Permit w CITY OF TIGARD MECHANICAL PERMIT
r � II" DEVELOPMENT SERVICES PERMIT #: MEC2004 -00541
- ° !° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/11/2004
PARCEL: 2S 112 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 200
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTTHH ER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Add (1) grill for TI.
Project Value: $250
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 8/11/2001 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 8/11/200 $5.80
Phone: Total $78.30
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 - 6911 Mechanical Insp
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- ° .
Issue By: / ; i1 /!/ � /! Permittee Signature �`_
Call (503) 639 -4175 by 7:00 P.M: for inspections nee d the c+'ext business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received a �,, .� ,, l''---60
City f Tigard Date/By: • e / PermitNo.:W ..RID .5 -V/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review !! Other Permit �
Phone: 503.639.4171 Fax: 503.598.1960 /6,/r Date/By:
Inspection Line: 503.639.4175 _s_14. I Date Read /B fur EI See Page 2 for
Ready /By:
Internet: www.ci.tigard.or.us Notified/Method: /t Supplemental Information
- TYPE OF WORK .. , , - COMMERCIAL FEE* `SCHEDULE. 'USE CHECKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees" are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION - Value: $
T .
❑ 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building
`, ._ - RESIDENTIAL EQUIPMENT SYSTEMS FEES*
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heatinp/cooling
Job site address: c Air conditioning or heat pump
/ 5 3 $t7 s_.,..6_, c/ / A • 1 (requires site plan showing placement) 14.00
City/State/ZIP: -7 D ®� f f� Furnace 100,000 BTU (ducts/vents) 14.00
�`�" / Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: a06, Project name glotrift,t.f."4/i4.- 1 9 Cao P Gas heat pump 14.00
Cross street/directions to job site: 7 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
4 -7)D / 9e /L crt: Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ ROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: 0-. C-7 7"--- 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: (..../1) (p�,t/. —e0 d00 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 10.00
Other: 10.00
Business name:
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: R ange
• CONTRACTOR Barbecue
_ Clothes dryer (gas)
Business name:
/pjL'�11 P ) fr''G Other:
Address: c� 7 _ /7y'* Aejr' MECHANICAL PERMIT FEES*
city/State/ZIP: ?p1 -4.,, , ek., q d aa Subtotal
) ? Fax: ( ) Minimum permit fee ($72.50) 7A • JO
Phone:
(.t03 e23 J— c�} /f �3 � c i 7 Plan review (25% of permit fee)
CCB lic.: a g State surcharge (8% of permit fee) ,rj , fro
TOTAL PERMIT FEE 7S �n
n
Authorized signature: This permit application expires if a permit Is not obtained within 14
d ays after It has been accepted as complete.
Print name: ��v.. 1 , t �,,, r . Date: / / 4 ' Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Permits m C- PelApp.doc 12/03 44 I /02/COM/WEB)
Mechanical Permit Application - City of Tigard • ' '
Page 2 - Supplemental Information
Commercial Fee Schedule:
; Total Valuation: • i 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 \Permits\MEC- PermitApp.doc 12/03 2
CITY V 24 -Hour
Inspection Line: (503) 639 -4175
INSPE • !VISION Business Line: (503) 639 -4171 MST �j
BUP /14.10_ DD, 3So�
Received Date Requested - 40 AM PM BUP 0 0377
Location 5 TI Suite 200 MEC 2=4=
Contact Person I r l (ai / Ph ( ) 367— a (c 5 PLM
Cont • Ph ( ) SWR
L 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
Firewa
Fire Alarm ^ '
Susp'd Ceiling
Roof
Oth= • /I� _��
rI AS' PART FAIL w ��
PLU = ING r
• st & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS FAIL
CHANICA
Rough-In •
Gas Line
Smoke Dampers
Fi':
�� PART FAIL
TRICAL
Service
Rough -In _ %VW
UG/Slab oir
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 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL