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Permit CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00068 41I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/29/04 PARCEL: 1 S133AD -02200 SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE SUBDIVISION: ZONING: R - BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: A2.1 VENTS W/O APPL: VENT SYSTEMS: STORIES: 2 BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: 472,000 BTU 15 - 30 HP: FIRE DAMPERS ?: Y 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: L 50 + HP: WOODSTOVES: FURN < 100K BTU: 0 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: 4 <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: 4 rooftop units & ductwork. Gas piping see MEC2004 -00069 Project Value: $71,200 Owner: FEES WESTGATE BAPTIST CHURCH Description Date Amount 12930 SW SCHOLLS FERRY RD [MECH] Permit Fee 4/29/04 $1,036.50 TIGARD, OR 97223 [MECPLN] Plan Rev 4/29/04 $259.13 [TAX] 8% State Surchar€ 4/29/04 $89.92 Phone: Total $1,385.55 Contractor: INTERIOR COMFORT SYSTEMS 10622 SE 172 BORING, OR 97009 REQUIRED INSPECTIONS Phone: 135118 Heating Unt Insp Duct Inspection Reg #: LIC 135118 Fire Damper lnsp S.D. Shut -down inspection Final Inspection 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. Y• may obtain co ies of these rules or direct questions • OUNC by calling (503)246 -6 •,9• • Issued By: 411 Permittee Signature: �l�i, C2i�rtn -2- _�� Call (503) 639 -4175 by 7:00 P.M. for inspections neede% the next b ess day Mechanical Per !; IE FOR OFFICE USE ONLY ' ' • City of 'Ti and Received l/ pyl(,2 ...00e, 0 g Date/By: �� / PP r / Permit No.: 13125 SW Hall Blvd., Tigard, OR p s' 1 0 200I Plan Revi . Phone: 503.639.4171 Fax: 503. i4 ^.0 1 . /��iat,� l N� yl � p � � i ,f Date/By: � y: '" 0f� Other Permit: Inspection Line: 503.639.4175 OF TIGARD ,. 1 A71 I. Date Ready /By: Juris: ® See Page 2 for Internet: www.ei.tigard.or.us CITY Notif•'d/Method:9 44,..._ i 0 7-76 Supplemental Information i�uILwi ,(a DIVISION . _;!. , _ i _._ �_�.�± % - - ' ° _. x6 ":�;(' _`' .i4." 7x,';,,t ^'%" -� �;,,v_.= w:,.�a!u;t:3 -Sb E z, 9�C t x e .;. , s;+„� ,r•,k, -a �. �. ,.; *k7 POPS =. ., ;.i '�`=: A `, i4 -1 >OF�*WORK :', ; ;,. r fi .. �. f T,. COMMERCIAL :FEE a ,SC i ULE 1 ' USE,CHECKLIST ew 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. Value: $ = :.;G<l' t:r.E:- :¢;.,. rr q :.�� a�k . - .::.:nrreasa ::$ ^•;;v,,: ,, 4:�rrq,2'.:,u :g:a s',:i *' .2_00 =6-.2 ,, °' � , .. i lCATEe0.1Kti'OF'�NO ik TION 1 : .` � , ..`, .., . .. .r. -- a�'":9! -"-'' ''' F �,.r,.. G '''' .... s.aam+ 2 . '"tm:a: �''.», ..._w _€ "' _. -< ' - " - , !.- .-..., Z.as,.d - P - x.�� R . S � // "RESif)ENTd'AL %EQUIPMENT' /'S'1'STENIS FEES* 1::] 1 - and 2- family dwelling ommercial /industrial ❑ Accessory building ` For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total "Pe'. ',k,-'. >fi,,`u' c!px.. ".t',,:: �.�;sv�tcr�ra..-,:�,�- �•.�:!, :�.. ^» ...';).( c.^,c =. < ; , c.�.s�, a��:w x�; �rtM :�.sr- .tas+a����;�G!a�.:rr ;'� ^f ts.., ^ .,r, I r,t� i I� p FORMATI N1)"s >''OG'ATLONr �' ': "',: `.';(' 'i'�` Heating/cooling 1', ,,,.. �).." c(: =., JOB S TE a. 2r, ;:,.,, _- =. ., ,,.N,, ;'Pi, >, Nfs:, g l R �j. /�' � Air conditioning or heat pump .j Job site address:, (�f (/l/ =�/ =? z (requires site plan showing placement) f 14.00 City/State/ZIP: fl - ( , il rei 0/ 9 7 23 Furnace 100,000 BTU (ducts /vents) 14.00 ` Furnace 100,000+ BTU (ducts /vents) 17.90 ' Suite/bldg. /apt. no.: v Project name: WE$T6ATe... 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 Flue /vent for any of above 10.00 Subdivision: I Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances . _' N , . r =�, ,� �' . �ee iiKi :.: ., �.; ...:,.;; i `I , a , ;, t3t~t'' : - ; •s^ ,, ; - fib;' Water heater 10.00 -, • „ , .,; e r rf a M : D ES�C RIP TIO N �OF"WO RK ^ 1" . s r r rk`,d <:r'"�:t • + <• aads^ r 3... n m ? « Y- C, » .:rra:ssact+.,+a;,: -i aa.. ,..:... . . , ` �e.,?.,.a "`;?,....",'','.:. , ,.:.);,^; Q (. Gas fireplace 10.00 G id. >r 4 / 1 / c' cJ ' iNf : eiyr� Flue vent for water heater or gas / fireplace 10.00 ..; 3 .a.,,/ .n / al t ti a . c t.1 V' to ed. Log lighter (gas) 10.00 ■ AuG 7+.9 e - A. + Fa a ,d "t-4„k. i Wood /pellet stove 10.00 ) 0 r e, 1/ J'0 ` _r / Wood fireplace /insert 10:00 = : yir . , PR O " ., ��� iii i ' Yo - . ; I]t : 'r<< ®°:t::! TENAN r . T > ,:-: ,: ; _ ; Chimney /liner /flue /vent 10.00 m i t N E R +, 4.rai tn s ' X ? Other: 10.00 Name: a e i . K 1 ra !4 1 G ( L.�/ - �i� Environmental exhaust and ventilation ,p p D Range hood /other kitchen Address: 1 2 / p / / s 6 G. 4 4 _,. �,� equipment 10.00 City/State/ZIP: i l S ,1 0 r I 1 2 � 3 Clothes dryer exhaust 10.00 'r` Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 r:' ;°" I u. : it -. s'. lar4 f N,s`.1 .` '° vv4; ,, ,<; ,? .:.> � ,,:r i�7;;H. N: Attic /crawls ace fans 10.00 a, i ,-`' a s ®APPLI . . " il 4 . ;,,. , i t a. ® . CO t'''* ,{ p Other: 1 0.00 Business name: Fuel to pip g C4gact name: $5.40 for first four; $1.00 for each additiona Furnace, etc. Address: Gas heat pump City/State /ZIP: - Wall /suspended /unit heater Phone: ("' ) Fax: : ( ) Water heater � J i 7 Fireplace E -mail: Range I , 1 � -e4 ! r' 6 ' I 'uaix , r," -., re F i R am . z O h ¢g tr = x <. `rt l .:r.!. x. �a7 , ,,v...� t COO N hail:,**,.., u.. " : , J;_.t � m ,,,,,,: 5 a . . , Barbecue Business name: f � . Clothes dryer (gas) h r- t r7 r 6� /t'`V'V f J i°v� % Other: Address: / 0 G 2 Z J'� I ' "a- °'` 1:M'EGH i,'i RMIT }FE'ES* : ' Ci /State /ZIP: _ Subtotal J0,3,4 , 5-11 ty D, 6 ri ' " C�� y 7 © Q � Minimum permit fee ($72.50) Phone: (S3) ;Ste 9a-* Fax: (s'j ?) 3 - 7/ 2 Plan review (25% of permit fee) z. 5/. 13 CCB lie.: / 3 ) • " - - 1 / Ee el ro 0 6 60 S y� State surcharge (8% of permit fee) 6 y, q L, TOTAL PERMIT FEE 1 3 B1 , SS Authorized signature: /� This permit application expires if a permit is not obtained within 180 gn ( ,�.iLiyv2. r-- L� / - 1" days after it has been accepted as complete. /4. r , r � . q e ix �r -- - -- Da te: 4 / 0 Y * Fee methodology set by Tri- County Building Industry Service Board r Print name: 7 ` i:\ Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: "1:01610110 , ., L41.,4 " :i att ; � erhnut Fee._ z $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 C.\j\ I $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. V )1 Note: All new commercial buildings require 2 sets of plans. > l a° 1 k, • 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 9 Received Date Requested l (? 704- AM PM BUP Location (07 3 © 5 CA) ( ° 'C Suite MEC - 6'06E Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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: i J/ Final 1 a?iP' PASS PART FAIL ( ft PLUMBING Post & Beam • Under Slab Rough -In 40 1 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 S • . - _Dampers .40 PART FAIL ICAL 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 for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL