Permit ii ,
C ITY OF T MECHANICAL PERMIT
41 4 . DEVELOPMENT SERVICES PERMIT #: MEC2003 -00600
" �= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/15/03
PARCEL: 2S112DC -00100
SITE ADDRESS: 15605 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 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: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 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:
> 10000 cfm: GAS OUTLETS:
Remarks: New Rooftop unit. Value: $5000.00
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WM I [MECH] Permit Fee 10/15/03 $72.50
PORTLAND, OR 97224 [TAX] 8% StateTax 10/15/03 $5.80
[MECPLN] Plan Rev 10/15/03 $18.12
Phone: Total $96.42
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
hone: 233 6911
Duct Inspection
Reg #: LIC 38868
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable Taws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00
Issued By: 1‘., Permittee Signature: _ '. __
Call (503) 639 -4175 by 7:00 P.M. for inspections needed e next l day
II -
Mechanical Permit Application . Received Mechanical
' Date/By: � FOR OF USE ONLY
7 / 3 12,11 Permit No.: tYvf-r 3O3 -06 (pct
City of Tigard Planning Appro al Building foul , oz03.-1
•J g Date/By: Building
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 - ' Date/By: JO '/503 1}$ Permit No.:
Phone: 503- 639 -4171 Fax:.,503- 598 -1960 Post Review Land Use 40,03, A Date/By: Case No.:
rn
Inteet: www.ci.tigard.or.us % • . 1
f l� Contact Juris.: See Page 2 for
24 - hour Inspection Request: 503 639 =4175 - Name/Method: �`
�[ � `1 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
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 „2/ ommercial/Industrial Value: $ c 42 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: is 5' 5 Dv 70( 41 0 Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
Project Name: s (/jL:k/ 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)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: Lot #: Repair unit 12.15
Tax map/parcel #: Other Fuel Appliances
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/ - .4„w ,4 /JAI/ T 4•. s ✓d (�.s78' Flue vent (water heater /gas fireplace) 10.00
-x i .5 11 /ii. [OL/C7 -, Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
PROPERTY OWNER 1 ❑ TENANT Other: 10.00 _
/ �"I J Environmental Exhaust & Ventilation
Name: � iF /� =� L /
/ Range hood/other kitchen equipment 10.00
Address:
Clothes dryer exhaust 10.00
Cit /State /Zip:
Single duct exhaust
Phone: 6„z y . c,3 ® e Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4. $I.00 each additional)
Phone: Fax: Furnace, etc. *'
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater •*
Business Name: P4 aT p Fireplace **
Address: 9 2 sE' - 7 ,vG Range *:
City /State /Zip: / -7z.sA � rf7/' '7 77 Clothes dryer (gas) •*
Phone: a 33•,9// Fax: a3. .9 Other: **
CCB Lic. #: 3e_,-rs' Total:
Authorized 04703 Mechanical Permit Fees*
Signature: � =1 _ Date: % Subtotal: $
Minimum Permit Fee $72.50 $ 7r. ,s--0
C/ZZ. ►y /, 7 Plan Review Fee (25% of Permit Fee) $ 1$, i a-
(Ple print name) State Surcharge (8% of Permit Fee) $ 5
TOTAL PERMIT FEE $ 0/ 1p . `7/
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 Fomu\MecPermitApp.doc 01/03
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and
$1.10 for each additional $100.00 or fraction
thereof.
All New Commercial Buildings require 2 sets of plans.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) 63 175
INSPECTION DIVISION Business Line: (503) 6 1
MST
BUP
Received / Date Requested / 1 AM PM BUP
Location l S' 0 5 7' .1'1 Suite MEC 3 -006 �d
Contact Person /�/ �'L� Ph ( ) 3e 7 —0 8 / c/ o PLM
Contractor - �� ) Ph ( ) 3 C� — 86 SWR
BUILDING Tenant/Owner 4W I U ► E.Av ELC
Footing
ELC
Foundation
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:
Final
r
PASS PART FAIL % f
PLUMBING t�
Post & Beam
Under Slab +
Rough Service
Water Service
Sanitary Sewer rfr/P,
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam c„0
Rough -In
Gas Line �J
Smoke Dampers
ma_
PAS PART FAIL
CTRICAL
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 Please call for reinspection RE: Unable to inspect no access
Fire Supply Line /► `
ADA Date l Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL