Permit CITY OF TIGARD
MECHANICAL PERMIT
i& DEVELOPMENT SERVICES PERMIT #: MEC2003 -00677
� � 11 � 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/26/03
PARCEL: 2S112DD -00500
SITE ADDRESS: 15860 SW UPPER BOONES FERRYRD B -15
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
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: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 70,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical tenant improvement, (1) rooftop unit with gas piping, rework existing ducts. Project value: $5,000
Owner: FEES
PACIFIC REALTY Description Date Amount
15350 SW SEQUOIA PKWY #300 CITY OF TIGARD MEI\ 11/26/03 $141.50
PORTLAND, OR 97223 [MECPLN] Plan Rev 11/26/03 $35.38
[TAX] 8% State Surchart 11/26/03 $11.32
Phone: 503 624 - 6300 Total $188.20
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 Gas Line Insp
Mechanical Insp
Reg #: LIC 38868 Duct Inspection
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility NotificatkaQ�Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001=00100. Yo2t \ may obtain copies of these rules or direct questions to OUNC by calling
(505246 -6699.
�k )
Issued B y: i` � /�I
� ),' Permittee Signature:
\� — Call (503639 -4175 by 7:00 P.M. for inspections needdd the ne5tt business day
Mechanical Permit Application FOR OFFICE USE ONLY .. -.
T � N� Received Mechanical
Date/By //� ��flj3 Permit No ry _(�Q, - k7
Cit of Ti and Planning Approval Building
Y g Date /By Permit No
13125 SW Hall Blvd. Plan Review
Tigard, Oregon 97223 Date/By 11'26 .63/"13$ Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
A.4 Y � I , Date /By Case No .
Internet: www.ci.tigard.or.us ,. Contact ) s rs ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method. i /6- 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.
❑ I & 2- Family dwelling ❑ Commercial/Industrial Value: $ 5'ooa 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: 5. G T. c , , eNYL2 BoQi>Zs rGtPy Gas heat pump 14.00
Suite #: Bldg. /Apt. #: / Duct work 14.00
Project Name: r oa, A 4 RE: �i Hydronic hot water system 14.00
c
Residential boiler
Cross street/Directions " to job site: (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: Lot #: Repair units 12 15
Tax map/ parcel #: Other Fuel Appliances
ax ma
P P Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
• .. Tai J .Ti./ kV/DUCT T co/Qs r , i p//v(r Flue vent (water heater /gas fireplace) 10.00
.QND RC v't7le. c sT /.G AUG t
Log Wood/Pellet (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY OWNER _ I ❑ TENANT • , ' ' -" Other: 10.00
Name: PAC - TIZUS -T Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address:
City /State /Zip: Clothes dryer exhaust 10.00
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
' ❑ APPLICANT •0 CONTACT PERSON • ' utility rooms) 6 80
Name: Attic /crawl space fans 10 00
Address: Other: 10.00
Fuel Piping
City /State /Zip: • *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc **
Gas heat pump **
E -mail: Wall/suspended/unit heater ••
CONTRACTOR Water heater
Business Name: p op "4'P Fireplace **
Address: gni ,sE / 7'N- AL/6 Range •*
BBQ '*
City /State /Zip: Pog-re_4N0 9 7 .22 Clothes dryer (gas) **
Phone: - -(. i ) F a x : . . 9•‹07 Other: •*
CCB Lic. #: *•*R m -6- Total:
Authorized Mechanical Permit Fees*
Signature: Date '' Subtotal: $ /y / SO
Minimum Permit Fee S72.50 S
Jet.Exty /t .w� Plan Review Fee (25% of Permit Fee) $ c 35. 3g
(Please print name) State Surcharge (8% of Permit Fee) $ //, 3,a
TOTAL PERMIT FEE $ /n ., ?
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 $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.
$100,001.00 and up $1,396.50 for the first,$100,000.000 and' . ' •
$1.10 for each additional $100.00 or fraction
thereof. °a
All New Commercial Buildings require 2 sets of plans.
•
•
•
. �. :�. , as • . •� +
'�r� ?'I •ate- r
•
•
is \Building \Permit Forms \MecPermitAppPg2 09- 01- 03.doc •
•
CITY OF TIGARD 24 -Hour •
BUILDING Inspection Line: (503) • _ 175
INSPECTION DIVISION Business Line: (503) '•f 71 MST
BUP
k (-3 Received he Date Requested 1/Z / / � 4 7 AM PM BUP
Location Location — . ' I _'_//' r ��� %�. Suite ( 3 -E1 7 7
Contact Person .' k 04i4 4J Ph ( ) 5-Y9 " 6 tQ / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
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 a /
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
4,10 PART FAIL
CTRICAL
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 LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date \ I Inspector � ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL