Permit 1 _ A
•
C ITY OF T I GA R D ar MECHANICAL PERMIT
ia DEVELOPMENT SERVICES PERMIT #: MEC2004 -00422
-•I - 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004 .
PARCEL: 2S112DA-00800
SITE ADDRESS: 15055 SW SEQUOIA PKWY 120
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
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:
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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate ducts & grilles for TI
Project Value: $9,000
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 6/29/200z $213.50
PORTLAND, OR 97224 [TAX] 8% State Surchari 6/29/200 $17.08
Phone: Total $230.58
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911
Final Inspection
Reg #: LIC 38868
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 questions to OUNC by calling
(503)246 -6
Issued B Cie0a...itA44 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex business day
Meg harical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard Date/By: y O// Pernv f e1tSS¢� ,9_, tNo.: ) /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /J "f L(�Oc
Phone: 503.639.4171 Fax: 503.598.1960 oar S , ; Date/By: Other Permit: 6.P9a 1 _ # 23 p'
Inspection Line: 503.639.4175 rI Date Ready/By: �Juris ® See Page 2 for r! „ Ai Internet: www.ci.tigard.or.us Notified/Method: , Supplemental Information
' r • -TYPE OF WORK . COMMERCIAL FEE* `SCHEDULE-T- 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, equipment, labor, overhead, and profit. t wo
CATEGORY OF CONSTRUCTION - ; , , .. g.. ` Value $ - i
.,
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ; • RESiDENTiAL'EQUIPlVIENT, SY STEMS FEES*
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
” JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address:
5055" 51w/ s /4 pit G. l (requires site plan showing placement) 14.00
City/State/ZIP: D / ek Furnace 100,000 BTU (ducts/vents) 14.00
' Fumace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: !Z Co Project name: /4t6 /SAC /F /, 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
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • . Water heater 10.00
_ Gas fireplace 10.00
/90D/7 O 6)(1.571 A Qic -ri fL Fog Ad 14/ Flue vent for water heater or gas
F �� PL J Log lighter fireplace 10.00
Log gh (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
T. ,PROPERTY OWNER I - ❑ TENANT Chimney /liner /flue /vent 10.00
�� ��US�
Other: 10.00
Name: C Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:
( s'pj ) Go2q• i. 00 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT - ❑ CONTACT PERSON c Attic /crawlspace fans 10.00
Business name:
Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc
Gas heat pump
City/State/ZIP: Wall/suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR . Barbecue
l/�'si Clothes dryer (gas)
Business name: /�'�,f Other:
Address: 9.-Ns- SG ` 7.7°∎ A . , MECHANICAL PERMIT FEES* , -
City /State /ZIP: /7 5 , QTz. ., t/D 9 72 Subtotal �.
Minimum permit fee ($72.50)
Phone: (507s) czn —e_49ii Fax: (03 ) .2 3 &.976 7 Plan review (25% of permit fee)
CCB lic.: 31 State surcharge (8% of permit fee) X7, S
TOTAL PERMIT FEE „230. 5g
Authorized signature: This permit application expires if a permit is not obtai within 180
-y days after it has been accepted as complete.
Print name: jy-der i y v.,v�� Date: J t � 9 /� ' Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \PermitsWEC- PemtitApp.doc 12/03 440 - 4617T (I 1 /02/COM/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.
i:\ Building \Perrnits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
3 BUP
Received Date Reque ted o J I AM PM BUP
Location / .57) Sc ' • -- Suite / 2-6 MEC o(3 4 °/ 11 ` 66(1Z ?---
Contact Person r , C_--J 1 Ph ( ),,.33-e 3' /1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall iI
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling , fRoof Wt-
Other: .� I 111-
Final
PASS PART FAIL
PLUMBING
ttA
Post & Beam
(� / friar
Under Slab
Rough -In 1 /
Water Service ► _ /
Sanitary Sewer �.
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
S • • ampers
/Antis'
PASS PART FAIL
LE - ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final fl 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 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL