Permit C ITY OF TIGARD MECHANICAL PERMIT
I I + DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00507
� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/03
PARCEL: 1S135AB-01002
SITE ADDRESS: 10220 SW GREENBURG RD 350
SUBDIVISION: THREE LINCOLN -TOWN OF METZGER ZONING: R -12
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Tenant Improvement - add (1) fan powered VAV box $2500 valuation
Owner: FEES
EOP LINCOLN LLC Description Date Amount
10260 SW GREENBURG RD
SUITE 100 [MECH] Permit Fee 8/19/03 $72.50
PORTLAND, OR 97223 [TAX] 8% StateTax 8/19/03 $5.80
Total $78.30
Phone:
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Phone: 331 - 0234 Final Inspection
Reg #: LIC 40981
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 qu stions to OUNC by calling
(503)246 -6699.
Issued By: Permittee Signature:
Call (503) 39 -4175 by 7:00 P.M. for inspections needed t ' e n ° xt busine - ) day
. - L
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Mechanical Permit Application
OFFICE USE ONLY
Date received:? (' 0 3 Permit no i 41) ,
� J1 City of Tigard Pro ect/a I no.:■ Ex ire date: J O
Cit o Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Y f Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: •
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ra ant improvement
❑ New construction ❑ Addition /alteration /replacement ❑ Other:
JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE
Job address: 10z2.0 5 w (- I3 q?,E, Qb Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: 3 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ ZS .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: F'V 50■_)(2 jurisdiction's fee schedule for residential permit fee.
City /county: TL/'&J > I ZIP: 9 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: ik Lt) AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
FAA) () \/ Eck Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
space insulated? ❑Yes ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
-- ' MECHANICAL' : CONTRACTOR - - - Boiler /compressors
Business name: 14 Ck-LkISTiLki CO . State boiler permit no.:
HP Tons BTU /H
Address: 5 NO COWIA13 I!.s 13LVp Fire /smoke dampers /duct smoke detectors
City: 'PD .TL_RAJD I State: ZIP: 9 - /yi 0 Heat pump (site plan required)
Phone: 331.0Z'y I Fax: 31.( Oc , E -mail: Install /replace furnace /burner BTU /H
Including ductwork/vent liner ❑ Yes O No
CCB no.: .-4Qt 951 Install /replace /relocate heaters — suspended,
City /metro lie. no.: ( I`7q wall, or floor mounted
Name (please print): C L F I-EftJ Vent for appliance other than furnace
CONTACT PERSON . Refrigeration:
Absorption units BTU /H
Name: CLl F I-EArZe J Chillers HP
Address: (V e COLUI.k@ \ gLV D Compressors HP
Environmental exhaust and ventilation:
City: POI r_/SD I State: bbl ZIP: 7L1 S Appliance vent
Phone: 33 I. 02 Fax: 3 /ofi0 E -mail: Dryer exhaust
OW Hoods, Type I/ II/res. kitchen /hazmat
hood fire suppression system —
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: I State: IZIP: Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: I Fax: I E -mail: Woodstove /pellet stove
Other: NSTht(L (I ) t/ V L F PB_) I
Applicant's signature:a ''.i�T Date: 8.18'D� ' Other:
Name (print):.�I Ff-I-F hl
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been e $
State surcharge (8%) ..
Name of cardholder as shown on credit card accepted as complete. TOTAL $
` Cardholder signature Amount
440 -4617 (6 /00 /COM)
CITY OF TIGARD 24 -Hour
BUILD,NG Inspection Line: (503) 6 9 -4175
INSPECTION DIVISION Business Line: (50 6 417 MST
� BUP
Received Date Requested 1a AM PM BUP
Location / a-o �v b A- {� P4' Suite 3 50 005 7
Contact Person /' �- Ph ( ) 3 £& ` DS 3 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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam t
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
SI oke Dampers
•`• SS PART FAIL
E CTRICAL
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: 111 Unable to inspect — no access
Fire Supply Line
ADA n r /
Approach /Sidewalk
Date 7 i `�/ � � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL