Permit C ITY OF TIGARD MECHANICAL PERMIT
s l DEVELOPMENT SERVICES PERMIT #: MEC2003 -00347
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/15/03
PARCEL: 25111 CD -00300
SITE ADDRESS: 15750 SW 98TH AVE ADM. BLDG.
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 240,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 2 <= 10000 cfm: 4 OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 2
Remarks: Mechanical work for new administration building.
Owner: FEES
TIGARD CHURCH OF GOD Description Date Amount
15670 SW 98TH AVENUE
TIGARD, OR 97223 [MECH] Permit Fee 12/15/03 $72.50
[MECPLN] Plan Rev 12/15/03 $18.13
[TAX] 8% StateTax 12/15/03 $5.80
Phone: Total $96.43
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line lnsp
Mechanical Insp
Reg #: Heating Unt lnsp
Cooling Unt Insp
Duct 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 -00
•
Issued By: r L Permittee Signatur°
Call (503) 639 -4175 by 7:00 P.M. for inspections n- : ded the next business day
Mechanical Perit Application FOR OFFICE USE ONLY
Received � / Mechanical _
.,. Date/By: y: -A-I-03 -0 ? Permit No. d)EC‘.-VD3 — ta I/ 7
City of Tigard Planning Approval Building
,1 y: Permit No.:
13125 SW Hall Blvd. ' ` Plan.Review Other
Tigard, Oregon 97223 ' - ' 'I `'bateBy:7 -2 9.03 / 8S ¢ Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - evie
Land Use
Ga��E�di(yi�ij�' + �; ,t oDate Case No.:
Internet: www.ci.tigard.or.us :
�� ` 1 1 ( Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 �e e Y O t= -- Name /Method: Supplemental Information.
- - C.- .tti1V
Z t : ,.'..,; -fief . ' a , TYPE N , , .: .-., -,.; ., ' -V. ,;C,QMMERCIAL FEE* S,CHEDLTLE IJSE CRECKLIS ' ,ii
®'New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: . performed. Indicate the value (rounded to the nearest dollar) of all
Rk� � _ r ; V : C�ATEG®RYO ONSTRTJC
: �TIbN_ mechanical materials ' equipment, labor, overhead and profit.
_ �� ��" i � „�
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ 13, CO D See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family ';, RESIDENT>'AL EQUIPMENT /SYS,TEMs, IEEE *xSCHEntatE
.f,.
Description I Qty I Fee(ea.) I Total
El Master Builder C!}l
Other: 42Gr( -. . ., . -:- Heating/Cooling � . .,:� = ,iu;; :':;;._. `'
Zin ~; 1) STI'EOTPLO, lYIATION and,L®CU ON MN Furnace - add -on air conditioning** 14.00 Z
Job site address: +56740 5W 9eRf Gas heat pump 14.00 0
Suite #: — \Pk4). Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system • 14.00
J A fiM I/�((r�{ /Ili ®(.iFi 1 Residential boiler
Cross street/Directions to job site: O
�mp ��' (for radiator or hydronic system) 14.00
L Ai■Jb /13171 bar” • Unit heaters (fuel, not electric)
r v � (in wall,'in -duct, suspended, etc.) 14.00
f t N Flue /vent (for any of above) 10.00 Z-
Repair units 12.15 —
Subdivision: - ° <
Lot #: — : .Othe t 7
�7 11 00 3 OD Water heater 10.00
Tax map /parcel #: Z
marmai ,t DESCRIi Ri tiomORK& / ,,, ;gym# Gas fireplace 10.00 0
A- N r12 j� Of� 2 � 115 5 Flue vent (water heater /gas fireplace) 10.00 z
APWA i if4f /V effi . NAZV ik 1 Log lighter (gas) 10.00 0
n l �Ut M bat Wood ce /in 10.00 O
Wood fireplace /insert 10.00 Q
#4 PIT„ '410.4141.0 � Oth
Chimney/liner/flue/vent mental ha hlatm10`00 ^
Name: Ilfi,4 Z alma! ! op kip .e; ' , , a . E "'lironr Ez ial i6Si `n. s x,
g bv Su J ovi ' veiti / Range hood/other kitchen equipment 10.00
Address: Y r u
Clothes dryer exhaust 10.00 D
City /State /Zip: fli OJT 972,74 / Single duct exhaust
Phone: 50- (034"11;00 Fax CjDa3- /03 -/ 3$ (bathrooms, toilet compartments,
]`CAI'KTGAN #T ,. A ;. `,IM„°' Z.' CO.NTACT PERSONN.O : utility rooms) 6.80 Z.
' Name: `yJ -I , mi y � f µ ja A... Attic /crawl space fans 10.00 2
Other: 10.00 —
Address: iQ 14w ?IjLLMAi) Sarg. Zo/ . __., r ...i' '1Fuel+Pipiiiii ": _i- ;;` m uN?RA— -� ;
City /State /Zip: iliela 0 b g. 47 72 Pik) * *(55.40 for first 4, $1.00 each additional)
Phone: CjQ•j -a Z - Fax: 40 • az- - P7(o0 Furnace, etc. ** y
E-mail: c ylkl e.r ZALk.m,/'Lr. 440131 Gas /sus nde d/unitheate( ** p
f **
, � t a , Wall /suspende > MwF = := :"e >}F`.. CONTRACTOR' .` ` y t'h ** A
��t�M�`Qi�V�!i Water heater
Business Name: OLD )1 E-C . , Fireplace ** n
Address: - — -Range . ** el
City /State /Gip: _ ___�_ Clothes otthes dryer (gas) ** 0
Phone: Fax: Other: ** --
CCB Lic. #: Total:
,- Mechanic Permit` F ees* ;-- Authorized • . Z 3 r Signature: Date: l' l.3 G3
Minimum Pert �Z , j d ✓ds1• ? Plan Review Fee (25% oe) / fj , / 3
(Please print name) . State Surcharge (8% of Permit Fee) $ s $ 0
TOTAL PERMIT FEE $ 4.4./3
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry geryice Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:.. .
.Tot`a1Valu
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or •
fraction thereof. •
AssuedCValuations Pcr<.Appliar"" w .. ; ' ; ,.., . ,•' tea;. ;,�
Value Total
Description: Qty (Ea) Amount .
Furnace to 100,000 BTU, including 955 -
ducts & vents
Furnace > 100,000 BTU including ducts 1,170 J 1 cf, 0—
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
3 hp; absorb. unit,
t 955 / 9/0 ..
to 100k BTU
3 -15 hp; absorb. unit, 1,700 •
101k to 500k BTU •
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 •
BTU
30 -50 hp; 'absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 .
i
Air mil. BTU n�� lL
Air handling unit to 10,000 cfm 656 G
Air handling unit >10,000 cfm 1,170 •
Non - portable evaporate cooler 656 . •
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust _ 656
Domestic incinerator 1,170 • •
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1 -4 outlets ( 360 '
Each additional outlet 63
TOTAL COMMERCIAL.`` $ T 2�3� •
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST / �����
1 � ' o 2�S i/ BUP �' -
Received Date Requested AM PM BU
Location �� S� / Suite MEC - 2 b 6 - 3 — 34_17
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner :, : ELC
•
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain 0
Slab Inspection Notes:
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler er ; !;r
Fire Alarm ® {1 •
Susp'd Ceiling — L e ���
Roof
Other:
Final _
PASS PART FAIL ,, ,• � � �.
PLUMBING G i ' }
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
ropers
PART FAIL
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 Please call '•r reins. -ction RE: Unable o insect — no access
Fire
ADA Supply Line f ,
Approach/Sidewalk Date Inspector tW �
�
Other:
DO N • T REMOVE this inspection record from the Job site.
?IQ PART FAIL