING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
eceived 70 M Date Requested AM PM BUP
Location 1 !, 5 51.0 ' 2' J Suite 5 -12 MEC 3
Contact Person a/ L'/ 7 Ph ( ) 73 `-/ ' 5 " PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: NCB ( 0✓ o
Ftg Drain ni0 (// G� fill 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
4 11F
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
AL
Pos eam
ugh - r�
Gas Line
Ste e Dampers
PART FAIL
EL - AL
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 �7 !,
Approach/Sidewalk Date / / r� /0 3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL