Permit C ITY OF TIGARD MECHANICAL PERMIT
0 001 -
! DEVELOPMENT 9 r sO R 9 SERVICES (503) 639 -4171 PERMIT #: MEC2004 -00589
DATE ISSUED: 10/4/2004
- 13125 /
PARCEL: 1S12600-00300
SITE ADDRESS: 09700 SW WASHINGTON SQUARE RD
SUBDIVISION: ROBDSVGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate gas meter and gas line for remodel.
Project Value:$2,000
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY MACERICH COMPANY [MECH] Permit Fee 8/26/200 $58.41
9585 SW WASHINGTON SQUARE ROAD [TAX] 8% State Surchart 8/26/200L $4.09
TIGARD, OR 97223 [MECH] Permit Fee 9/2/2004 $14.09
Phone: [TAX] 8% State Surchart 9/2/2004 $1.71
Contractor: Total $78.30
RAYBORN'S PLUMBING
19990 SW CIPOLE RD
PO BOX 69 REQUIRED INSPECTIONS
TUALATIN, OR 97062 Gas Line lnsp
Phone: 503 692 - 4139 Final Inspection
Reg #: LIC 87852
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 • : -1010 t r•.. OAR 95 y01 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
( 13)246-6699.
sued By: .d ` y _ j�� / • Permiftee
•
Call -( .3) 639 -4175 by 7:00 P.M. for inspections need • e next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Dacte/Bey /0 y pi Permit No • d ,•• ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax. 503 598.1960 /� -; , r \ Date/By Other Permit:
Inspection Line: 503 639.4175 - IL Date Ready/By Juns ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method. 1 . 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, lab r, overhead, and profit
• CATEGORY OF CONSTRUCTION - - ' -- Value $ h (MO
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
12 Multi-family For special information use checklist.
y ❑ Master builder ❑ Other:
Description I Qty Ea I Total
. ' ` • ' JOB SITE INFORMATION AND LOCATION ' - Heating/cooling
Job site address: Q �^ l ''� yai l '\ /1
I�UC1 1:u-.) L i / - i - I 1Q - / -0 1 , TAb . Air conditioning or heat pump (requires site plan showing placement) 14 00
City/State/ZIP: --- 7 - 1,c o 4 Q. 0 P q 7 3 Furnace 100,000 BTU (ducts/vents) 1400
Furnace 100,000+ BTU (ducts/vents) 17 90
Suite/bidg. /apt. no.: Project name: � QD b-, }./ 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
C �C� . , "' Gas fireplace 10.00
O .� l ilk, Flue vent for water heater or gas
b 'N fireplace 10 00 Log lighter (gas) 10 00
Wood/pellet stove 10.00
Wood fireplace/Insert 10.00
❑ PROPERTY OWNER I ❑ TENANT - Chimney/liner /flue/vent 10 00
Name: Other: 10 00
I ,' � 1 - u�? � Environmental exhaust and ventilation
Address: Qp^ -iL� � \ Range hood /other kitchen
\� p � �• p r t Qt+ 1 7 equipment 10 00
City/ State/ZIP i i ` OQ C a 2--j Clothes dryer exhaust 10 00
Phone: ( ) ` Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6 80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace 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:
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: oY m4 6 I �� Other
Address: I Clb SLo CA1 LA �� to9 MECHANICAL PERMIT FEES* '
City/State/ZIP:- A L-A l t• Q 97nA09— Subtotal
Phone: (5D5) 699,, 1 543 Fax: ( ) Minimum permit fee ($72.50) 7 ,��
Plan review (25% of permit fee)
CCB lic.: $-] 8 5 - State surcharge (8% of permit fee) 5. so
TOTAL PERMIT FEE 'g , 30
Authorized signature: .---- This permit application expires if a permit is not obtained within 180
J./11111111.- days after it has been accepted as complete.
Print name: InillIP Date: (v_ _c( • Fee methodology set by Tn- County Building Industry Service Board
r\Building\Pemuis\MEC PemutApp doc 12/03 440 -4617T (I i /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Suppleniental Information
Commercial Fee Schedule:
' 'Arz■=.-2
.;J.
$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 OF TIGARD . 'IMG- "zop�_ O��i
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BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171fljl�
Inspection Requests (24 Hrs.): (503) 639 -4175 +�- _..
INSPECTION WORKSHEET FOR DATE: 4/'ve10 TIME: PAGE:
SITE ADDRESS: g 1 Q b V V tic k)1vL54z,v\ S &. CLASS OF WORK:
SUBDIVISION: - ^ S n _ LOT #: TYPE OF USE: i.
PROJECT NAME: V I/ 1 rG. Vi✓ �
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
LA Med4t1A71 i CAJI
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: L fr 7A / <- Phone #: (503) 718-