Permit CITY TIGARD MECHANICAL PERMIT
r� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00833
.,� 13125 SW Hall Blvd., Ti gard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/27/2004
PARCEL: 2S112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 250
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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. Valuation: $995.00.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 12/27/20( $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 12/27/20( $5.80
Phone: Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Duct Inspection
Phone: 538 -2953
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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
tr/
Y� Issued B Permittee Signature:
� r
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Per Ii D FOR OFFICE USE ONLY
City
of Tigard 7 P ermit No.
tY g DateBy:.�.G 7 � � r' �`NE. �2A `/ Gq33
13125 SW Hall Blvd., Tigard, OR 97 2 7 2004 Plan Review
Phone: 503.639.4171 Fax: 503.5984W / (11 `:� , �r Date/By: Other Permit:
Inspection Line: 503.639.4175 el I Date Ready/By: Juris: H See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA' i Notified/Method: 1J C. Supplemental Information
BUILDING DIVISION
5 TYPE OF WORK COMMERCIAL FEE* SCHEDULE — 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, ov an profit.
•
CATEGORY OF CONSTRUCTION Value: $
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building
RESIDENTIAL EQUIPMENT / SY EMS FEES*
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 5't ,/ Air conditioning or heat pump
�� )2,—`1#`1 (requires site plan showing placement) 14.00
City/State /ZIP: f G t �� Fumace 100,000 BTU (ducts/vents) 14.00
11 ^ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: i Project name: ] jli 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
d 4 �,e Git Gas fireplace 10.00
• Flue vent for water heater or gas
fireplace 10.00
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: 7 lam/ 4 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 ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax :: ( ) Water heater
Fireplace
E -mail: • Range
CONTRACTOR �yJ Barbecue
Business name: t 'OZ 1 ^t ✓ Clothes dryer (gas)
4 , re � , / Other:
Address: r T FEES*
MECHANICAL PERMIT
City/State /ZIP: ''/ " �I/' ,a
` < 12 ` c Subtotal
/ •/ Fax: Minimum per fee ($72.50) n1 .._x6 Phone:
��) 25 $) �U) 5-- 3 2_ -2 71_,
Plan review (25% of permit fee)
• CCB lic.: / 2 l ( State surcharge (8% of permit fee) 5 YO
[ J TOTAL PERMIT FEE C
This permit application expires if a permit is not obtained within 180
Authorized Signature: f days after it has been accepted as complete.
Print name: G' 1 yam. Date: �/l y �i� * Fee m ethodology s et by Tri -County Building Industry Service Board
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.
$100,000.01 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 Date Requested /� AM PM BUP
Location 1 S R 9 s �� Suite .2 0 MEC (DO -,06 $33
Contact Person Ph ( ) PLM
Contractor Ph ( ) 5 57— ° 9, S.3 SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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 .4
Susp'd Ceiling �.
Roof ,L AF Vu
Other: - w -
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
eam
Rou h-
as e
Smoke Dampers
PART FAIL
TRICAL
- 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 0 Please call f• i reinspectio RE: 1 111t— = i Unable to inspect — no access
Fire Supply Line ♦
Approach/Sidewalk Date 0 , Inspector 1 11 Ext
Other:
Final D • NOT • EMOVE this Inspection record from the job site.
PASS PART FAIL