Permit C ITY OF TIGARD MECHANICAL PERMIT
a DEVELOPMENT SERVICES PERMIT #: MEC2004 -00237
'�J II 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/3/2004
PARCEL: 2S113AB-01201
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16535
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
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: Relocate ducts & grilles for TI.
Project Value:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 5/3/2004 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 5/3/2004 $5.80
Total $78.30
Phone:
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 - 453 - 4822 Duct Inspection
Final Inspection
Reg #: LIC 62196
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
require : - : • ow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
9 -001 -0010 throug BAR 95 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
03)246 -6699.
Issued By: ,, /41 i ittk � � ., ,:!,/ Permittee Signature
Call (503 • 9-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard , DateBy: -cZ
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
/ /���
Plan Review
/az
Phone: 503.639.4171 Fax: 503.598.1960 � r: �ij Date/By: Other Permit:
Inspection Line: 503.639.4175 � ■ i,�. � Date Ready/By: orris: See Page 2 for
Internet: www.ci.tigard.or.us - Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCRF.DULE — USE CHECKLIST
❑ New construction fg 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 . ' Value: $ 500.00
. - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling cg. Commercial/industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION . Heating/cooling
Job site address: 165 0 5 SW 72 nfa A
Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: T ( A 2 d 0(& C 7 a 2 y Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 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
Flue vent for water heater or gas
Duct Rdcli +(t�(1 RelovAtion Surf R21oc.Atro,� Log 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
riN rr /� Other: 10.00
Name: p A C i r t Rum/ I� As S oc Environmental exhaust and ventilation
Rang
Address: 15 3 5 S W s e Q V 0 t a f p kW 3 00 equ e hood /other kitchen
t. equippment 1 0.00
City/State/ZIP: (70 R f And 0 g, g 7 2 a 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
Business name: 1 Other: 10.00
G I ` m Ale Co n tRol Fuel piping
Contact name: 0 A R Q P n U .2t., $5.40 for first four; $1.00 for each additional
Address: 1 6500 S W f t/ A 'e Furnace, etc.
7,
Gas heat pump
City/State/ZIP: P,) (4 • ( A A d 0 (. 1 7 2 y Wall/suspended /unit heater
Phone: 51)3 C( 53" � � a ,� Fax:
( ) (5 03) 968 7a 2 y Water heater
Fireplace
E -mail: Range
CONTRACTOR . Barbecue
•
Business name: C I i m R 1 Co /I t 0 I O Otthhthes dryer (gas)
Other
Address: 16 S 00 s W 7Y' tr U Q MECHANICAL PERMIT FEES*
City/State/ZIP:12 0 (Z fA „d( 0 K q 7 2 y Subtotal y�
Phone: ( ) ` I Fax: (St 3) q 6 S ' 7 Minimum permit fee ($72.50)p - 5V
503 y 5 3 - 4 y Plan review (25% of permit fee)
CCB lic.: 6; I q b State surcharge (8% of permit fee) .5 • (CO
TOTAL PERMIT FEE 78'. 36
Authorized signature: ��� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 0 ,() fz D Date: S [3i o so • Fee methodology set by Tri- County Building Industry Service Board
i:\ BuitdingTemtits \MEC- PermitApp.doc 12/03 440- 4617T(11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard ' 4,
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: - 003) 639 -4175
INSPECTION DIVISION Business Lin : (503) 639 -4171 MST
ByP
Received /2 i 4 / " Date Requested — AM PM BUP
Location /6 5D Suite 66 it —01/
Contact Person 9%44'7 Ph ( </..cr Z Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC -
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: V6,Lo SIT
Post & Beam
Shear Anchors ` VL/LS
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 A /
Post & Beam I -'
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
...,•.:.a . mpers
Final
4143 FAIL
3 RICAL
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 E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA V `
Approach/Sidewalk Date 3 / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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