Permit C ITY OF T I GA R D MECHANICAL PERMIT
� ,k DEVELOPMENT SERVICES PERMIT #: MEC2003 -00571
.- �° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/19/03
PARCEL: 2 S 103 D D -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 0 <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Add furnace and a/c
Owner: FEES
COMMUNITY OF CHRIST Description Date Amount
5321 WINDSOR TERRACE
WEST LINN, OR 97068 [MECH] Permit Fee 9/19/03 $79.40
[TAX] 8% StateTax 9/19/03 $6.35
Phone: 503 657 - 4974 Total $85.75
Contractor:
MORELAND COMMUNITY BUILDER
13855 NE 24TH
VANCOUVER, WA 98663 REQUIRED INSPECTIONS
Phone: 360-690-4140 Mechanical Imp
Final Inspection
Reg #: LIC 153225
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00
Issued By: ,,,, � Permittee Signature: , -
i
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
w
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
Date/By: Permit No.: VIE O° 3 —Qb J7 J
City of Tigard Planning Approval Building
�J g DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: B tip 203.7- 00.27$
Phone: 503- 639 -4171 Fax: 503-598-1960 Land Use
I Date/By: Case No.:
Internet: www.ci.tigard.or.us ,.I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: T - 4 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
® Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION
mechanical materials a ipment, labor, overhead and profit.
❑ I & 2- Family dwelling El Commercial/Industrial Value: $ j— 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: a r,t -Cli Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning•• I 14.00
Job site address: j 353 55 SvJ e(�t1..1 •F. C y-i 01/)4 y Gas heat pump 14.00
Suite #: Bldg. /A t. #: Duct work I 14.00
Project Name: �W1,1/ytM.vt.��'''y �4\4 jrj , cht �) Hydronic hot water system 14.00
Cross street/Directions to job ( ob s'ite: ( orid boiler
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) 1 10.00
Subdivision: I Lot #: Repair units ' 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
rapt 'Fikv-6I 4. ek IilC. l-I,.,jti\60, 1n Flue vent (water heater /gas fireplace) 10.00
Q Log lighter (gas) 10.00
rv �n Y`�. Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
It PROPERTY OWNER , I ❑ TENANT Other: 10.00
C, �
Name: yVV1.Wv.t.VA,1 D` � t r ' Environmental Exhaust & Ventilation
VV � , T Range hood/other kitchen equipment 10.00
Address:
3655 t ck. I+►vf
Clothes dryer exhaust 10.00
City /State /Zip: Tir 11 va. 01r/ Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT [] CONTACT PERSON utility rooms) 6.80
Name: /1-pyt )1,49r
,g r-t- /i Attic /crawl space fans 10.00
Address: j 3�5; °aZ� 1z a,L6� {° �-l ti ✓ Other:
. 10.00
� Fuel Piping
City /State /Zip: J IR ••(55.40 for first 4, $1.00 each additional)
Furnace, etc. 1 ••
Phone: 5D3 cj 67 7 go () Fax: Gas heat pump ••
E -mail: WalUsuspended/unit heater ••
CONTRACTOR_ Water heater ••
Business Name: • a ' y nt f Fireplace ••
Address: 4'b00 /0L. ,a/iP''41/i i Range **
City /State /Zip: V4 �P,ie w�: q V C tthes dryer (gas) ••
Phone) (p10t41 J Fax: Other: ••
CCB Lic. #: 6322 i /. , . ro Total:
Authorized Mechanical Permit Fees'
Signature: � .. % s ate: gh//b.3 Subtotal: $ 7/. `/O
/n �� Minimum Permit Fee $72.50 $
th (C Yl(.(f I I) , ` r W o 4iv J Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 6. 35
TOTAL PERMIT FEE $ $S 7S
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\MecPerrnitApp.doc 01/03
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.-
$100,001.00 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.
•
•
.
i:\Building\Permit Forms \MecPermitAppPg2 09- 01- 03.doc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST -
�� (2-0/6 BUP
Received YJ2 / 5 3 Date Requested AM PM BUP
r 3 Do 7/
Location •` _ s-. uite
Contact Person -I. i.i �a� l Ph ( S '-� Cb S S/9 75Z PLM
Contractor nn Ph ( )) n I SWR
BUILDING Tenant/Owner ____1/___ C _ ELC
Footing
ELC
Foundation Access: GA tea; ELR
Ftg Drain � �
Crawl Drain k S3
Slab Inspection Notes: SIT
Post & Beam .1 A 4i1 gAr
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 7 -- /
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling n ,
Roof `. J
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
PAS FAIL
- • :earn
Rough -In •
Gas Line
S u • .e Dampers
Final
� "' PART FAIL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector l Ext
Other:
(� V
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL