Permit A- CITY OF TIGARD MECHANICAL PERMIT
A *AN �1 DEVELOPMENT SERVICES PERMIT #: MEC2001 -00164
.. I - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/18/01
PARCEL: 2S 112DA -00800
SITE ADDRESS: 15115 SW SEQUOIA PKWY 100
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:
ELE 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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical tenant improvement
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI PRMT CTR 5/18/01 $72.50 2720010000
PORTLAND, OR 97224 PLCK CTR 5/18/01 $18.13 2720010000
5PCT CTR 5/18/01 $5.80 2720010000
Phone: Total $96.43
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Insp
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtai co ies of these rules or direct questions to OUNC7 calling (03)246 -9189.
Issue By: Permittee Signature: 411,
Call (503) 639 -4175 by 7:00 P.M. for inspections need - d the ne' business day
.� 0it' 1i%i
Mechanical Permit Application
Date received: 6- /0 /U / Permit no.: // /4 y
-44' City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 - 4171 t 1
Fax: (503) 598 - 1960 `2 2 D2001 , Case fileno.: Payment type: '^
Land use approval: 1 Building permit no.: v v \
TYPE OF PERMIT N
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ie enant improvement
❑ New construction ddition/alteration/replacement ❑ Other:
J OB SITE INFORMATION COi%IMERCIAL VALUATION SCHEDULE
Job address: / .-.- // 5 5t� 5r i o ,, d Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: / o d 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: / . L C 7T- p5 le.67z t7 jurisdiction's fee schedule for residential permit fee.
City /county: , _ , , / ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and I. ation of work on premises: /A41/- gea_C-ES AND COMMERICAL/INDUSTRI 1 EQUIPMENT SCHEDULE
.6G70 flu T / D) ,< h,-e P.' 'lnP Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned Yes ❑ No Air conditioning (site plan required)
Is existing space insulated ?es ❑ No Alteration of existing HVAC system
NI ECI IAN I CAL CONTRACTOR Boiler /compressors
Business name: _ mymP /SSoe , State boiler permit no.:
HP Tons BTU/H
Address:15a? ti E C Cf'.iGY-/ Fire/smoke dampers/duct smoke detectors
City: TS „L,D I State I ZIP:g7a3 2. Heat pump (site plan required)
Phone: �33 . �// I Fax: a35 .g767 I E - mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 3�, e: g s/i /OS Install/replace/relocateheaters- suspended,
City /metro lic. no.: 5/$3 wall, or floor mounted
Name (please print): ,6 � , t Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
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 Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: E.G_ 4 , 5 j Exhaust fan with single duct (bath fans)
Mailing address: p 5- . ... 5 -c7 31 , t , - Q„p yd f-W r e747 Exhaust system apart from heatin or AC
City: Tit�.b.�i> I State�z, I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E - mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Name (print): 7: / Other: _
Applicant's signature r!� I Date:J�S�o/ O��
_ y„� j 7
`Not all jurisdictions accept credit cards, please call jurisdiction for more informations Permit fee $
❑ 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 (6/00/COM)
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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) Fumace 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+
fraction thereof, to and including including ducts & vents 17.40
$10,000.00. Floor Furnace
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) including vent 14.00
$1.54 for each additional $100.00 or Suspended heater, wall heater
fraction thereof, to and including 4) p 14.00
$25,000.00. or floor mounted heater
$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) <3HP;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 including 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 2.3 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 Boller Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit
i:\dsts \forms\mech- fees.doc 10/11/00 .
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7 — ?,-- AM PM BLD
Location / . $ w _ u / v 4— p/e 4.. Suite MEC .
Contact Person /1pc4./ fcck4 r - Ph 2 — 6 9// 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
�H d
Post & Beam
Rough In
Gas Line
Smo - Dampers
gret PART FAIL
RICAL
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 Date /l'3l �/ Inspector X Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.