Permit CITY TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00019
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/17/04
PARCEL: 1S135DD-05102
SITE ADDRESS: 11993 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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: 75,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
. FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace rooftop unit. Project Value: $4,000 •
Owner: FEES
JEFF PAINE Description Date Amount
[MECH] Permit Fee 2/17/04 $118.50
[MECPLN] Plan Rev 2/17/04 $29.63
[TAX] 8% State Surchar€ 2/17/04 $9.48
Phone: Total $157.61
Contractor:
VAN AIR CONTROLS
13327 S GLENN DR.
MULINO, OR 97042 REQUIRED INSPECTIONS
Phone: 503 - 632 - 5991 Mechanical Insp
Final Inspection
Reg #: LIC 157864
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 qup tions OUNC by calling
(503)246 -66 i
Issued By: >QP \ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the rIxt business day
1(713 5 Itw
Mechanical Permit RE NIVED FOR OFFICE USE ONLY
City of Tigard Received 1 Permit No.:
� g 15 Date/By: ( I �� ,fi ` G. .�A� 0 •
13125 SW Hall Blvd., Tigard, OR 9722 N Plan Review Au
Phone: 503.639.4171 Fax: 503.598.1 • 200 ki ,0, a � ;rte Date/By: Z. .-1, /�f 5 Other Permit:
Inspection Line: 503.639.4175 tr l I Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us
QF TIa�nG/► � I� J` - Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, fpm t, labor, overhead, and profit.
I v
CATEGORY OF CONSTRUCTION ' Value: 14040. Op
RESIDENTIAL IP NT / SYSTEMS FEES*
❑ 1 - and 2 family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 \a 5 t u.), Pc t,L Aiquresste showing pump
(requires site plan showin placement) 14.00 $./\
City/State/ZIPr O \ O R ci 7Z,L3 Furnace 100,000 BTU (ducts/vents) 14.00
J l Furnace 100,000+ BTU (ducts/vents) 17.90
' Suite/bldg. /apt. no.: Project name: 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
ic) 14.00
Unit heaters heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above 10.00 f
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
1 Gas fireplace 10.00 9
i `4���� I `W .e c ` fs `�.-. to I4 A Au) Flue vent for water heater or gas
/f' y 1 ( (/ fy U J 1 Log lighter (gas) 10.00
0 // ��� fireplace
1 Wood /pellet stove 10.00
��( / , Wood fireplace/insert 10.00
10.00
�\\jjj Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: Oelem b. S- ne \ \y -?'4 Environmental exhaust and ventilation
Range hood /other kitchen
Address: eC 1s t 5,tx \ ( Ave equipment 10.00
City/State/ZIP: Ti 0 R 972:2-3 Clothes dryer exhaust 10.00
J Single -duct exhaust (bathrooms,
Phone: (503 a.5 3 -137 ( Fax: ( ) 54 e toilet compartments, utility rooms) , 6.80
❑ APPLICANT ❑ CONTACT PERSON , Attic /crawlspace fans 10.00
ij �`i L l� � - F 10.00
Business name: Fuel uel piping
Contact name: G( VAt) e $5.40 for first four; $1.00 for each additional
/ Furnace, etc.
i
Address: L3 3 2_ .5 e G � p t Gas heat pump
City/ State/ZIP: m ` < . R 3 0oi Z Wall /suspended/unitheater
Phone: (5'D� $ 4 c_(, 3 1 5 Fax: : LSQ�.633,4.- g( 2 Water heater
JJ Fireplace
E -mail: C Range
CONTRACTOR Barbecue
Business name: VAN A; 1 roNTRi, LS a c Clothes dryer (gas)
Other:
Address: ea MECHANICAL PERMIT FEES*
133a� S. �t M u,l,ry D
City /State/ZIP: Mu.11 lnA CA . 9 7 y L Subtotal ( 1 sD
Minimum permit fee ($72.50)
Phone: ( 503 ) 0 > 63
$y�l -,(� Fax: 3 3$& Z Pl an review (25% of permit fee) Z q ,
CCB li.: tl�t•_a � 7 g State surcharge (8% of permit fee) q .Y8
I s permt app on TOTAL PERMIT FEE J,p 7..6 (
ALLthor Si a ture: This expires if a permit Is not obtained within 180
gn days a fter it has been accepted as complete.
Print name:& - e5 VA n) u tine,yn,, Date: J_' 3 -024 • Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Perrnits\MECPennitApp.doc 12/07 440- 4617T(11 /07JCOM/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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i:\ Building \Permits\MEC- PemvtAPP.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50341
INSPECTION DIVISION Business Line: (503f 171 MST
3/ / BUP
Receivett �- 1 Date Requested 3 / J`O9 AM PM BUP
Location 11 v Suite al# — a9 1
Ph (
Contact Person i r a-�'�^ (�.3) 0 - 1 3 PLM
7�
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: r 1 -�' SIT
Post & Beam l_4
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear I 0 G 0 O — C7 v�_— 2/ WO W c/ I (ZY J
Framing + , /
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL / •
PLUMBING
Post & Beam
Under Slab
Rough -In 4
Water Service
Sanitary Sewer
WE
Rain Drains
Catch Basin / Manhole
grf , I
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
rna
PART FAIL
E RICAL
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 D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA J9 / - /�
Approach/Sidewalk Date / I nspector ` Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL