Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00179
..� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/11/2004
PARCEL: 1 S136AD -04000
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: 1 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install exhaust hood & make -up air unit.$10,000 Valuation
Owner: FEES
SMITH, EDITA M Description Date Amount
833 NW 170TH DR [MECH] Permit Fee 5/11/200 $231.50
BEAVERTON, OR 97006 [MECPLN] Plan Rev 5/11/200 $57.88
[TAX] 8% State Surchart 5/11/200 $18.52
Phone: [MECPLN] Addi Pln Rv 5/11/200 $62.50
Contractor: Total $370.40
HOLLAND CUSTOM FABRICATION
PO BOX 318
DONALD, OR 97020 REQUIRED INSPECTIONS
Phone: 503 - 678 -3097 Mechanical Insp
Cooling Unt Insp
Reg #: LIC 91110 Hood Inspection
Duct Inspection
Final Inspection
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 -! : : 'ugh OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) 46 -6699.
By: / - ' _ / Permittee Signature: /Or
Issu =d B ;!; , ,
Call (5 1 - 639 -4175 by 7:00 P.M. for inspections needed the next business day
/ /3Y swP,cFA
Mechanical Per • ' ;� FOR OFFICE USE ONLY
C Received
City of Tigard �r- Date/ y/GQ/Oy Permit NOM - y ,
13125 SW Hall Blvd., Tigar , O 97223 Plan Review
``1i �1 0 / i,� R .Ni , „ ,tom G
� 7 ��! '13' 8 2UU4 �� j4glyK �l li\ Date/B . � - �/-Of ���
Phone: 503.639.4171 Fax: 503.59 Other Permit: � %� ®�Q� / QDr��� t w 1
Inspection Line: 503.639.4175 _24 f ,, V
ard.or.us Date ReadyReady/By: fur s: ®See Page 2 for \
Internet: www.ci.ti
g CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION � _
TYPE OF WORK COI141VIERCIAL. FEE *, SCHEDULE USE CHECIQ IST'
Mechanical permit fees* are based on the value of the work
❑ New construction IX] Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ /Or OOD
CATEGORY 'OF CONSTRUCTION - . _ _ : ,
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
❑ 1 - and 2- family dwelling i:i Commercial/industrial ❑ Accessory building
❑ Multi-family For special information use checklist.
y ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION ,: ,`.;' '' ' Heating/cooling
Job site address: I 1 6 $ J w '1 C- r `
h • Air conditioning or heat pump
L (requires site plan showing placement) 14.00
City/ State/ZIP: Q to Furnace 100,000 BTU (ducts/vents) 14.00
f �-/ Furnace 100,000+ BTU (ducts/vents) 17.90 (�
Suite/bldg./apt. no.: Project name: '4( -1 1/124 f-4- PIA/ Gas heat pump 14.00 " I
Cross street/directions to job site: Duct work 14.00 �J
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
Gas fireplace 10.00
7' 6 33 a-4-e- � /'�? Flue vent for water heater or gas
iivyhn.eM 7' / fireplace 10.00
pTn t?.vJ /1 2t 7 b Log lighter (gas) 10.00
�t 0 / ��lfi . A. fi & VA./ ./ r7/," Wood/pellet stove 10.00
o L /7 �^ �� _ D
r y' €' o , Wood fireplace /insert 10.00
✓7 . • Chimney/liner /flue/vent 10.00
' ❑,:PRO R TY OWNER KTENANT =
Other: 10.00
Name: 1 � - 4 �,�
�r lt pe5. 6 f Environmental exhaust and ventilation
Address: I (Go g 5'(A) (f If c.0(.4,-)-, equipment .1 10.00
City/State/ZIP: i a f t° (' Qe F 11 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ('$?') 7(39.. /2z 2_ Fax: (6z9 ci 7 r-7-2.75 toilet compartments, utility rooms) 6.80
. ' LVI APPLICANT • . ❑ CONTACT PERSON ' Attic /crawlspace fans 10.00
Other: 10.00
Business name: i
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 Barbecue
�` Ld G' - .. A� _ Clothes dryer (gas)
Business name:
, 't f i C", c ' Other:
Address: ' v( S I 014 w P, 0 . p‘ i t ? l . MECHANICAL PERMIT FEES*
City/State/ZIP: G 13, (di D(2, -? p 2 0 Subtotal 9.3/. SO
�r 3) g .3p Fax: (5'33 ) C -2 6- - 54/ 4 ( Minimum permit fee ($72.50)
Phone:
�" �o� l� Plan review (25% of permit fee) ,y �, 98
CCB lic.: 9%1,11064J 5: -05 State surcharge (8% of permit fee) / pi. fa-
%'�( TOTAL PERMIT FEE 707.90
Authorized signature: "7/1,,, (...1
expires if a permit is not �Z . S� p Dpt,
This permit application "sN
days after it has been accepted as cot G K
Print name: pi i k-e ltd I I /1-ry D Date: y/9 /in 11 • Fee methodology set by Tri- County Building Indu 3 70.
i:\Building \Permits \MEC- PermitApp.doc 12/03 440.4617T (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.
is\ Building \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING 1, Inspection Line: (503) 63 5
INSPECTION DIVISION Business Line: (503) 6 1 MST
BUP
Received _ Date equested AV?
Location BUP
Location / 7 S 3S G -' �� L Suite „P ? c /— Oa / 7
Contact Person /X2 Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner N ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: T /1-0dczi SIT
Post & Beam � / / / / ��
Shear Anchors �7 � G'
� ` .
Ext Sheath/Shear `�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL CAt
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS P T FAIL
ECHA L
Pos Beam
Rough -In
Gas Line
•
Smo_= Dampers
` �44 PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA � `
Approach/Sidewalk Date 0 1 Z ' / /4)si I nspecto r v "` Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL