Permit . '
C ITY OF TIGARD MECHANICAL PERMIT
4 111 ‘1 4, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00249
;4 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/3/2004
PARCEL: EL: 1 1 513 S135AB -00100
SITE ADDRESS: 10350 SW LINCOLN ST
SUBDIVISION: TOWN OF METZGER ZONING: R-4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: El VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 DOMES. INCIN:
ELE 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: 2 GAS OUTLETS:
> 10000 cfm:
Remarks: Refrigeration equipment.
Project Value: $4800.00
Owner: FEES
WASHINGTON CLACKAMAS CO Description Date Amount
SCHOOL DIST 23J [MECH] Permit Fee 6/3/2004 $136.90
6960 SW SANDBURG STREET [MECPLN] Plan Rev 6/3/2004 $34.23
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/3/2004 $10.95
Phone: Total $182.08
Contractor:
COMMERCIAL REFRIGERATION INC
5920 SE GLISAN STREET
PORTLAND, OR 972133790 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
hone: 234 -6445
Final Inspection
Reg #: LIC 65271
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules ar- set forth in OAR
952 -001 se : : •h OAR 952 -001 -0100. You may obtain copies of these rules or • -ct it estions to OUNC by calling
(503) , 6 -6699.
I
Issue; By: • l . � ._ _ /1; j Permittee Signature: i MVAA
Call (503 .39 -4175 by 7:00 P.M. for inspections needed t • 4 ° u s day
iP tfite g5
Mechanical Permit Application
Date received (0 y Permit no.:T�+ C 0t/- -Gvd^
City of Ti C E I V E D
- • g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW HO k]vd, T L gaZ� 97223 Date issued: By$ I Receipt no.:
Phone: (503) 639 -417 AT
Fax: (503) 598 -1960 Case file no.: Payment type:
ITY OF TIGARD Building permit no.:
Land use appro ILDIPIG DIVISION Building .5 P IT
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory prc 0 Multi - family 0 Tenant improvement
❑ New construction 0 Addition/alteration /replacement ❑ Other: XI
JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE
. Job address: t z) 3 S) SGJ Li i(Jc ST Indicate equipment quantities in boxes below. Indicate the dollar Q
Bldg. no.: I Suite no.: value of all mechanical materi s, equipment, labor, overhead,
. Tax map /tax lot/account no.: profit. Value $ L/1 you .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: p. E_Tx.aPG 62"- • jC Weld . jurisdiction's fee schedule for residential permit fee.
City/county: - 'fjQ p I ZIP: 9 2-.? i& 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises?Z#05144C, AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE 1.
,VA&Il2/t.!!� C (J ))� QLL,t(p PI 42 a r A_ (4) AU:. ' S'.f/S 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
Ali conditioning ng plan required)
N k L
Is existing space insulated? 0 Yes ❑ No Alteration of f existing HVAC system
• MECHANICAL CONTRACTOR , Bo, er compressors
Business name: Co &i lM e a.ci 4 c, Pare,,425 ostei � State boiler permit no.:
� HP Tons BTU/H c: t
Address: 5 2.0 /USE i Fire /smokedampers/duct smoke detectors
Ci ty: O Mr State: on_ ZIP: Q 72_43 Heat pump (site plan required)
'ma-
Phone: 2_3(4 - Ke-/ s- I Fax:33U•04 Gr1 E -mail: Install/replace furnace burner BTU /H
n Including ductwork/vent liner 0 Yes 0 No
CCB no.: O (7 S /--� / Install/replace/relocateheaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): , eft n c !t c c Kic 4 c e14'1 Vent for appliance other than furnace
. I` CONTACT PERSON Refrigeration: .-
Absorption units BTU/H
Name: 9 A /‘'t f) , Pr S Avr v Chillers HP
Com ressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type If 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
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel pi ip ng each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: C Fax: E -mall: Woodstove/pelletstove
Other:
Applicant's signature: fie Date:5=6-OS/ Other:
g'
Name (print): / L Gj 2.0i('C!t. G
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /3�
0 Visa ❑MasterCard Notice: This permit application Minimum fee $ •
Credit card number: / / expires if a permit is not obtained Plan review (at Z s %) $ — .W 72. , 24 ,
Expires within 180 days after it has been State surcharge (8 %) $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ O
Cardholder signature Amount 440-4617 (6/00 /COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: - Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qh (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to.500k BTU 16) Ventilation system not included in
-
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. B ... 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, . 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
is \dsts \forms\rnech- fees.doc 10/11/00
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION 'DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested f� 7 -1 AM PM BUP ,/
Location Z U 3S0 &-. I (el &'Y -' Suite MEC °19 - d act
Contact Person 9ellAr Ph ( ) 3 � y 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 - Fec -- Ct�r T erk.)
Framing /
Insulation / tl 0 J a46__ss l ()� iC (�� r Drywall Nailing 6lJ / l
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab Ifwo 1
Rough -In
Water Service r` �•
Sanitary Sewer !,
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In ✓�
Gas Line
- Pampers
W O PART FAIL
RICAL
Service
Rough-In � i �
Low Voltage � �- ■��C-,�
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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL