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Permit , CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2004 -00130 ` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/19/04 PARCEL: 1S12600-00300 SITE ADDRESS: 09644 SW WASHINGTON SQUARE RD G -13 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 ?: 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 ducts, grilles & (1) VAV box. Owner: FEES PPR WASHINGTON SQUARE LLC Description Date Amount BY THE MACERICH COMPANY [MECH] Permit Fee 3/19/04 $146.98 9585 SW WASHINGTON SQ. RD. PORTLAND, OR 97223 [TAX] 8% State Surcharl 3/19/04 $11.76 Phone: Total $158.74 Contractor: ARROW MECHANICAL 10330 SW TUALATIN RD TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone: 692 - 1565 Mechanical Insp Final Inspection Reg #: LIC 5193 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 requi - you to . •w rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 I - ued By: j 4,•!:mm, ric4/ - Permittee Signature: , Call ( • .39 -4175 by 7:00 P.M. for inspections n- • ded the next business day Mechanical' Permit Application Received lication FOR OFFICE USE ONLY Mechanical / ['CAW / ' /30 Date/By: ( 4 I C/7 Permit No.: " Planning Approval Building . City of Tigard Date/By. Permit No. 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By. Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 � Post - Review Land Use nWdl�°tf I & Date/By Case N. Internet: www.ci.tigard.or.us `^ - ' , y,. e� ' Contact s : El , Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name/Method. I WO, Supplemental Information. 6 , TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work Fa Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATrEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2- Family dwelling ® Commercial/Industrial Value: $_ 1 q Zf) r See Page 2 for Fee Schedule ❑ Accessory Building I=1 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: t. $' .S NW vAfp - )- sm6.- 1 SC Gas heat pump 14.00 Suite #: 6- 13 I Bldg. /Apt. #: Duct work 14.00 Project Name: 13 a TO CO uoc 'r4 m t. (s Hydronic hot water system 14.00 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 Other Fuel Appliances Tax map /parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 09) N (C'.: .) VA V 6o c ) 0 -5) Ne* 60 61 A ce3 Flue vent (water heater /gas fireplace) 10.00 (C.-- Log lighter (gas) 10.00 U CT Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue/vent 10.00 ❑ PROPERTY OWNER I ty TENANT Other: 10.00 Name: g a s G /4 1- d �'0 I ((� c `r-,9 6 L (',� Environmental Exhaust & Ventilation Range hood /other kitchen equipment 10.00 Address: 9 s W vv/w4)Ne,,.r®,n/ S 6- l 3 Clothes dryer exhaust 10.00 City /State /Zip: T j 6 EZ P) d Oa_ 1 7 72 _3 Single duct exhaust Phone: Fax: (bathrooms, toilet compartments, ❑ APPLICANT ® CONTACT PERSON utility rooms) 6.80 Name: AZT -T- c 14 A a. el Attic /crawl space fans 10.00 Other: 10.00 Address: ;0330 $i„ 7 / 1 , �p il & ? / Fuel Piping City /State /Zip L-t 4 i i; „ O'Z 9 ?6 ( Z * *($5.40 for first 4, $1.00 each additional) Phone: 3 / / I Fax: D3 6 9 q - / y 79 Furnace, etc. ** M Gas heat pump ** E -mail: Wall /suspended/unit heater ** CONTRACTOR Water heater ** Business Name: r9 /20 0 Pte AN (-- Fireplace ** � Address: / 0 3 D �D T Q� t. /� `!�s „v( Range ** BBQ City /State /Zip: 'r(0_ t_ - TJji j t ii 9 706 F.. Clothes dryer (gas) ** Phone: 50 6 97 — is 65 Fax: 9)3 G , /-/ '77 Other: ** CCB Lic. #: ®5- 1 q Total: Authorized Mechanical Permit Fees* ? / � d 'Signature: Date: l q` Subtotal: $ Minimum Permit Fee $72.50 $ J•40401. A ���� �!✓L f -- P Review Fee (25% of Permit Fee) $ • (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ 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 Fornms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $5,000 00 Minimum fee $72 50 7a.57) $5,001.00 to $10,000.00 $72.50 for the first $5,000 00 and $1.52 for each additional $100 00 or fraction �J thereof, to and including $10,000 00. ` "( $10,001.00 to $25,000.00 $148.50 for the first $10,000 00 and $1.54 for each additional $100.00 or n O fraction thereof, to and including $25,000 00. $25,001 00 to $50,000.00 $379 50 for the . rst $25,000 00 and $1.45 for each additional $100.00 or 6 fraction thereof, to d including ' $50,000 00. $50,001.00 and up $742 00 for the first $' 1,000.00 and $1.20 for each addition.' $100.00 or fraction thereof. Assumed Valuations Per Appliance: Value Total Description. Qty (Ea) A ount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 < 3 hp; absorb. unit, 955 to 100k BTU 3 -15 hp; absorb. unit, 1,700 101k to 500k BTU 15 -30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30 -50 hp; absorb. unit, 3,400 1 -1.75 mil BTU >50 hp; absorb. unit, 25 >1.75 mil. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non - portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in applia• e 656 permit Hood served by mechanical haust 656 Domestic incinerator 1,170 Commercial or Indus :.I,incinerator 4,590 Other unit, includi • ood stoves, 656 inserts, etc. Gas piping 1-4 outlets - 360 Each additional outlet 63 TOTAL COMMERCIAL $ VALUATION: i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 CITY OF TIGARD 24- Hour , - BUILDING Inspection Line: (503 � 75 INSPECTION DIVISION Business Line: (50 a, MST BUP Received / ' 3 5 Date Requested 9' 4Z AM PM BUP Location q (O 4 ,1V WA— - Suite G / ' J o Or) / 3 6 Contact Person Ph ( ) to 9 2 /670 0 S PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner [;lLe, ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: A C- C/71 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 'L Post & Beam �' Under Slab � Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final P' ' RT FAIL i AL !p , Gas Line 410 Le Su = Dampers V Fin•. PART FAIL EL TRICAL 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 Approach/Sidewalk Date Y , / ' 2' v `� � � Inspector \ v" Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL