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Permit • - tt CITY TIGARD MECHANICAL PERMIT PERMIT #: MEC2004 -00032 r'II - 13125 DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 1/27/04 PARCEL: 2S 102 B D -00100 SITE ADDRESS: 12645 SW PACIFIC HWY SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: R -12 BLOCK: LOT: 052 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: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 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: 2 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace (2) gas furnaces. Owner: FEES ROMAN CATHOLIC ARCHBISHOP OF Description Date Amount PORTLAND IN OREGON 2838 E BURNSIDE [MECH] Permit Fee 1/27/04 $72.50 PORTLAND, OR 97214 [TAX] 8% State Surchart 1/27/04 $5.80 Phone: Total $78.30 Contractor: COLUMBIA HEATING + COOLING INC P.O. BOX 230397 8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS TIGARD, OR 97223 Phone: 503 624 - 2704 Heating Unt Insp Final Inspection Reg #: LIC 76359 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 Issued By: Permittee Signature: � _ - � , _ Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day ' \ Mechanical Pe Application FOR OFFICE USE ONLY S Received Mechanical Date/By: / — ,0 2 7 -- ' ° `/M., Permit No.: LG0/001- -CZ233 "D— City of Tigard Planning Approval Building Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Ocher Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503 - 598 -1960 Post - Review Land Use Internet: www.ci.tigard.or.us ' Date/By: Case No.: wt�'!�'�I Contact ,.ups ® See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: / t--r Supplemental Information. TYPE OF WORK_ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ ew construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ddition/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 ❑ 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 El Master Builder ❑ Other: Heating/Coolin JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning•• 14.00 Job site address: / 4 5 S uJ - W/}l -( P[ C_ - 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 Tax map /parcel #: Other Fuel Appliances Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 /) LID /es c +e.. q Q s - ..4,,r>'-e+ 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 0 PROPERTY OWNER I ❑ TENANT Other: 10.00 Name: Environmental Exhaust & Ventilation Address: Range hood/other kitchen equipment 10.00 Clothes dryer exhaust 10.00 City/State /Zip: Single duct exhaust Phone: Fax: ❑ APPLICANT (bathrooms, toilet compartments, ❑ CONTACT PERSON utility rooms) 6.80 Name: �-tA, vvy-t CA " " ` Attic /crawl space fans 10.00 Address: g O .5 S I. ineJ e 1 / ` ) 9 Other: 10.00 Z/Gr Fuel Piping City/State /Zip: - 771 v g t p "($5.40 for first 4, $1.00 each additional) Phone: L a y ft/7 9 I Fax: Furnace, etc. •• Gas heat pump +• E-mail: WalUsuspended/unit heater •• CONTRACTOR Water heater +• Business Name: Cd (a b, a 1+44. Co. i.../ ? Fireplace Address: pp Q d 3 O 31 7 Range +• City/State/Zip: BBQ •• Ci ty p: 77 a PA— 97 aI 3 Clothes dryer (gas) •• Phone: G y a 70 v I Fax: .5'9 P' D 290 Other: •• CCB Lic. #: 7 3 $ 9 Total: Authorized Mechanical Permit Fees* Signature: (_7":0•22 Date: /-4 7•0y Subtotal: $ '7.2 • �Z Minimum Permit Fee $72.50 $ ,,Q t G9 ,9. .44.-/AV Plan Review Fee (25% of Permit Fee) $ (Please print name) ' State Surcharge (8% of Permit Fee) $ S , k0 TOTAL PERMIT FEE $ 7y , ao 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. is \Dsts\Perrnit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard I _ A, •- �• 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 $1 0,000.00 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 • c. • and including $100,000.00. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. Vii? . �:. :� • • r S9 • • is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 175 INSPECTION DIVISION • - ' Business Line: 9 -4171 MST BUP Received 6 34/ F>e Date Requested 2 / a 0 C PM BUP Location / 2 6o ei Suite eat DC's a 2. Contact Person ` l Ph ( O ) lv W - 2 ? d VPLM Contractor CC. PPA ) �� SWR BUILDING Tenant/Owner T�iT 1 IG71(11 "`�a ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear non (, / y C Framing CY�t� cam`' Insulation „ Q J , / / Drywall Nailing (�C C_ vc rL�{' Fire wall 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 PASS PART FAIL MECHANICAL f ��► Post & Beam � f111i1• tj Rough -In ((�� ==�� - Gas Line 2' (t),Ns �`� • .e Dampers final • �" - ART FAIL ICAL 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 ()? Date `�' ` Inspector L? Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL