Permit CITY TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00588
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/1/2008
PARCEL: 1 S126DC -04400
SITE ADDRESS: 09430 SW CORAL ST ZONING: C -P
SUBDIVISION: LEHMANN ACRE TRACT LOT: 007 JURISDICTION: TIG
PROJECT: MARTIN OFFICE BUILDING
Project Description: Installing gas line for outdoor generator.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
MARTIN, ROBERT CLARE Description Date Amount
THELMA M
BY JO RENE M MOODHE [MECH] Permit Fee 12/1/2001: $62.50
SHERWOOD, OR 97140 [TAX] 12% State Surch 12/1/200f $7.50
Phone: Total $70.00
„Contractor:
COREYCO CONSTRUCTION INC
- 1' PO BOX 3173
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 734 -7975
FAX 503- 650 -3278
Reg #: LIC 157976
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 or 1.800.332.2344.
Issued By: / % /�. Permittee Signature: /
ofr
Call 5 •.4175 by 7:00 a.m. for inspections that busines ay.
This permit card shall be kept in a conspicuous place on the job site u ' completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Date /By � U r �� Permit No.:
-.. 13125 SW Hall Blvd., Tigard, OR 97 _ ' __ ' �'
'
Plan Review
lig
Phone: 503.639.4171 Fax: 503.598. !.s. d, v Date By: Other Permit: .1 . _if I GA RD Inspection Line: 503.639 4175 0 4 �0� Date Ready /By: — � runs See Page 2 for
Internet: www.tigard- or.gov O C , , Notified /Method. / 6 Supplemental Information
' ' ° O 1 9. 1 P ea01 1 -
'TYPE WO G ` Q � � � � N...-. - COMMERCIAL F *. SCHEDULE — USE CHECKLIST
❑ New construction Addition /altera,tsi i • a cement M echanical 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
- '"_ '� _ "F "CATEGORY OT„ CONSTRUCTION ' _ , Value: $ / 700
RESIDENTIAL EQUIPMENT /SYSTEMSPEES*-
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
Master builder For special information use checklist.
Multi -famil
❑ Multi-family ❑ ❑Other: Description Qty. Ea. Total
"'' " :. -', , : - ' SITE. , '-INFORMATION .AND. LOCATION : _ Heating/cooling
Job site address: Air conditioning or heat pump
3 S Ca 5 (requires site plan showing placement) 14.00
City /State /ZIP: -q D k G 7 � 7 3 Furnace 100,000 BTU (ducts /vents) 14.00
6 Fumace 100,000+ BTU ( ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: I n a w '� �i y �
1 / r Gas heat pump 14.00
Cross street/directions to job site: (5---r� -Z a (/ F9 ( -0-14 S Duct work 10.00
v Hydronic hot water system 14 00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, to -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
, , ` " : DESCRIPTION WORK; • . , ` . - Water heater 10.00
' Gas fireplace 10.00
��,� r� Co vea 64.5 14 Flue vent for water heater or gas
` fireplace 10.00
't
0 ti L -/ ..C 4- rq (D ice. -- Log lighter (gas) 10.00
P r--e- S,5Vrc ee.5 Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
' ❑' PROPERTY .OWNER ' , _ ' El TENANT. ,
Other: 10.00
4 4 t Name: t2 r 1 % h ' � V ,- (c Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust • 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
S:1 APPLICANT - ❑ CONTACT PERSON ' ' - . Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
- CONTRACTOR " . ,, U ' Barbecue
f
Business name: /' Clothes dryer (gas)
p c /G ® (�,,.. cd Other:
Address: 17 /'� Lf 4 S „L _MECHANICAL PERMIT FEES*.
City /State /ZIP: 0 R . C e' 6y �) q -rrq Subtotal
J ✓✓ 8-
Minimum permit fee ($72.50) (
Phone: (f 3If _. 7175 Fax: (erR) 6c 7 Plan review (25% of permit fee)
�/
CCB lic.: ! L. 7 l ` ' _// </ State surcharge (12% of permit fee) 7
JJ ! / / „D TOTAL PERMIT FEE �f j,w
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: re , .7 Date ■ A o * Fee methodology set by Tri- County Building Industry Service Board
r _
IABuilding \PermitsVv1EC- PermtApp oc 01/19/07 441 4617T 11 /02 /COM/WEB)
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.
$100,000.01 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.
•
•
1: \Building \Perniits\MEC - PermitApp doc 01/19/07 2
CITY OF TIGARD
. , 1
BUILDING DIVISION PERMIT #: MEC2008-00588 I
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639-4171
halo DATE ISSUED: 12/1/2006
Inspection Requests (24 Hrs.): (503) 639-4175 .., AL .
INSPECTION WORKSHEET FOR DATE: 12/4/2008 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 09430 SW CORAL s-r CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 007 TYPE OF USE:
PROJECT NAME: MARTIN OFFICE BUILDING
DESCRIPTION: Installing as line for outdoor generator,
OWNER: MARTIN, ROBERT CLARE, PHONE #:
CONTRACTOR: COREYCO CONSTRUCTION INC PHONE #: 5034347975
Inspection Request Scheduled For: Date: 12/4/2006 Pour Time:
Code '# Inspection Description Confirm # Contact # Message •
699 Mechanical final 07878&01 603-734-7975 N
Corrections/Comments/Instructions:
t
4- Alk
1.
AC' /
PARTIAL APPROVAL n CANCEL pi NO ACCESS
I FAIL I ALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ------- Date: /Z ' Phone #: (503) 718-
2
. ,
_ ,
r .
CITY OF TIGARD
BUILDING DIVISION i - PERMIT #: MEC2008-00588
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1/2008
Phone: (503) 639-4171 a&g_ tfilgtii it
Inspection Requests (24 Hrs.): (503) 639-4175 M. IL
INSPECTION WORKSHEET FOR DATE: 12/2/2008 TIME: 7 PAGE: 16
SITE ADDRESS: 09430 SW CORAL ST CLASS OF WORK:
SUBDIVISION: LFI-11vIANN ACRE TRACT LOT #: 007 TYPE OF USE:
PROJECT NAME: MARTIN OFFICE BUILDING
DESCRIPTION: Installing gas line for outdoor generator.
OWNER: MARTIN, ROBERT CLARE, PHONE #:
CONTRACTOR: CORFYCO CONSTRUCTION INC PHONE #: 503J347975
inspection Request Scheduled For: Date: 12/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 078680-01 603-734-7975 N
Corrections/Comments/Instructions:
/ /0 - I — K 61tq' ' 4
......
.7
a--0 pi I do .
0 0 .
A.-.
- 111 PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
0' FA / EI CALL FOR INSPECTION
11]
ADDITIONAL FEES ASSESSED
.
Inspector: Date: (1-71— Phone #: (503) 718-W
-----.,
. -
08/08/2008 12:59 FAX 4257412500 NITROR INC R1001
�/l c //?C. • Medical Glues • Medical Gas Line Verifications • Analgesia Equipment
Verification Report
Inspector of Record
FAX 4h_
From: B. }Ivan McAllister
- "(1 - 0 k7N-
To: l I j' ` CU (7 S
Of: �'� n-fi e i m b j ► "`-' '
Fax: 5c' 1 . �R.�i 9 51
Date:
This fax is to confirm testing has been performed at the
following facility:
Facility: De- n ark m0 `P(L
Address 2 4 30 CD .1
City, State: 1. r 4 1(3&
Test Date A +7 - 1) _ Hospital _ , Dent] , Level I le ircie one
Medical Gases: Oxygen , Nitrous oxide 'I( _, Medical air _, Nitrogen,
VacuumA , Dental Air , Dental Vacuum . Other
Test completed
Interim Report or Completed passed per NFPA.
If co leted final report to follow in seven to ten working days.
ci e Yt 4'1, n tic )U °r` VC ` new co ea
$, j. %' +. �_.. • :;c- 3"rRTT, CMGV
Aamcrtempreport
2706 164th Street S.W.. Lynnwood, WA. 98037
(425) 7414807 • 1. 800 - 736.7047 g Fax: (425) 741 -2500
- d .17TS6E8 9NIHWl1d 3QH3Sd0 Wd80:2 8002 80 2nd