Permit CITY OF TIGARD
MECHANICAL PERMIT
1� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00683
s`�''` ..f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE I 1 136 004
PAARCRC : 1S136
SITE ADDRESS: 11535 SW PACIFIC HWY
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS: 7
Remarks: Gas piping for (7) commercial kitchen appliances.
Project Value:$500
Owner: FEES
SMITH, EDITA M Description Date Amount
833 NW 170TH DR [MECH] Permit Fee 10/15/20( $72.50
BEAVERTON, OR 97006 [MECPLN] Plan Rev 10/15/20( $18.13
[TAX] 8% State Surchart 10/15/20( $5.80
Phone: 503 245 - 1864 Total $96.43
Contractor:
ARJAE SHEET METAL CO INC
5510 SE MCLOUGHLIN BLVD.
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 231 - 1171 Gas Line Insp
Final Inspection
Reg #: LIC 60835
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. Th. rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rul: sr direct questions to OUNC by calling
(503)246 -6699. l�\
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t he next business day
O r �'
Mechani Al Perr{' fcati FOR OFFICE USE ONLY
City of Tigard " r% �� Date/By: /0 i3 6C/ Permit No.: fee,e1C/ _00 3
13125 SW Hall Blvd., Tigard, OR 97223 e�� =D Plan Review ��/
Phone: 503.639.4171 Fax: 503.598.1'960 �c 'i ey /40,110 „yyM I ' ;' Date/By: I U '� f if V ' / Other Permit:
Inspection Line: 503.639.4175 y ® �NV \ r - ' � 1
�� ■ �' Date Ready/By: pl7 S 7 See Page 2 for
Internet: www.ci.tigard.or.us ��� ®� N ed/Method: i(a Supplemental Information
1 44 .
' TYPE OF WORK •
COMMERCIAL FEE''. SCHEDULE= USE 'CHECKLIST
❑ New construction ddition/alteration/replacement Mechanical 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.
' - CATEGORY OF CONSTRUCTION _ "
Value: $ L a°°—
: : :- RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling t'Commercial/industrial ❑ Accessory building
❑ Multi family Master builder 0 Other: For special information use checklist.
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION • Heating/cooling
Job site address: C Air conditioning or heat pump
11 S 3 5 5t �O (-Uri (requires site plan showing placement) 14.00
City/ State/ZIP:
J O 1 - ?... Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU ( ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK. Water heater 10.00
a DE / C 7) ^ � 1 , , ( � t Gas fireplace gas
10.00
°� (. �"IM l y fireplace vent for water heater or as
( firepp lace 10.00
Ck.t.0 4..04-A"--4..SLA L) Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I T ENAN T Chimney/liner/flue/vent 10.00
` Other: 10.00
Name: 441/4.L fl.1 )1C '' 'i M . j OO� Environmental exhaust and ventilation
Address: if Range hood /other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) I Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: Ks\ 0) $5.40 for first four; $1.00 for each additional
Address: 1I�/ "/ Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: A (-4 S A/ c f , ' t Clothes dryer (gas)
/" Other:
Address: _ 0 S C 1�C 11St l� 1 t A 1 f a MECHANICAL PERMIT FEES*
City/ State/ZIP: 9 r-A lct,, S. 9nV-7L Subtotal
) Fax: 1 Z 3d Minimum permit fee ($72.50)
Phone: (
�j Z3 �7 I (t�j ) �g Plan review (25% of permit fee)
CCB lic.: G 0g35 / State surcharge (8% of permit fee)
�1/ TOTAL PERMIT FEE
Authorized signatu . This permi application expires if a permit is not obtained within 180
___
l days after it has been accepted as complete.
Print name: Age D►M, ,�24,3ko•: Date: (a — I3 — "=".' • Fee methodology set by Tri-County Building Industry Service Board
B \P
i:\uildingermits NEC- PermitApp.doc 12/03 _ U 440 (I 1 /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.
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639-4
MST
INSPECTION DIVISION Business Line:., (503) 63
BUP
Received _ Date equested / , 494? I PM BUP
S
Location J /S J A j Suite 7o V' Qe 6
Contact Person J t Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain p
Slab Inspection Notes: /)�S' f /�� 7 4 1 < SIT
Post & Beam n
Shear Anchors (�7 I n Z S.
Ext Sheath/Shear /
Int Sheath/Shear
Framing
Insulation UQ7 l 6 /\ a L ( a
Drywall Nailing
Firewall \re � •
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
PA • T FAIL
�0
Pos Beam
Rough -In
Gas Line
Sm� - Dampers
PART FAIL
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 El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
3 /
Approach/Sidewalk Date L7 / c/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL