Permit CITY OF TIGARD
MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2002 -00270
`•f I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/25/02
PARCEL: 2S1 12 D D -00200
SITE ADDRESS: 15500 SW 72ND AVE 200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 2
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: Mechanical tenant improvement, add additional grilles and (2) vent fans in bathrooms. Value of work is
$2,000.00
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 6/25/02 $72.50 2720020000
PORTLAND, OR 97224 5PCT CTR 6/25/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911 Duct Inspection
Reg #: LIC 38868 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more t an180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility ' otification - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 -401 -0080. You -y obtai copies of these rules or direct questions to OUNC by calling
(rfl. 174.R_A RA -
Iss - By: ,L 0 ± ' �,„%� ��,,. - Permittee Signature: -
Call (503) • -4175 by 7:00 P.M. for inspections needed the next business day
e
MechanicalPermit Application
Date received: & 0 .16 - Oa- Permit no.:ileedbes49--1/4270
1 y:'r:1'(. City of Tigard Project/appl.no.: A M - date:
CuyojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
0 1 & 2 family dwelling or accessory O Commercial/industrial ❑ Multi - family Tenant improvement
❑ New construction 0 Addition/alteration /replacement 0 Other:
3011 SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /g$ 3t,„," '7RND AL/ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: p'1', or) value of all mech cal materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ ;f / 000 .
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: OF / 4 t'714C ii G jurisdiction's fee schedule for residential permit fee.
City /county: / / gA 1 ZIP: 1 & 2 FA\lI l,Y 1111 FLUNG 1'ER1117' FEE SCHEDULE
Description and location of work on premises: AND COMi%IERIC:UJINUUSTRtAl I:QUII'11ENTSCHEDULE
ecLOZd 4/ X e e:�cs ADD a -soc Fal E7004647 Fee(ea) Total
Est. date of completion/inspection: FAA./ .3. Desaiption Qty. Res.only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? ❑ Yes 0 No Air condition ing handling unit CFM
toioning (site plan required)
Is existing space insulated? U Yes O No Alteration of existing HVAC system 1
11ECIIINI(:AL CONTRACTOR Boiler /compressors
Business name: '� ate boiler permit no.:
RQ7� M P Assoc. A 35CJC �iv . HP Tons BTU/H
Address: lrp 7 4 , f c Cr i f Fire /smoke dampers /duct smoke detectors
City: / -rzA,do 1 Staten, 1 ZIP: 9 za 3,a Heat pump (site plan required)
Phone:a33 I Fax ; 74, ? I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner O Yes ❑ No
3 $ Install /replace/relocate heaters — suspended,
City /metro lic. no.: !�s S — <i wall, or floor mounted
Name (please print): Jt ' a" Vent for a liance other than furnace
e on:
Absorption units BTU/H
Name: jC geir 3! 4 L Chillers HP
Address: r' - Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone -Ca j Fax: ' E - mail: Dryer exhaust
Hoods, Type 1/ II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) Z
Mailing address: Exhaust system apart from heating or AC
City: I State: ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorativefireplace
City: 1 State: I ZIP: Insert—type
Phone: Fax: E -mail: tove/pelletstove
1 Other.
Applicant's signature: G 7 I Date: _ 947 Off,
Name (print): (/ y � t��v 7 �`
`Not all jurisdictions accept credit cards, please call jurisdiction for more informatio Permit fee $ 70� .
O Visa O MasterCard Notice: This permit application Mi n j mutn fee $
/ expires if a permit is not obtained Plan review (at %) $
Credit care number: within 180 days Expires within after it has been , State surcharge (8%) .... $ -� tr
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 7$ • C)
Cardholder signature Amount , 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES ' =.
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: - PERMIT 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) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
faction 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 Fumace
$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 C Pump Cond
fraction thereof. footnotes p
Minimum Permit Fee $72.50 SUBTOTAL: 7) <3HP; absorb unit
$ to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) 9) 15-30 HP; absorb
$
Required for ALL commercial permits only unit .5 1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM
10.00
Value Total 13) Air handling unit.10,000 CFM+ -,
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Fumace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust •
Vent not included in applicance 445. 10.00
permit 18) Domestic incinerators
Repair units 80 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, ' 1,700 20) Other units, including wood stoves •
101 k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: - $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge • _ $
Air handling unit >10,000 cfm 1,170
Non- portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656 - -
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1
$62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes. additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge-one-half hour) $82.50 per hour
Each additional outlet 63 `State Contractor Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL - $ Residential A/C requires site plan showing placement of unit
VALUATION:. ` ,1' :: ''_ * '3 ; All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms%mech- fees.doc 12/26/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received - Date Requested 1 AM PM ,BUP
Location 1 Si-o U 7,,? 44 Suite 0 0 c - _• i1
Contact Person - Ph ( ) - j " 3 9
Contr... Ph ( ) SWR
Tenant/Owner ELC
Foundation ELC
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:
r
PART FAIL
• :ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line !�
DAoach/Sidewalk Date Y /" &ui"
Approach/Sidewalk 2 Inspector Ext
PP
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL