Permit C ITY OF TIGARD MECHANICAL PERMIT
l6 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00307
�'I I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/9/03
PARCEL: 2S 103 D D -00900
SITE ADDRESS: 13855 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: 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: Relocation of ducts & grilles. Project Value: #1,100.
Owner: FEES
COMMUNITY OF CHRIST CHURCH Description Date Amount
5321 WINDSOR TERRACE
WEST LINN, OR 97068 [MECH] Permit Fee 6/9/03 $72.50
[TAX] 8% StateTax 6/9/03 $5.80
Phone: Total $78.30
Contractor:
PERFORMANCE MECHANICAL
19949 E BURNSIDE RD
PORTLAND, OR 97233 REQUIRED INSPECTIONS
Phone: 503 - 492 -5605 Duct Inspection
Final Inspection
Reg #: LIC 147003
•
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 yo . • show rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
1
Is . ued By: I il.� �. - l et ! j Permittee Signature: �'/I/1/Lt / A.,107
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Pe Application FOR OFFICE USE ONLY
Received i 2 Mechanical / "
Date/By: 9 o !) Permit No.: Nte g -- 60,50
Cl of Ti and Planning App oval Building
`J g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By:. Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post Land Use
/ /�'r NV; r Date/By: Case No.:
Internet: www.ci.tigard.or.us • ii " Vi I Contac 1 s.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 ' -' Name/Method: a 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, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ / /OG. '2 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: /,3 8 3 ca) ,m , Gas heat pump 14.00
Suite #: Bldg. /Apt. v Duct work 14.00
�/,-- __ __ Hydronic hot water system 14.00
Project Name: (!pie'l ail d, ( ek,e/r.A Residential boiler
Cross street/Directions to josite: (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: 1 Lot #: Repair units 12.15 Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
*---
y
L OC-1 i u-0 .TS %i GJQ.t tom__ 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
IM PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: ep, 7'y OT �4s1 ��u r kitchen
Environmental Exhaust & Ventilation
Range hood/other kitchen n equipment 10.00
Address: 1;',0 sex o204iCc Clothes dryer exhaust 10.00
City/State /Zip:T�p Pd Qk, q 72S' / Single duct exhaust
Phone: &$G/ . ( X16 Fax: (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Ann A el-74 Attic/crawl space fans 10.00
Addre �",� J LL/i s ��sa/' �jY �P Other: 10.00
c Fuel Piping
City/State /Zip: (14'$/ a /1/7 . 0/766? * *($5.40 for first 4, $1.00 each additional)
•
Phone: j 93 ` 4-7.yq 14i 1 F ax: J--3 —6,5z) .-,/.2/7 Furnace, etc. +*
Gas heat pump
E -mail: aAI'el, t ct'ff,(i, Cam Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: ?Rog.4,vnatlCe__ /rneAd ie: ( Fireplace *5
Address: /994. 9 z u,'nsi,,„/P. Al Ran ** **
City/State /Zip: 70/ R 7Z.3 3 Clothes dryer (gas) **
Phone: ,/63 -942 -s-6 051 Fax: Other: •*
CCB Lic. #: /4/20d3 Total:
Authorized Mechanical Permit Fees*
Signature: , , . ice% _,ice 1 Dater Subtotal: $
Minimum Permit Fee $72.50 $ .9A • SO
/1/2 n 6-4Q,.,7 Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ ,6i . g
TOTAL PERMIT FEE $ 7 g * ..0
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 •
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: ,
iADsts\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
Received A, i J`3 Date Requested AM PM BUP
Location ', / .I � � Suite CP,3----(97) 3 d 7
Contact Person / in Ph ( �. j �OS7 _ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner &71/1/1 v/ - el (. -c�c� ELC
Footing ELC
Foundation Access: % � �C t )-t �?/LCy-4 /3 -eG(p
Ftg Drain 9,F57-3
ELR
Crawl Drain
Slab Inspection Notes: � �i` G/4 SIT
Post & Beam 1 C D,
Shear Anchors 6
Ext Sheath/Shear
Int Sheath/Shear
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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
T FAIL
AL
Po _ : Beam
Rough- -
Gas Line
S . 'Ice Dampers
f 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: lE1 Unable to inspect - access
Fire Supply Line
ADA
Approach/Sidewalk Date /A0/0 L Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL