Permit A, CITY OF TIGARD
MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00022
..��i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/21/04
PARCEL: 2S112DD -00701
SITE ADDRESS: 15822 SW UPPER BOONES FERRYRD BLD.0
SUBDIVISION: OREGON BUS PARK II ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 2
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 2 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Mechanical TI: (2) rooftop units, distribution ducts, gas piping & (2) exhaust fans. Project Value: $10,000
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 - WMI [MECH] Permit Fee 1/21/04 $231.50
PORTLAND, OR 97224 [MECPLN] Plan Rev 1/21/04 $57.88
[TAX] 8% State Surchaq 1/21/04 $18.52
Phone: Total $307.90
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Phone: 233 Gas Line Insp
Mechanical lnsp
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 tlfica to Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952- 1 -0100. Yo may obtain copies of these rules or direct questions to OUNC y calling
(50 )246 -6699.
�� iG / Permittee Signature: x
Iss d By: P
• ;I �:l: , 1
• Call (503) ;39 -4175 by 7:00 P.M. for inspections needed th next business day
Mechanical Permit Application FOR OF USE ONLY
Gity of Tigard pa;Y / d Permit No �/}
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �� it � G
Phone: 503.639.4171 Fax: 503.598.1960 I / Date/gy Other Permit
Inspection Line: 503 639.4175 Date Ready /By Page 2 for
Internet: www ci.tigard.or us J urs ® S ee Pa
I r Notified/Method 7 6- Supplemental Information
TYPE OF WORK _' ■COMMERCIAL FEE*, .SCHEDULE - 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.
' •CATEGORY OF ,CON , • ' Value $ i 0 0
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwellingommercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty Ea. I Total • - • , ; ' „,-' :JOB'SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: > � a
�S 22 � p2 , � JCS /CR t/ Rol. (requires site plait showing placement) 14.00
City/State/ZIP: , / �� 0 OZ . G _ Furnace 100,000 BTU (ducts /vents) c 2— 14.00
1 `�^' Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.:
(1....--1 -7 name: �L„� ��� C 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
Flue /vent for any of above 10 00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
, ,, i' I .DESCRIPTION: " OF WORK• " ' - Water heater 10 00
' ~ � is •.: -.' �. ' ,. . � - , - '" s., _.;-
_ Gas fireplace 10 00
le 1 i 3 t,../ /,E�LG 1 wC7KK. Q � - c -X4 /'s .P.)" 5 Flue vent for water heater or gas
` fireplace 10.00
-A S 7 1P/ N er Log lighter (gas) 10.00
Wood /pellet stove 10 00
. Wood fireplace/insert 10 00
Chimney /liner /flue /vent 10 00
PROPERTY OWNER ' ' ' I - _ . '. ❑'TE NANT Other 10.00
Name: P,(f Z - - 11 z. v ST Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms, 2
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 4 6.80
rf• _
"i ", ' lie D - ® , ; CONTACT PERSON : , • Attic /crawlspace fans 10 00
Other: 10.00
Business name: Fuel i Jn
P R
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc. 2
Address:
Gas heat pump
City/State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR "' l , - Barbecue
Business name: Clothes dryer (gas)
d ,' : ;3.� Other:
Address: en.jr8 5 E= f '" / avc , , ; . MECHANICAL PERMIT FEES* •
City/ State/ZIP: 73 r V Q- Subtotal r /gi, 5r,
/ Minimum permit fee ($72.50)
Phone: (37p 3) 33. -c, q 4 Fax: (.5`p3) a 3g • 97" 7 Plan review (25% of permit fee) 37, 8
CCB lic.: �S State surcharge (8% of permit fee) / $ • 7 0�
TOTAL PERMIT FEE �p7 9c
AUthOrlZed signature. This pe rmit application expires if a permit is not obtained within 180
da aft i t has been accepted as complete.
Print name: ) e_ ` F— t / �var / Date 0/0/1 • Fee methodology set by Tri- County Building Industry Service Board
i \Buiiding\Permits \MEC- PemutApp doc 12/03 440 -4617T COM/WEB)
•
Mechanical Permit Application - City of Tigard q •
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation:.. ti Permit Fee: : r� , ,� : ,u�; U �•,; : , .
$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'td$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. A "t• ,
$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.
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is\ Building \Permits'MEC- PermitApp.doc 12/03 2 ".
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 -4171 MST
i1 BUP D d (o �sZ�
Received Date Requested % AM �PM/� BUP Lk-060
Location / 4 ;13'2, Z . , Suite �x-�t" MEC Z?._
Contact Person . . Ali - 2- Ph ( ) LU - g6e f PLM 4 1 - U O O C)
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: —�
Ftg Drain v� �V /` ELR
Crawl Drain 1� l !�_
Slab Inspection Notes: - - SIT
Post & Beam
Shear Anchors ' ()�l . ��
Ext Sheath/Shear
Int Sheath/Shear -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
'ART FAIL
- j :ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• • PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
4 •ASS PART FAIL
• RICAL
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 El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line 7 /�
ADA
Approach/Sidewalk Date J/4 L / Inspector 7Y
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL