Permit CITY OF T I GA R D MECHANICAL PERMIT
- 1 ;ow DEVELOPMENT SERVICES
PERMIT #: MEC2001 -00163
13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 5/16/01
PARCEL: 2S1 12 DA -01400
SITE ADDRESS: 06650 SW REDWOOD LN 300
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 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:
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: 1
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Mechanical tenant improvements, relocating grilles and ducts.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 5/16/01 $72.50 2720010000
PORTLAND, OR 97224 5PCT CTR 5/16/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 233 -6911 Duct Inspection
Reg #: LIC 38868 Final Inspection
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 • i ica i • Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0080.
You , ay obtain co•'es of t1 / e rules or direct questions to OUNC by = ►ng (503 246 -9189.
Issu : By: % y�J . -�, Permittee Signature: 4 _
Call (50• .39-4175 by 7:00 P.M. for inspections needed t e next 1 siness day
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Mechanical Permit Application
Date received: 5/, (/ O/ Permit no.:1 ,/ oo /37
City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 ', l.
Fax: (503) 598 -1960 b DO f Ci Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family enant improvement
❑ New const ructionAddition /alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: r_ SO 51.v 7awo00 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Q yo I Suite no.: 36 0 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: C E.c, y t .,./ 57 jurisdiction's fee schedule for residential permit fee.
City /county: T1( I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: ,mOV6 e / z z e 5 AND COMMERICAL /INDUSTRIAL EQUI PIS ENT SCHEDULE
4 no i;7' DUG % Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
space heated or conditioned ❑ No Air handling unit CFM
Is existing p Air conditioning (site plan required)
Is existing space insulated' Yes ❑ No Alteration of existing HVAC system
Boiler /compressors
/� State boiler permit no.:
Business name:
no - •ri,/ ,6ssoe . HP Tons BTU/H
Address: g 0 7 ,v e C OLC *4 Fire/smoke dampers/duct smoke detectors
City: p`�gyr.TLa,�,n I StatexOY I ZIP: ay-7, Heat pump (site plan required)
Phone: a. 3 _ e_9 // I Fax:o23g E - mail: InstaWreplacefurnace / burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 3•gG $ Install/replace/relocate heaters
City/metro lic. no.: y c 3 wall, or floor mounted
Name (please print): &,,e-cni ,_ , T Vent for a, pliance other than furnace
CONTACT PERSON efngerahon:
Absorption units BTU/H
' Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER NER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: 7 /,, .d 57 Exhaust fan with single duct (bath fans)
Mailing address: / 5" -s w , 4 PKwY of30F7 Exhaust system a art from heating or AC
City: 77 7) State: Oe • ZIP: Fue p p g an distribution up to 4 outlets)
� j Type: LPG NG Oil
Phone: Fax: E -mail: Fuel i ing each additional over 4 outlets
rocess p ping (schematic required)
Number of outlets
Name: ' Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: ax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature , a ,.- v I D ate: s /� /o/ Other:
Name (print): , ) ,rEm/ ,<A.,..i •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Cl Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $
Cardholder signature Amount 440-4617 (6I00/COM)
MECHANICAL PERMIT FEES ••
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
$10,000.00.
fraction thereof, to and including 2) ducts & vents 17.40
$
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* "
7) <31-1P;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace induding vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half hour) $72.50 per hour
*State Contractor Boiler Certification required for units >200k BTU.
"Residential A/C requires site plan showing placement of unit.
i:\dsts \forms\mech- fees.doc 10/11/00
IF , .
C ITY OF TIGARD BUILDING INSPECTION DIVISION MST
2 4 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
:.
Date Regtlested 6 , AM PM BLD
Location c , 60 5r v A d &.vvc "ct 4 — Suite ?‘, MEC Zridj. /€ 3
Contact Person Ph 2 3 3 / PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
41:4 •
'• : - Beam
Rough In
Gas Line
Smo - = • mpers
r •
PA : PART FAIL
ECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
' Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 6 /
Other Date I nspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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