Permit *), CITY OF TI LAID MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00150
8 "-1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/25/04
PARCEL: 25101 BB -01500
SITE ADDRESS: 12254 SW GARDEN PL BLD1
SUBDIVISION: CROW PARK 217 ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Mechanical TI, relocate ducts & grilles, add (1) restroom vent fan.
Project Value: $1,500
Owner: FEES
SPIEKER PROPERTIES LP Description Date Amount
4380 SW MACADAM AVE STE 100
PORTLAND, OR 97201 [MECH] Permit Fee 3/25/04 $72.50
[TAX] 8% State Surchaq 3/25/04 $5.80
Phone: Total $78.30
Contractor:
HUNTER DAVISSON INC
1800 SW PERSHING
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 234 - 0477 Mechanical Insp
Final Inspection
Reg #: LIC 01612
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other pplicable 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 : , , C�f�OC Permit S ignature: `
� �6
Call (503) 639 -4175 by 7:00 P.M. for inspections n- • • ed the next business day
Mecha anical Permit Application FOR OFFICE. USE ONLY ,
nical �� Received Mechanical V/
Date/By. y. ,5 Permit No G'e-OI oV-exY D
City of Planning Ap.roval - Building
`J Dr Tigard g DateBy Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
rtpol ' Date/By y Case No
r.
Internet: www.ci.tigard.ous 1 Contact Juris . ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 '""''- "' "'`
P q Name/Method. Supplemental Information.
TYPE OF_WORK COMMERCIAL FEE *: SCHEDULE - = ,USE'CHECKLIST'- : -'
❑ 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
' 'CATEGORY OF CONSTRUCTION. mechanical materials, equipment, labor, overhead and profit.
❑ ' 1 & 2- Family dwelling Ettommercial/Industrial Value: $ /5 -- See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family -- - RESIDENTIAL" EQUIPMENT /SYSTEMS:FEE *SCHEDULE
Description - Qty - Fee(ea.)- - Total --
❑ Master Builder ❑ Other: Heating/Cooling
- " JOB SITE INFORMATION 'and LOCATION - ' " `. Furnace - add - air conditioning ** 14.00
Job site address: %ZZCy S'i„J &,O'L 6,w 6(„ Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: - 7--EL Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14 00
/ -1411 .58/0 ,t/65er `tv .413 C 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
...-. " " DESCRIPTION.OF WORK . Gas fireplace 10 00
,/77i4 64-,/(tS Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10 00
Wood/Pellet stove 10 00
t/J%4 // ea , A) Wood fireplace /insert 10 00
Chimney/liner /flue /vent 10.00
`/PROPERTY_ OWNER. ° , .1:1,TENANT: --:.' r ., • : '' ,, .
Other 10.00
Name: - Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address:
City /State /Zip: Clothes dryer exhaust 10 00
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments, f
❑APPLICANT" , ,.. CONTACT`P1 RSON 7; utility rooms) 6.80
Name: T,tl-\I 1 M Lj Attic /crawl space fans 10.00
Address: f " Other: 10.00
�qNW l .! r 7✓> 7►1Z Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
E-mail: Gas heat pump **
Wall /suspended /unit heater **
', _ , . ` CONTRACTOR; :: :. , - : ' , Water heater **
Business Name: /-] p n -7 04-vii so ,J Fireplace **
Address: jkjy) Sc lWJ/fiti,r Range **
BBQ **
City /State /Zip: f%ttj OK 2262 Clothes dryer (gas) **
Phone: 93 t/ _G I/77 Fax: ,9J6 /6-? ( Other: **
CCB Lic. #: it Total.
Authorized Mechanical Permit Fees*
Signature- r- / Date - Subtotal: $
Minimum Permit Fee $72.50 $ 7 ' 5-15
'q-0o )/l .(d i—ft/ Plan Review Fee (25% of Permit Fee) $
(Please pnnt name) State Surcharge (8% of Permit Fee) $ 5. 6
TOTAL PERMIT FEE $ 7c( 7 j 0
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\Pemvt 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.
$1 0,001.00 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:.. 03) 639 -4175
INSPECTION DIVISION Business Lind: (503) 639 -4171 MST
BUP
Received � � / 8 Date Requested `y` 6 Z9 - AM PM BUP
Location /2- 2 P/ Suite d Cin « 7 / 5-0
Contact Person ,( 4 a.0 Ph (S7) '73 2/SZ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear -
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
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
ough -In
Gas Line
- ropers
1C 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: n Unable to inspect – no access
Aire Supply Line :/ / t '— ,l ,
ADA Approach /Sidewalk Date Inspector GI
..146r Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL