Permit •
.er
C ITY OF TIGARD MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2003 -00087
13125 SW Hall Blvd., Tigard, OR 9 7223 (503) 639 -4171 DATE ISSUED: 3/13/03
PARCEL: 1S136DB-00201
SITE ADDRESS: 11571 SW PACIFIC HWY •
SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 2
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 tenant improvement, installation of (2) bath fans.
Owner: FEES
WILMINGTON TRUST CO, TRUSTEE Description Date Amount
BY FRED MEYER, INC
3800 SE 22ND AVE [MECH] Permit Fee 3/13/03 $72.50
PORTLAND, OR 97242 [TAX] 8% StateTax 3/13/03 $5.80
Phone: Total $78.30
Contractor:
GEORGE STEWART
DBA STEWKO
8644 SW RAVINE REQUIRED INSPECTIONS
BEAVERTON, OR 97007
Phone: 503 - 702 -7071 Mechanical Insp
Final Inspection
Reg #: LIC 92040
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 -00
r4
Issues By: , � ._�� - ,� � 14+ I Permittee Signature: i / % � �y '
- - - i
Call (503) ' 9-4175 by 7:00 P.M. for inspections neede ' the next business day
5 ' FOR OFFICE USE ONLY
Mechanical ermit Application Received 7 Mechanical ,,,�,p
Date/By: 7 � Permit No.: N 4J 2 2
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
O ` _ g . _ DO �y
M �i
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 4 „ , , , F � {\ Date/By: Post - Review Land Use Case No.:
Internet: www.ci.tigard.or.us ■ �.f I Contact Juyse. ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: /(2 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
[iPAddition/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 124)Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: / /5 7) S Le../ PrIc i,,c /la-y Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
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
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER I ('TENANT Other: _ 10.00
Name: s�u,.� Environmental Exhaust & Ventilation
�� Range hood/other kitchen equipment 10.00
Address: //5 7/ St4/ )` /7/,i", Clothes dryer exhaust 10.00
City /State /Zip: 54 ..1_ eV '777- Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments, a /, 6O
❑ APPLICANT AONTACT PERSON utility rooms) 6.80
Attic/crawl space fans 10.00
Name: 6-7 1 / Other: 1 0.00 _
Address: 6/ 6L.c) //./9 Fuel Piping
City/State /Zip: I 5 77 * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone03 byy obS)` I Fax: **
Gas heat pump
E -mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: 15!2/25V -g 72c.P
Fireplace * *
Address: '3-'6, y .SGr 12/ft/ /NF Range •*
BBQ **
City /State /Zip: ,4c—e".) t 9fL 97 Clothes dryer (gas) **
Phone:5O3 70 2-70 Fax Other: **
CCB Lic. #: a p 4 Li / .5 Total:
Mechanical Permit Fees*
Authorized Subtotal: $
Signature: Date: fj b3 Minimum Permit Fee $72.50 $ 76( .. 0
5 772.einro.eArpE Plan Review Fee (25% of Permit Fee) $
(Ple iSrint name) State Surcharge (8% of Permit Fee) $ 5. SO
TOTAL PERMIT FEE $ '7 g , A O
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\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard e, = Ito' •
Page 2 - Supplemental Information
Commercial Fee Schedule:
•
Total Valuation: Permit Fee:
$1.00 to $5,000.00 ° ' ' Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
•
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
•
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 •
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
i:\Dsts\Permit Forms \MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION.. Business Line: (503) 639 -4171 BUP 3 - O0 '27
Received Date Requested —0-1 AM PM BUP
Location / S 71 Suite 40 2003 —00,7 g 7
Contact Person = Ph ( ) /d 7 71 PLM
Contractor Ph ( ) SWR
�@UILDIN Tenant/Owner ELC
0o ing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation /-e G7-iC C L w ci�.�
Drywall Nailing Q 1/z Z /O) C ui /�C�/cs S O �-e it
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Oti =r:
'ART FAIL
• I.; :ING
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
Rough -In
Gas Line
Smoke Dampers
Final
PASS 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: Unable to inspect — no access
Fire Supply Line
ADA / /2 //e2 _3 Inspector Ext
Approach/Sidewalk Date p
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•