Permit clT OF T I GA R D MECHANICAL PERMIT
;��;� DEVELOPMENT SERVICES DATE
PERMIT #: 9/ 6/02 -00396
13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171 PARCEL: 2S113AA -00900
SITE ADDRESS: 16530 SW 72ND AVE B -07
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 000 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 235,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: L 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: extend Gas line to existing units
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 9/16/02 $72.50 2720020000
PORTLAND, OR 97224 PLCK CTR 9/16/02 $18.13 2720020000
5PCT CTR 9/16/02 $5.80 2720020000
Phone: Total $96.43
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Final Inspection
Phone: 453 -4822
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 requires you to follow r;'es a•opted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -00 -001V roi• OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OU ► _ : ling . ! )246 -9189.
Issue By: Permittee Signatu
CaII (503) 639 -4175 by 7:00 P.M. for inspections needed the ne t business day
Mechanical Permit Application OFFICE USE ONLY
• Date received: '" ' d Permit no.: /n@G,bD1 00 '
r < .
,, ,,f i City of Tigard Project/appl. no.: Expire date:
Ci 'ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
.10B SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: la 5 30 S w -7,Z Ave Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: 1340 - l Ta x l g o ►p t j jurisdiction's fee schedule for residential permit fee.
City /county: 776olieO “,„4, . 'ZIP: 9 72.2/ 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
AND COMMERICAL /INDUSTRIAL E %I
UIPE,NTSCIIEDULE
Description and location o work on remises: 4l jZAt! F Q
`. Mai 777 4 S )'74 6AS MeA Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or c ditioned ?A Yes ❑ No
Air conditioning (site plan required)
Is existing space insulated?,110 Yes ❑ No Alteration of existing HVAC system
MECHAN CONTRACTOR Boiler /compressors
Business name: e L! A9�¢ r Gwl,l77PaL State boiler permit no.:
HP Tons BTU/H
Address: /( so S AJ -- 72 /101-/44/L —' Fire/smoke dampers/duct smoke detectors
City: 7: I State:' ZIP: q 7 Heat pump (site plan required)
Phone:50 4f5yeffeZ Fax;c0j -W ,241E- mail: J InstalUreplace BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 62/96 ja - D___S--e , 3 Install/replace/relocate heaters - suspended,
City /metro lic. no.: /L.// 9 wall, or floor mounted
Name (please print): A a ` • Vent for appliance other than furnace
CONTACT PERSON' Refrigeration:
^� Absorption units BTU/H
��¢
Name: 4 •f�G(,t/! Chillers HP
Address: 1 _ Compressors HP —
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: az. Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
P sT Exhaust suppression a system
duct
Name: 7 Exhaussst fan with single duct (bath fans)
Mailing address: /5350 qw (4,i4 li ,j/ # 3e Exhaust system apart from heating or AC
11 Fuel piping and distri (up to 4 outlets)
City: Alert/ Ay State ZIP: T 2224/ Type: LPG NG Oil
Phone' •a Oa Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: 'State: ' ZIP: Insert - type
Phone: F, • : A mp E -1.. il: Woodstove /pellet stove
Other:
Applicant's signatu ...—....•_,I...... i r � Date: 9�GZ Other:
Name (print): 17:: - 411 4,.c�1.L
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application
❑ Visa ❑ MasterCard Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been
State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount
440 -4617 (6/00 /COM)
J
MECHANICAL PERMIT FEES
•
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
ti .
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
fraction thereof, to and including 2) Fumace 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 or Pump Cond
fraction thereof. footnotes below. Comp *'
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU - 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb
unit 100k to 500k i3TU 25.60
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
unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM
Value Total 10.00
Description: Qty (Ea) Amount 13) Air handling unit 10,000 CFM+
17.20
Fumace 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
floor mounted heater appliance permit 10.00
Vent not included in applicance 445 17) Hood served by mechanical exhaust
permit
10.00
Repair units 805 18) Domestic incinerators
< 3 hp; absorb. unit, 955 17.40
to 100k BTU 19) Commercial or industrial type incinerator
3 -15 hp; absorb. unit, 1,700 69.95
101k to 500k BTU 20) Other units, including wood stoves
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:
>1.1. 75 mil. BTU $
•
Air handling unit to 10,000 cfm 656 8 % State Surcharge
Air handling unit >10,000 cfm 1,170 g $
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to o a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1 170 1. Inspections outside of normal business hours (minimum charge -two hours)
$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 - outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 *State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ * * Residential NC requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
is \dsts \forms \mech - fees.doc 02/05/02
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested q1 q AM PM BUP
Location / .r 36 72- .-7 L Suite , 7 MEC --- 3 9
Contact Person Ph ( ) PLM
Contractor Ph ( ) q.c. 3 SWR
BUILDING Tenant/Owner 61 / ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: r ( J l SIT
Post & Beam ,v `tZ
Shear Anchors E L2 — e
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
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
mampers
Fin.
0 C - 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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date i Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL