Permit • q •
. , CITY OF TIGARD MECHANICAL PERMIT
CI DEVELOPMENT SERVICES PERMIT #: MEC2005 -00031
� --- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/20/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09714 SW WASHINGTON SQUARE RD F -4
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: B 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Relocate diffuser and thermostat (pneumatic) Value: $600.00
Owner: FEES
WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY [MECH] Permit Fee 1/20/200: $72.50
9585 SW WASHINGTON SQUARE RD [TAX] 8% State Surchart 1/20/200: $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
BEWLEY MECHANICAL
5591 SW ARCTIC DR
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 626-8986 Mechanical Insp
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. Tho .e rul are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain copies of these 'ule- jor irec qu -stions to OUNC by calling
(503)246 -6699. c
Issued By: ���� Permittee Signature: \. IA
Call (503) 639 -4175 by 7:00 P.M. for inspections neede • the next busi /ess day
Mechanical Permit Application FUR OIF USE ()NIA -
C `JW gard Receives -.20 O -O< --- PermttNo.: Mt t -
DateBy � 0o S - Oao3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i ADate/By Other Permit
l
Inspection Line: 503.639.4175 4 f c•I � Date Ready/By: rilfil ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction 0 Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ther: mechanical materials, equipment, labor, overhead, and
CAT .1' i ' V OF CONSTRUCTION
Value: $ (Q 6 ��
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2 family dwelling '\ Commercial/industrial ❑ Accessory building
❑ Multi - family 0 Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOC TIQN atinglcooling
J '� f A
Job site address: � �j C /i`' ���/// frj g �i�( (requires r site plan conditioning show ing heat placem ent) 14.00
City / State/ZIP: i ( f e / / ZZ Furnace 100,000 BTU (ducts/vents) 14.00
Project name: Qo,/O Furnace 100,000+ BTU (duds/vents) 14.00
Suite/bldg. /apt. no.: I s Tias heat pump 14.00
Cross street/directions too site: Duct work 14.00
�j ` /� Hydronic hot water system
/ /� /'� 1�� -Cr Residential boiler (radiator or
hydronic) 14.00
/ Unit heaters (fuel -type, not electric), 14.00
in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: I Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
1 , a
I DESCRIPTION OF WORK Water heats 10.00
`� Gas fireplace 10.00
� S ,/ Flue vent for water heater or gas
e� .. a � *, =/ ,r fireplace 10.00
`� +�W I Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
PROPERTY OWNER ' I ❑ TENANT
/ 1 � / �� Chimney/liner/flue/vent 10.00
Other: 10.00
Name: vV� �j e /1 Environmental exhaust and ventilation
Address:
` �- Range hood/other kitchen
equipment 10.00
•
City /State/ZIP: - Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) 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 additiona
Address:
Furnace, etc.
Gas heat pump
City /State/ZIP: WalUsuspended/unit heater
Phone: ( ) . Fax: : ( ) Water heater
Fireplace
E -mail:
Range
1 CONTRACTOR Barbecue
n //) n _ I Clothes dryer (gas)
Business name. G^ ( V V �(�' ItV//��L Z
� �' � o � Other:
Address:
C Q 1 J 3 „,., ) c+ /v ._ I MECHANICAL PERMIT FEES*
City /State /ZIP: N - e - N - UYl 2', U v 5 Subtotal 7a. 5
Phone: (9 ) � Z Ct 9g'� Fa x: « ') Co L\ \ -...Co- 0 Min ime%it fee )
Plan r eview w (2255% of permmit it fee
CCB lic.: r p Ia / /rcharge (8% of permit fee) , V) `-C g State surcharge L TOTAL PERMIT FEE 7 '. 3n
Th perm application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: /Z - N { p 4 I Date: • Fee methodology set by Tn County Building Industry Service Board
i \ Building \Pennits\MEC- PetmitApp doe 12/03 4404617T (1 I /02/COMM'FB)
Mechanical Permit Application - City of Tigard ® J �. •
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$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 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date RequestedI —°2//�� AM PM BUP
Location ` 71/ t �- sly - VII) Suite MEC 0 -00, -5 -1-6) c )10 3/
Contact Person Ph ( ) — gc PLM
Contractor • Ph ( SWR
BUILDING Tenant/Owner ► - �L: _ ELC
Footing
Foundation ELC
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 _ 1
4k
Other. I ,
I-MI`��-��
PASS
PLUMBINGRT FAIL r ®!
Post & Beam \ W. —
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
PASS PART FAIL
LE ' - ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspectio fee of $ required be Ire next inspectic .. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Q Please - I for reinspe tion RE: � El Unable to inspect – no access
Fire Supply Line 4 60
ADA arrk
Approach/Sidewalk Date Inspecto Ext
Other:
Final DO s T REMOVE this Inspe Ion record from the job site.
PASS PART FAIL