Permit j CITY OF TIGARD MECHANICAL PERMIT
j DEVELOPMENT SERVICES PERMIT #: MEC2004 00056
DATE ISSUED: 2/11/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102AD -01100
SITE ADDRESS: 08845 SW COMMERCIAL ST
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 1 <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: New rooftop HVAC and gas piping. Value: $12,000
Owner: FEES
BIRKEMEIER, BRENT T AND Description Date Amount
JANET D TRUSTEES
10573 SW NAEVE ST [MECPLN] Plan Rev 2/11/04 $64.63
TIGARD, OR 97224 [TAX] 8% State 2/11/04 $20.68
[MECH] Permit Fee 2/11/04 $237.82
Phone: Total $323.13
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 -6911 Gas Line Insp
Mechanical Insp
Reg #: LIC 38868 Duct Inspection
Misc. 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. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 - 6699. �/�
Issued By: Ay _ L , %%L, -_ Permittee Signature:K ,.,�^
( Call (503) 639 -4175 by 7:00 P.M. for inspections needed a negbusiness day
Mechanical Permit Application FOR OFFICE USE ONLY
��y : Rece -, Mechanical
p Date/ByC' I (_0 Li e 6 Permit No. m CG ..c / - C2 OO 5..(=P
City f Tigard Planning Approval Building
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Other
Tigard, Oregon 97223 Date/By:I - /t -0/85 Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us I fI Date /By:
2 Contact Case No.:
Juris.: ® See Page _ for
24 -hour Inspection Request: 503 -639 -4175 Name/Method Supplemental Information.
.....a° , 4 ' ,, :TYPE';OF,AVORIC ° ; ,: :c. . < .. . .:, '„,COMMERCI'ALATEE *:SCHEDUEEG r R
USECHECKI;IST�� :�;,, -
❑ 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
y, _
7 �'���:_ �, - <, �, �"= �CATEGORI' kUFr'CiDNSTR [JCTION =A*4:%s. mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling El i Commercial/Industrial Value: $ Oda See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDE IAL; EQUIPMENT /SYSTEMS.°FEE' S'CHEDULE
Description I Qty Fee(ea.) Total
❑ Master Builder ❑ Other: Heating/Cooling
,, ;:" -- z.": ?JOB ;SITEtINFOHNIATION" and = LOCATION " ° ;�l" ` `> Furnace - add - air conditioning ** 14.00
Job site address: g' S-4/ 5 w Co)t!/i/F.-7tCGi 14 Sf Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: G,4 e Lopfe� Hydronic hot water system 14.00
Residential boiler
Cross sheet/Directions to job site:
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.)' 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
'' ; a , . 7 "'' :fiDESCRIPTTION.10 -F W RIZ . , ,;``
- � - Q w - �� "�`� �� „ 0 Gas fireplace 10.00
!.. ' ., , S 7(77'1 t..4,,,i /�L/ G... Flue vent (water heater /gas fireplace) 10.00
4 - -� 5 P ) f i N / Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
.. }PROPERTY OWNE1 r'' " ;;;.Ir: MI IENANTs^ i, '.,' = -' * °' ',':° Other: 10.00
Name: SAC •
4.E ,e O l ` Environmental Exhaust & Ventilation
T T Range hood/other kitchen equipment 10.00
Address: .
City/State/Zip: Clothes dryer exhaust 10.00
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
to PPI:ICANT: ,:'' _.- ® CONTACT °PERSON >s " /- J utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
Gas heat pump **
E-mail: Wall /suspended/unit heater **
":i .';',ti,._ _ ° , ': "CONTRACTOR.; -- `' *= ' �, : � .. Water heater **
`-���' :
._ �.r,_ . .... .. - ....
Business Name: ��iC P Fireplace **
Address: 9 7 $ 7,. . / 7'k AvC Range **
City /State /Zip: P n ,4,,, ' k. cis 7aa,2 Clothes dryer (gas) **
Phone: .55,3. ays .e..9 // Fax:S - ,„zy, •9 7e. 7 Other: **
0
CCB Lic. #: 3g Total:
Authorized �J Mechanical Permit Fees*
Signature: c��o`9 Date: // i O Subtotal: $ D...31.,
_____57__ Minimum Permit Fee $72.50 $
J � A4- Plan Review Fee (25% of Permit Fee) $ 1�' . to 3
< (Please print name) State Surcharge (8% of Permit Fee) $ =0. lea 5
TOTAL PERMIT FEE $ 3 . :,-"N
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service 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: •
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.
$100,001.00 and up $1,396.50 for the first $100,000.000 and • • " . . ' •
$1.10 for each additional $100.00 or fraction
thereof. • . .
All New Commercial Buildings require 2 sets of plans.
•
i:\Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requ-sted __ AM PM BUP
Location _ _ , i _ Suited d S6
Contact Person Ph ( ) • LM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation / arg - Q -7431id s 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 ART FAIL
HANICALT
P eam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL -
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 .2 / ! 7 / r7 I - r Inspector Ext
Approach /Sidewalk Date I
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL