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Permit C ITY OF TI G D MECHANICAL PERMIT 4I � DEVELOPMENT SERVICES PERMIT #: MEC2002 -00195 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/02 PARCEL: 1 S126C0 -01107 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: 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: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Installation of some new grills Owner: FEES PPR WASHINGTON SQUARE LLC Type By Date Amount Receipt P.O.BOX 21545 PRMT CTR 6/10/02 $72.50 2720020000 SEATTLE, WA 98111 5PCT CTR 6/10/02 $5.80 2720020000 PLCK CTR 6/10/02 $18.13 2720020000 Phone: Total $96.43 Contractor: ARROW MECHANICAL 10330 SW TUALATIN RD TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone: 692 -1565 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 requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 010 thr. u! OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by al ' ,03)246-9189. Issue By: Permittee Signature:. Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the ext business day - , Mechanical Permit Application mislifriemmiim 49- ih ,, Date received: Permit no.: )I j �''!..L City of Tigard i ° Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall B1vi 9 Date issued: By'. I Receipt no.: - Phone: (503) - 639 -4171 - - v I Fax: (503) 598 - 1960 Case file no.: Payment type: MAY 10 20P7 Land use approval: Building permit no.: CI A X vir A AkIY I11E OF PERMIT 0 1 & 2 family dwelling or accessory latommercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction Addition/alteration/replacement 0 Other: JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE Job address: Of/ I I 5 a S try h Sq, • indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: y i value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . E. Lot: (Block: ISubdivision: *See checklist for important application information and Project name: A-I d v jurisdiction's fee schedule for residential permit fee. City /county: 17 civ d I ZIP: 1 S. 2 FAMILY DWELLING PERMIT FIX SCHEDULE Description and l c lion of work on premises: 1 AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE' Fee(ea) Total Est. date of completion/inspection: Description Qty. Res. only Res.only Tenant improvement or change of use: 13VAC: Air handling unit CFM Is existing space heated or conditioned ?1a zes 0 No _ Air conditioning (site plan required) - - "Is existin s ace insulated ? = es - CI - No — — - - -- — - - - - - - g P Alteration of existing HVAC system MEClIAN CONTRACTOR Boiler /compressors �� .� '` , ` - / State boiler permit no.: put HP Tons BTU/H Address: Fire/smoke dampers/duct smoke detectors TQ `I City: I State: I ZIP: Heat pump (site plan required) Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner ❑ Yes ❑ No G1 CCB no Install/replace/relocate heaters - suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON' Refrigeration: Absorption units BTU/H Name: NI6 ( V 1 ( k Chillers HP 1-3'7- pas v< s fc 4--1 Com ressors HP Address: T Environmental exhaust and ventilation: City: a C. State: ZIP: d 5- O 1 Appliance vent _ Phone: smiinfiranamize E -mail: Dryer exhaust OWNER Hoods, Type 1/lures. kitchen/hazmat hood fire suppression system Name: A b \b 0 r y Exhaust fan with single duct (bath fans) Mailing address: I•3 z -( P°51": j\vt Exhaust system apart from heating or AC City: Tor 1� Cr C I State: C I ZIP: 0 . F-1 Fael piping and dishibation (up to 4 outlets) Type: LPG NG Oil Phone: Fax: E -mail: Fuel pi I ing each additional over 4 outlets ENGINEER ' + esspp ,g (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert - type Phone: ax: E -mail: ' Woodstove/pellet stove Applicant's signature: /WA/i ' /diilrlf.'iii�r , der M/�'/>�/ : Name (print): C h o MC (4 (J - V Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ Notice: This permit application ❑ Visa ❑ MasterCard Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. TOTAL $ ` Cardholder signature Amount 440-4617 (6/00tCOM) MECHANICAL PERMIT FEES ' k 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 to 100K BTU 14.00 ASSUMED VALUATIONS PER APPLIANCE: 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 applicants 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 18) Domestic incinerators >50 hp; absorb. unit, 5,725 17.40 >1.75 mil. BTU 19) Commercial or industrial type incinerator Air handling unit to 10,000 cfm 656 69.95 Air handling unit >10,000 cirn 1,170 20) Other units, including wood stoves Non - portable evaporate cooler 656 10.00 Vent fan connected to a single duct 446 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 $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: 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 NC requires site plan showing placement of unit. hdsts\forms\rnech- fees.doc 10/11/00 CITY F.TIGARD 24 -Hour "BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 • M,ST BUP • �. Received Date Requested AM PM BUPI / Location ' / w SO- ' Suite P — MEC c / 95-- Contact Person �//'l Ad -/-7 Ph ( ) 9.2 iC � ,S PLM Contractor 0000 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 • '.ART FAIL L •;•rg Gas Line Smoke Dampers F . - . PART FAIL 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 iC) 7 Approach/Sidewalk Date 2--- Ext - Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY 24 -Hour B UILDING Inspection Line: (503):639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 M ST aiak / %33 � s Bu — � ° / ?.;\ Received Date Requested F` AM PM O / 6 Location : - 0 r i/ Suite G� g1fylkS 4 0 c — GO /9, Contact Person �'J.r .r>, Ph ( S� /) � I — 7/ / O PLM Contractor ti Ph ( ) SWR in BUILDING Tenant/Owner Q ELC �, Footing ELC > &i AM Foundation Access: • V Ftg Drain • . ELR Crawl Drain - Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear AV Int Sheath/Shear n,, at- _ Ov /C S " _ ,9 ��_ Framing Y ►' \ Insulation Drywall Nailing Firewall Q .- -06 /Gj O c l Fire Sprinkler Fire Alarm / 4� t _ f-n S s-e--e.Q. Susp'd Ceiling J jQ (� � �) S 4 o ./ ) 1,,.. / � Cl Al oJ' 7 ` ZL < /� (A-1 -i _S r k 1 4 . �� c-� ASS PART 440/ PLUMBING L j /' / �/ . �� 5���� C 1 Post & Beam t� \ /J/� ,� lo-{K /�� . ' _ • Under Slab / 1 u� • Rough -In Water Service Sanitary Sewer 6 .�/�`" (- 2 - Q d / � ( T2' Rain Drains ` Catch Basin / Manhole / 1 V S u 5 s-S ( .s-4 c-e-fQs . Storm Drain Shower Pan lj C� / J ��` -y ' p — r--e Other: �. Final - = �, - PASS PART FAIL r i " —` MECHANICAL - : • Post & Beam x C� • Rough -In 1� Gas Line Q 1 \ pN✓ Smoke Dampers • PART FAIL RICAL: :, 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 ._ : 0 Please call for reinspection RE: 0 Unable to inspect - no access Fire Supply Line �p ADA Approach/Sidewalk � Insp ector /�` Y ? Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL