Permit w-
/; CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00245
' .-�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/20/02
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09573 SW WASHINGTON SQUARE RD B -6
SUBDIVISION: WASHINGTON 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 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: Install fan for powered VAV boxes and newduct work/grills.
Owner: FEES
PPR WASHINGTON SQUARE LLC Type By Date Amount Receipt
P.O.BOX 21545 PRMT CTR 6/20/02 $72.50 2720020000
SEATTLE, WA 98111 PLCK CTR 6/20/02 $18.13 2720020000
5PCT CTR 6/20/02 $5.80 2720020000
Phone: Total $96.43
Contractor:
BEWLEY MECHANICAL
5591 SW ARCTIC DR
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 626 -8986 Final Inspection
Reg #: LIC 63582
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. T ose rules are set forth in OAR 9.52- 001 -0010 through OAR
95 - 001 -0080. You may;ob; ' copies of these rules or direct qu stio to OU by calling
(c 117dR -QlRQ \'
Is a By: P►th AZ / /aj,I Permittee Signature: V
Call s ) 639 -4175 by 7:00 P.M. for inspections needed the next busin s day
i le 7 -69.
- A : �' Mechanical Permit Application
Date received —/.0 ...0 .2/Permit no.: In 67(.06a -�‘,./4 r5
City of Ti and
g I r� n Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, T ga R 9�7 � i Date By bb Receipt
Phone: (503) 639 -4171 l it
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: 'JUN 1 fl 20 Buildingpermitno.:
s ii Ny• is d4 ' 6S El
o u9V _ -
❑ 1 & 2 family dwelling or accessory Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ( C) (4z s` „. e y. t < wee , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 573 I Suite no. .p I1(te 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: U / jurisdiction's fee schedule for residential permit fee.
City /county: ,,,t_ I ZIP: 1 6 ( 1 & 2 FAMILY DWELLING PERMIT FIB SCHEDULE
Description and dilation of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
• Pon L._ -4: ' I 'a eS z /_ __ , . NM u Fee(ea.) Total
Est. date of completion/inspection: �j+ri Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned ?kYes ❑ No Air handling unit CFM — • — =
Is existin s a c e i n s u l a t e d ? 0 Yes ❑ No — =Air_ conditioning (site plan required) -- - _ _ -
g P Alteration of existing HVAC system
IA
. ` t 11JECIIANICAL CONTRACTOR • Boiler /compressors
Business name: „ V State boiler permit no.:
HP Tons BTU/H
Address: C,9( s 1,4 /4-ce c C. Fire/smoke dampers/duct smoke detectors
City: 4 ;,._ - „ -y,, ,, State: v . ZIP: Sr . Heat pump (site plan required)
Phone:(QQ& .- t, .,
. Fax: , r 4 E -mail: vv�� Install/replace furnace burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: (03552_ Installlreplace/relocate heaters - suspended,
City /metro lic. no.: 9 2_/;5 wall, or floor mounted
Name (please print): c .- h ef„,) , Vent for appliance other than furnace
CONTACT PERSOI`.i Refrigeration:
Absorption units BTU/H
Name: k�,,, g • Chillers HP
Address: 1
Compressors ressors HP
SS �� t 1 / /,,5 D Environmental exhaust and ventilation:
City: ig, Oc/' p r< 4.- (yL I State: del ZIP: 97i)(5 Appliance vent
Phone: i - , ro Fax:(c(a /, ,3 z E- mail:/, ,a Dryer exhaust
OWNER Hoods, Type U Wres. kitchen/hazmat '
hood fire suppression system
Name: .... / Exhaust fan with single duct (bath fans)
Mailing • ddress 1 _1 - aust system apart from heating or AC
City ,p ,8 Star .b14 ZIP: 3 23� ap ping an . button up to • out ems
Type: LPG NG Oil
Phone:. ( - Fax: A ,,, E - mail: A/1 Fuel o i l i n g each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
r _
Name: e" erk. r y -Aqi, 15
1� I , Other listed appliance or equipment:
Address: % ., `� C 3' s 1).^.4 S� Q Decorative fireplace
0
City:(A) A �' /� Statea,� I ZIP: 1 be, / Woodsto �
Other: Ilet u
r'
Phoneta It fRR -(! 9 ) I Fax: I E -mail:
�/� C..4.,2-61.-
Applicant's signaturej, „.34 0 I Date: Lo /.3 - d z other:
Name (print): fC_Eav si,. k., 1�Ps.1 /tP_u �
Not all jurisdictions accept credit information. cards, please call jurisdiction for more information. Permit fee $ /L SD
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained r
Credit card number: Expires w ithin 180 days after it has been Plan review (at _ %) $
State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ '
$ Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES _s
i
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$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
ASSUMED VALUATIONS PER APPLIANCE: to 3- 1K BTU 14.00
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 2,310 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 _
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator handling unit to 10,000 cfm 656 i / c/ 69.95
Air handling unit >10,000 cfrn 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct r 446 4/V4o 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 � e TOTAL RESIDENTIAL PERMIT FEE: $
` //
VALUATION: 7
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 Boiler Certification required for units >200k BTU.
"Residential A/C requires site plan showing placement of unit.
1:ldsts\fomulmech- fees.doc 10/11/00
CITY TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
l r1
BUP
•
Received Date Requested 3 AM / v -- ) PM BUP
Location q 5 3 W 50 RD Suite MEC 0 ' 000 . 51 J
Contact Person �i✓ Ph ( ) 6 e?-6 - 8 PLM
Contractor Ph ( ) SWR -
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors • V `'
Ext Sheath/Shear L
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
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
Smoke Dampers
PART FAIL
•
• ECTRICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line _
ADA
1:41/4. Approach/Sidewalk Date Inspector " i Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY, OF TIGARD 24 -Hour
BUILDING Inspection Line: 4 a), §39 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ' "/' AM PM - BUP
—!
Location C73 "fr. S n_ • g P Suite de ( P MEC a - 6 d a 4 1.0
Contact Person 13 L-P41 / Ph ( ) 6 - S 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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan -
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
oug
as Line
Smoke Dampers
FP S PART FAIL
ECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date if D I nspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL