Permit F.M.
CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00185
` VI ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/13/04
PARCEL: 1312600-00300
SITE ADDRESS: 09718 SW WASHINGTON SQUARE RD F -5
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: a 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: 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: Alteration of ducts & grilles for TI. Project Value: $7,500
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQ. RD. [MECH] Permit Fee 4/13/04 $186.50
PORTLAND, OR 97223, [TAX] 8% State Surchaq 4/13/04 $14.92
Phone: Total $201.42
Contractor:
BEWLEY MECHANICAL
5591 SW ARCTIC DR
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Duct Inspection
Phone: 626
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
Utili ∎•. i !cation • -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR
95 - 001 -0100. You .y obt.'n c•pies of these rules or direct qu do to UN by calling
:03)246 -6699.
Issued By: - '' 4 - r m it tee • S k
Call (503) •39 -4175 by 7:00 P.M. for inspections needed the next business ay
Mechanical Permit Application FOR OFFICE USE ONLY
d
Receive 1•f /' _ /�/
City:of Tigard Rec 4 � Permit No I l L(./ (f
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /Gi�.•dr �. ti\ Date/By Other Permit
Inspection Line: 503 639.4175 _AI. r:4 al Date Ready/By Ju 0 See Page 2 for
Internet: www.ci.tigard.or.us Nonfied/Method /! C,. Supplemental Information
' TYPE. OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
%! ew construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overheoit and profit
- - • CATEGORY 'OF CONSTRUCTION Value: $ Q
RESIDENTIAL'EQUIPMENT /. SYSTEMS TEES*
❑ 1- and 2- family dwelltngommerciallindustrial ❑ Accessory building
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty Ea Total
JOB SITE INFORMATION AND LOCATION - Heating/cooling • Job site address: 7, _ 'J � ( g fires s o pl g p )
�1 ]t' �� re i titres sitte lan rig shoor wDen lacemenump t
14 00
City/State /ZIP: _ Furnace 100,000 BTU (ducts/vents) 14 00
/ ( C , Fumace 100,000+ BTU (ducts/vents) 17 90
Suite/bldg. /apt. no.: Project name: 14 U Q 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
/ � (0.,...._ Gas fireplace 10.00
,vj 4- .eve..„, Q,{^
/ /l / I am Cd- Flue vent for water heater or gas
//�� fireplace 10 00
"\-) ° e CL1 c \ `-f-'(--e---g-ill- �° ` ei, Log lighter (gas) 10.00 4/1 a d 7 J y� Wood /pellet stove 10.00
� --C Wood fireplace /insert 10 00
❑ PROPERTY OWNER ❑ TENANT • Chimney/liner/flue/vent 10.00
Other. 10 00
Name: 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
' 1 ❑ APPLICANT - . TCONTACT PERSON - : - ' Attic /crawlspace fans 10 00
Other: 10 00
Business name: rA� M .. G� Fu el piping
` P g
Contact name: I,
. Q - 6- $5.40 for first four; $1.00 for each additional
Address: C Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
- • ' CONTRACTOR , . ' . ' - Barbecue
Business name. tt � P i �) ' Clothes dryer (gas)
�f i kt v" er 1._ C rn Other.
Address: C' l
'� 9 1 � c....3 �C 4 t C �, _,, , MECHANICAL PERMIT FEES *`
City/State/ZIP: C- c,;(.J � r\--- &E! Cr �\ Subtotal
rr __ Fax: / _ ` 4 .0.,
Minimum permit fee ($72 50) / (� . S
Phone:
(�) W co ' ( �[��l 6 3 Plan review (25% of permit fee)
CCB lie.: 3 ,r , R 2 State surcharge (8% of permit fee) /V. 7
pgj,,..--- TOTAL PEmMIT FEE �Q �A
Authorized signature: l[ _-t This perrr application expires if a prmit is nct obtained within I80
days after it has been accepted as complete.
Print name: \ t7 .0_,/,t_ (e L � 4 ( Date: y(_ l� _ a ' Fee methodology set by Tn- County Building Industry Service Board
i \Bwlding\Pemits \MEC- PemutApp doe 1 2/03 44 - 4617T (1 I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
TotaI Valuat on ° :; {tea :s,_p ;Perimt? ee�- _ p 4
$1.00 to $2,000.00 Minimum fee $72.50 G / t)--°'
$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 L� 0
$10,000.00. 0
$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.
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