Permit •
C ITY OF TIGARD MECHANICAL PERMIT
�� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00663
a `� ,.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/2004
PARCEL: 2S1 12 D C -00500
SITE ADDRESS: 15883 SW 72ND AVE BLDG -B
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 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: Relocate ducts & grilles for TI.
Project Value: $650
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
[MECH] Permit Fee 10/4/200z $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchari 10/4/200 $5.80
Phone: Total $78.30
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911
Final 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 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 questions to OUNC by calling
(503)246 -6699.
Issued By: gr� 1 i Permittee Signature:
a
Call (503) 639-4175 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application . FOR OFFICE USE ONLY
City of Tigard Date/By: ( •NQ Permit No. 4'4 �,t• � Received
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Ge s p ; gp ,, g, ;� Dat ew Other Permit j # �, ...0, ^D
Inspection Line: 503.639.4175 � _ i l11 Date Ready/By: tuns H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK - :._ COMMERCIAL FEE* SCHEDULE -I USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION TION _ : • Value: $ �[
• 02,-
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling pCommercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description 1 Qty. I Ea. I Total •
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / ` S 8.:_/ s 2 z Air conditioning pl or heat placement) pump
(requires showing ires site plan showin 14.00
City/ State/ZIP: / I r4-A- V 0A..e__ Furnace 100,000 BTU ( ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: • / o Furnace 100,000+ BTU (ducts/vents) 17.90
VA 0 4 f/t 7 -- Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK. Water heater 10.00
Gas fireplace 10.00
/vecpe / 2/ .65>c(, / 1 ,-,7 e.,.) & LA- /g . Flue vent for water heater or gas
J fireplace 10.00
Re..te f 72c A .14 0 - Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00 • ❑. PROPERTY OWNER (TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: •' f 041Qi1c.Q Environmental exhaust and ventilation, -
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT NeCONTACT PERSON Attic /crawlspace fans 10.00
• Other: 10.00
Business name: rQ:, 1 ig - . rs ' b`f ' Fuel t io
PP R
Contact name: Q /Z-c.lc_e_ g f r y c _ 4 _, $5.40 for first four; $1.00 for each additional
Fumace, etc.
Address: 9 > g'� S J 5 % Gas heat pump
City/ State/ZIP: /d ,_t ,4. e %Vt 9) LL�S G 3 Wall/suspended/unit heater
( � i 5 . _ 4 / 5 , c (, 3) g , _ Water heater
Phone: J ' ) Fax:: 4
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: s',7,A,.,, ,41 ,tgo "J-� Other: dryer (gas)
Address: - MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 3 O O b D State surcharge (8% of permit fee)
TOTAL PERMIT FEE ) 2_.,5
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print nameA.z Q a �....., Date: /0 - y .... -� r • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Perndts\MEC- PermitApp.doc 12/03 440- 4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard .,
Page 2 - Supplemental Information
Commercial Fee Schedule:
To tal 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.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received -g 4 Date Requested /1 AM PM BUP /
Location /SOD p 3 7 ✓f'J Suite MEC 02O0 / 7
6 - ea 663
Contact Person .[ -�A� Ph ( PLM
Contractor Ph ( ) SWR
-4
BUILDING Tenant/Owner C
Footing
Foundation ELC
Ftg Drain Access: 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: tI '
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
MECHANICAL
Post & Beam
Rough -In
Gas Line
Sm... Dampers
PART FAIL
• RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call or reinspection RE: r –_ 11 Unable to inspect – no access
Fire Supply Line
ADA `
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REM OVE this Inspection record from the Job site.
PASS PART FAIL