Permit CITY T I GA R D MECHANICAL PERMIT
:, I� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00135
t��l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/23/04
PARCEL: 1S12600-00300
SITE ADDRESS: 09653 SW WASHINGTON SQUARE RD M -2A
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: 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:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Install (1) exhaust fan, ductwork & grilles, insulate existing ductwork
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY [MECH] Permit Fee 3/23/04 $116.58
9585 SW WASHINGTON SQ. RD.
PORTLAND, OR 97223 [TAX] 8% State Surchar€ 3/23/04 $9.33
Phone: Total $125.91
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 692
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 1.80 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 - 001 -00
Issued By: /yf 63 Permittee Signature: ,__ ,
■
Call (503 9 -4175 by 7:00 P.M. for inspections needed the next business day
FOR OFFICE USE ONLY
Mechanical PefifilfrlitiE lion Received Mechanic /
.
Date/By: Permit No cV i- " /3.5
City of Tl and MAR 2 3 2004 Planning Approval Building _
g Date/By. Permit No.afze pp y-400 /5-
13125 SW Hall Blvd. CITY OF TIGARD Plan Review Other
Tigard, Oregon 97223 tL ��lr �,` Date/By. Permit No.:
Phone: 503- 639 -4171 Fax: ISI �" Post- Review Land Use
{� Date/By Case No.:
Internet: www.ci.tigard.or.us j I Contact Juris.: El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 W Name/Method 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.
❑ 1 & 2- Family dwelling IN Commercial /Industrial Value: $ .” O. See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description j Qty I Fee(ea.) l Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: ?6.53 ,5 IA /45 /J a16,7 SAD Gas heat pump 14.00
Suite #: M Z— ) Bldg. /Apt. #: Duct work 14.00
Project Name: , 7 p G u 2 . E I L� Hydronic hot water system 14.00
V P 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
Re units 12.15
Subdivision: Lot #:
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
/ Ai 5 a. 0 LL -iGg t, y FAH DU G11,t) an (. Flue vent (water heater /gas fireplace) 10.00
$ GAL ° t F ,5. � I as S t0 L 43 7t--- eir DA -r/.t54(,P Log lighter (gas) 10.00
Wood/Pellet stove 10.00 •
A u TJeret Pr— Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER I MI TENANT Other: 10.00
Environmental Exhaust & Ventilation
Name: A c try R 6 i i9 l eg.,(f Range hood/other kitchen equipment .10.00
Address: q55 ,$ A ) GItI MA.9P,9®g, SO. i47tI D Clothes dryer exhaust 10.00
City /State /Zip: Ti (rpraO, ()ll'Z Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT itj CONTACT PERSON utility rooms) 6.80
Name: /9-d Y Sc ILI A-c Ma. Attic /crawl space fans 10.00
Other: 10.00
Address
/63 3 4 s a n LAVA' t 0 Fuel Piping
City /State /Zi.: „ t- , �/, • , G _ ,"?a6, 7- * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. 4.* Phone: St3 (21I 2 - 9.5-/., ,s" F ax: ,o 3 (� q p s, 5 79 Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: fi26tp I /`l(.cc al] CpC Fireplace ** **
Address: /n 3 3 0 ,s W Ti., �a.n�/ob ez� BB Qe **
City /State /Zip: la r L/J rr 4 oa_ ei 70 61. Clothes dryer (gas)
Phone: .56,S 61 Z -/54._.c 1 1 Fax: 503 691.-/T 7 9 Other: **
CCB Lic. #: 051 co Total:
Authorized / ` Mechanical Permit Fees*
Signature: Date: 3/ Z Volf Subtotal: $ // , S
l Minimum Permit Fee $72.50 $
j 4 MLes" DO ✓e"(P r- Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ , V
TOTAL PERMIT FEE $ /a
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
0-1
Commercial Fee Schedule: r ( f ` o / �
Total Valuation: Permit Fee: ' J Total
00 to $5,000 00 Minimum fee $72 50 \
$5,001 00 to $10,000 00 $72.50 for the first $5,000.00 and $1 52 I „ 1 9
for each additional $100.00 or fraction W 1
thereof, to and including $10,000.00.
$10,001 00 to $25,000 00 $148 50 for the first $10,000.00 and I
$1 54 for each additional $100 00 or ji
fraction thereof, to and Including /
$25,000.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and D /
$1.45 for each additional $100.00 or
fraction thereof, to and including /
$50,000.00 ` 1 9 1
$50,001 00 and up $742.00 for the first $50,000.00 and \ Ut
$1 for each additional $100.00 or \�) t /
fraction thereof.
Assumed Valuations Per Appliance: j / , 1 „
Value Total
Description: Qty (EEa) ) Amount v
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, 5,725
>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 appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, Including wood 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 I Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
P
Received ' / I G Date Requested M d 3 1q — DV AM PM BU -
Location o 5 3 /mil �' (� � Suite r Z 0
Contact Person Ph ( )
Contractor 0.2,/ 'it • Ph ) SWR
BUILDING Tenant/Owner C-r1 ()7 . 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
—1Toof d Ceilinq�j
goof
Other:
Fi
PART FAIL
• • BING
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
"Gas Line
Smoke Dampers
O P 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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ft
ADA Date 3 - 1 q -0 �f ' fi /iN /� 4.4 4—G &K pct z 5v94
Approach/Sidewalk Inspector
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL