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CITYOF TIGARD _ MECHANICAL PERMIT
DEVELOPP!!CNT SERVICES PERMIT#: M -OQ423
DATE ISSUED: 7/23/0323/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S13513C-00200
SITE ADDRESS: 10000 SW CASCADE AVE
SUBDIVISION:
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:
Fl.E 3 - 15 Hr': 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 OTHER UNITS: 2
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace(2)wall units a/c with like kind. Vclue: S,1910-00
Owner: FEES
GTE NORTHWEST INC Description Date Ama,ant
GARY N WILI_IAMS �MLC'lIJ fcrmit fee 7123/03 $72.50
GTE TELEPHONE OPERATIONS
IRVING,TX 75015 ITAhj god,ytatcTax 7/23/03 $5.80
Total $78.30
Phone:
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 462-4822 Cooling Unt Insp
Reg#: LIC 50897 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-09
Issued By: ._ Ci<<��_4 ( Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business dray
Mechanical Perinit Application ROW
Date received: permit no.:� ?
City Of Tigard f-,F,1 I pro ecUa I.no. --
J Pp Expircdatc:
City ojTigarrl Address: 13125 SW 11x11 Blvd,Tigard,Ok
Phone: (503) 639-4171 Dale issued: By Receipt no.:
Fax; (503) 598-1960 ,? : 003 Case file no.: payment type:
Land use approval: Building permit no.:
U I &2 family dwelling or accessory un j,rlVindustrial U Multi-family U Tcnant improvement
0 New construction ®Addiliunialtcralion/ ilacemcn U Other:
Job address: /C pCjo SU-) 92 Secs a E__ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no,: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax IoUaccount no.: profit. Value$
Lot:_ Block: Subdivision: _ 'See checklist torr important application information and
Project name: r - i Cs �� ,_ G(_)r.e , jurisdiction's Ice schcdulc for residential permit flee.
City/county: j ZIP: Q a3 t
Description and 1r ation of work on premises: tF-,o 2 a t ,;1 R ►r
tualKagg
Fee(ea.) Total
Est.date of completion/inspection: Description (AV. Res.only Res,onl)
Tenant improvement or change of use: ��-
Is existing space heated or conditioned?U Yes U No An handling unit CFM_
Is existing space insulated?U Yes U No Air conditioning(site p an rex %aired) --- --
Alteration of existing - AC system
3oilerT%compressors
Business name. P uAO State boiler permit no.:
Hp Tons BTU/H
Address:'a( j C ^a.� it smo a dampers/duct smoke detectors
City: C.t v.1 3 to '}L 'LIP: 7��1 _ tai pump(site p an requa e ) -
Phone: - ' Fax: 5<r E-mail: nstal/repacefurnact-7burner —HT1 — -CCB no.: c t 7 Including ductwork/vent liner U Yes U No
Insta I/rcp ace a ocate eaters-suspended, —
City/metro lic.no.: �'a`a 9 wall,or floor mounted
Name(pleaseimm): ` ,; Vent fora ianccuthcrthanfurnace
alkl&Xm lie WA of gerat on:
Absorption units BTU/H
Name: '•� Chillers-- Hp
Address: Compressors---__— HI'
_ -— Environmental ex nst an vent at on:
Oily: le Z :': Appliancevent
Phone: - —Fax: E-mail: )r erexaunt
floods, 11/res. itchy azmat -- ----
hood fire suppression system _
Name: "7z( Z-U I L, _ Exhaust fan with single duct(hath fans)
Mailing address: F trusts stem a)art from lieaun or AC
City: _ State: ZIp: Ue p ping andistribution(tip to outlets)
Phone: t;lx: f: mail: Type LIKi NG Oil
'iT i in each additions over 4 outlets
rocesspiping(schematicrequire )
Name: Number of ootlets
Address: — -— — -- (•1 er ism appliance or equipment: -
Decorative fireplace
City: fl(ate: I ZIP: ::Tnsert--type _
I'llone: Fax: E-mail: oo stov pc et stove — --
Applicant's signuwrc. D (rihcr: -
ate: 7 Z:3ter:
Name (print): o� r� --
Na nil Jurisdictions accept credit cards.plEar.cell 1uricdictinn Gr rna�infrxrnation
PcnnU fele.....................$
U Visa U MasterCard Notice:This permit application Minimum fee................$
Credit card number:—_ expires if a permit is not obtained
Plan review(at 96) $
within 180 days after it hes been _
� _
Name of c Ider m shown on credit card - accepted as complete. State surcharge(896)....$
--- --- $ TOTAL .......................$ •
Carrlhalder signarurc Atnoant
400.1617(6C1a,COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VAL ATION:__ PERMIT FEE - _ f5escripiion- Price Total
$1.00 to$5,000.0 Minimum fee$72.50 Table 1A Mechanical Code _ Qty (Ea) Amt__
$5,001.00 to$10,00 00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BW
l;
$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
$ ,001.00 to$50,000.00 $. 9.50 for the first$25,000.00 and v 5) Vent not Included in appliance rmit
25
$1. for each additional$100.00 or _ _ __ 680
lractmvthereof,to and including 6) Repair units1 12.15 -
$50,001.00 and up $742.OG r the first$50,000.00 and Check all that apply: 0013oilet Heat Air
$1.20 for ch additional$100.00 or For Items 7.11,see or Pump Cond
fraction the of. footnotes below. Com" -
_____ __ _ _ 7)<3HP;abcorb nil
Minimum Permit Fee$72.50 SUB TAL: $ to 10OK BTU _ 14 00
8)3-15 HPA bsorb
0%State Surch e $ Unit 100V6 500k BTU _ 25.60
_ _� __ rJ)15- HP;absorb
25%Plan Review Fee(of subtota $ unit -1 mil BTU _ _ _35.00
Ft uired for ALL commercial permits o- 1 30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: It
1-1.75 mil BTU 52.20
11)>50HP:absorb
- -- �` "� unit>1.75 mil BTU 87.20
_ 12)Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Tot 13)Air handling unit 10,000 CFM+
Desrxi tion: _ D Ea A_mo _ 17.20
Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
ducts&vents 10.00
Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
duets&vents _ _ i 6.80
Floor furnace Including vent 955 _ 16)Ventilation system not Included In
Suspended heater,wall heater or 95 appliance permit 10.00 -
floor mounted heater Hood served by machanical exhaust
Vent not included in applicance 45 - 10.00
hermit 181omestic incinerators
Repair units - - 805 17.40
<3 hp;absorb.unit, , 955 19)Co merdal or industrial type incinerator
to 100k BTU 69.95 --
3-15 hp;absorb.unit, 1,700 20)Other its,including wood stoves
101k to 500k BTU 10.00
15-30 hp;absorb.unit,501_kto 1! 2,310 21)Gas pipin one to four outlets
mil. BTU 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4- r nutlet(each)
1-1.75 mil.BTU 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fe $72.50 _ SUBTOTAL: $
>1.75 mil.BTU
Air handling unit to 10,000 cfm 656 81i.State Surcharge $
Air handling-unit>10,000 cfm 1,170
No nrtable eva orate cooler 658 TOTAL- RESIDEN L PERMIT FEE: $
Vent fan connected to a singif duct 446
Vent system not Included In 658 ----- ----- - - -
a (lance ennit
_� Other Inspections and Fees:
Hood served by mechanicalexhaust _ 656 1 Inspections outside of normal bu\iequited'ttn"r
inimum charge-two hours)
Domestic incinerator 1,170 $72 so per hour
Commercial or industrial incinerator 4,590 2 Inspections for which no fee is sped (minimum charge-half hour)
Other unit,Including wood stoves, 656
$d 5o per hour
Inserts,etC. 3 Additional plan review required btions or revisions to plans(minlmun
_ charge-one-half hour)$72.0 per
Gas piping 1-4 outlets 360
Each additional outlet 63 "State Contractor Boller Certificr units>200k BTU.
_ `*Residential Arequires Slte plan showing placement of unit-
TOTAL COMMERCIAL $ AX
VALUATION:
i:\dsts\forms\mech-fees.doc 08/06/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received __-__ Date Re1uested_ AM----_-. PM BUP _
Locatior / 0006) _ Suite MEC 3 —
Contact Person ___ _ Ph(.. __.) � =��U�_ PLM
Contractor _
_ __ n, Ph SWR
BUILDING Tenant/Owner )_ — — ELC --
Footing --- ELG -- —.------
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 --�—
Firev.all /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling — - --
Roof
Other-
Final
ther 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
PASS PART FAIL -�-- -----
M_ECHANICAL
Post$ Beam
Rough-In
Gas Line
S"e Dampers -
Final --
PASS PART FAIL ---
ELECTRICAL
---- ------
Service
Rough-In --- ----- �-
UG/Slab --- _ _ -------
Low Voltage
Fire Alarm ---------- - ------- --
Final LJ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE
1-1 Please call for reinspection RL._ - Unable to inspect-no access
Fire Supply Line
^ 1.
AC,
Appropch/Sidewalk [lets `� ��! � _ Inspector Ext
Other
final O NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 5W Hall Blvd., Tigard,OR 97223 (503)639-4171
`ll�077
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Plarlck/Rec. #
Permit # 77-L�'_
Phone (503) 639-4171 Date Issued
CITY OF TIGARD FAX (503) 684-7297 Issued by __
TDD No. (503) 684-2772
Inspection (503) 639-4175 _
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development1 ,_-- Number of Inspections per permit allowed
Address A)" L'-' i- i__ (_IGS-i.I! ��.�c (_, .. Service included Items Cost(ea) Sum
Ciry/State2ip�C ��
4s. Residential-per unit 4
1000 ep II or In" $11000
"'� Each addrlional 500 sq It or
Name (or name of business)_ LZ1 portion thereof $2500 _
Commercial FlResidential ❑ LimitEn $2500 ^
r asch h Manuf'd'd Nome or Mod dor z
Ow.11inp Service or Feeder $60 00
2a. Contractor installation only:
4b.Services or Feeders
'• lJ 6utallalion alteration.or relocation
Electrical Contractor'// ��(�t�./ 1� 4-��(t' 200 amps or leer+ $CQ 00
Addre s���C�C'� �.J l�J. . 201 snips to 400 amps i- $130 00
Ciry�� State Zip ' .Z D Fol amppssto tOWto(300�mps $18000
Phone No. (her 1000 amps or vons $34000
Contractor's License No. X5„1 g lie onnoct only --- $5o 00 _
Contractor's Board Reg. No. !uy_5(c•� 4c. Temporary Services or Feeders
��., Inatallatir, alleration or relocation
Signature of Supr. Elec'n �tr.,� C'Y` ' 200 amps or loan _— $5000 --
License No. 3155 S Phone No. 201 amps to 400 amps Eir,on
401 amps to 800 amps $t no no —_�-.^-
Ovar 800 Ants to 1000 volts,
2b. For owner installations: see•b•abmie
4d. Bran--h:.;r suits
Print Owner's Name!_----- New,alteration or exteneron per panel
Address a)The tee Ir r branch circuits with
City_--____- State_______ Zip purchow of servilee or 11seder res
Eat',branch circuit
Phone No. _- b)Thu tee for branch prruile wirhouf
The installation is being made on property I own which is ph chase of sonke or".oder reo
not intended for sale, lease or rent. Fact adrint circuit b 500 -25,t-CP
Each nddawrml hrancit circuit $5 00 �_,,
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (i/ required): Each pump or irrigation circle $4000 2
Eacd1 sign or otAhne lighting $4000
Signal cimutl(s)or a limited energy ,/r
Please check appropriate Item and enter tee in section SB. panel,alteration or extension _L_ $40 00 'Ty
_4 or more residential units in one slrur.ttuo Minor Labels(10) —_ $10000 _
Service and feeder 225 amps or more
System over 600 volts nominal 41.Each additional Inspection over
_Classified area or structure contaminq spHclal occupancy the allowable in any of the above
as described in N E.0 Chapter 5 Per inspection $1`,
Per hourlily,nn
In Plant
Submit 2 sets of plans with application where any of the above
apply, Not required for temporary construction service. 5. Fees:
NOTICE 5e. Enter total of above fees $ ,•
5 Surcharge(05 X total fees) $ S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOH Plan Review if rpquirpd(Scat 3! $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account>r $
Balance flue $
uJ.tr��
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