10200 SW GREENBURG ROAD-4 Y�
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10220 SW GREENBURG RD
4"" FLOOR I
CITY OF TIGARD Commercial Building Permit Application Recd By --
13125 SW HALL BLVD. Tenant Improvement DateRec'd--_.�-_-_
TIGARD, OR 97223 Date to P.E. _
503 639-4171mate to DST
p" Permit x bu
Print or Type Related SWR
Incomplete or illegible applications will not be accepted caller,_
Name of Devolopment/Projec! -��-_ - Existing 9uilding`II1""''� New Building O
Job Litncol vl CeKi
Address Street Address Suite Building
1ca2e sW C-°&Klo'-o Ind. F°STN Data
Bid P• City/Slate zip Existing Use of Building or Property:
T� ,N-EE
i,IhlrQl_/�1 P Office
Name
Property K � p� P Z� I Proposed We of Ruilding or Property.
{ �I� E'-l�Li o G N �
Owner Mailing Address I Suite C)'T-T-1 C":�
0300 -3W GreeiAL—!!tFj. No. O(SWries. —
City/State Zip — Phone ^ (0 s i X
tDrid a► 97223 52-S Sq.-FtOff Project-
Occupant
r ject:
Occupant Name
(Coirrjdr Occupancy Class(es)
Name
I rr
Contractor Mal IbV Pacj-1 tc_ Type(s)of Construction —
Prior to permrt Mailing Address Suite
squall licenses
a copy73* NF �2ck on school �c( Will this project have a Fire Suppression System?
of all licenses _ yes 1 No ❑
are required If Clty%Slate Zip - -Phone Americans WItSabIIIt12S Act ADA
expired in C.O.T. I (ADA)
database , 1-717-1- V)2--')79_7 Valuation X 251/6 =$_-- _ Participation
ctr,,gon Const.Cont.Board Lica Exp.Date Complete Accessibility Form
5 9�� I-E, ?_�I g 00 ��. Project ---- $ ----
__.` ou
Name — ValuationjnU
Architect f" R' �`r J0er`fkrt 1h r Plans Required: See Matriy for number of sets to submit
Railing Address Suite on back
City/State Zip Phone I hereby acknowledge that I have read this application,that the Information
fortl a.ild to/- '97't0 Z2,-%56 given is correct,that i am the owner or authorized agent of the owner,and
/
Engineer Name that plans submitted are In compliance with Oregon State taws
)Signature of Owner/Agent Date G --
Mailing Address Suite '_Yy� YG___Ie _'_' ��A3 _99
Coijct Person Name — Phone -
City/State Zip Phone 1 [, GIUr 22.1 6--j
` FOR OFFICE USE ONLY
Indicate type of work. New O Addition O Demolition O Map/Tl.fl -- —� Land Use:
Accessory Sta rture O Foundation Only O Aiterationx
_Repair 0 _ Other O _ Notes
Description of work:
EXTrF►`'SION of GXI.rTIrt S CoP-PL1100P To -
Rip-M " l-dor W CnPILIboR SYSTC-M
Nota Site work Permit Application must precede or accompany Building
Permit Appllcatkm
I\COMNEWTI DOC (DST) 5198
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. for an electrical submittal, the application must contain the
signature of the supervising electrician before plan revrev4 will be conducted.
After plan review approval. Plans Examiner will contact the applicant to request
additional plan sets for distribution purposes. (Copy for Contractor, Citv,
Washington County, Tualatin Valley Fire & Rescue)
Total# of
TYPE OF SUBMITTAL Plans KEY---
Submitted
S (Private) �� 1� S = Site Work
B (New or Add) — ~-- 1- - B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
6-& M (New or Add) _ ! 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E �3 Alt = Alternation to Existing
(New , Add) T Building
B
* orB & M (Alt) __ 1
3
*B & M & PRE(A—
"B M & P & E & F(Alt)–, 3
NOTES-
*Shaded areas designate ALT submittals only.
I wstsvormmmatmom deet 10/30/98
rte•
ELECTRICAL PERMIT
\
CITY O F T I G A R D PERMIT#: ELC 1999-00756
DEVELOPMENT SERVICES DATE ISSUED: 12/22/1999
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL.: 1 S135AB 01002
SITE AODRFSS: 10220 SW GREwENBURG RD 4TH FLOOR
SUBDIVISION: CIURFEWNCOLN-TOWN OF METZGER ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
F-- —R
(Description: Add a first branch ciruits for the 4th Floor Corridor
I _ RESIDENTIAL UNIT TEMP SRVC/FEEDERSMISCELLANEOUS _
1000 SF OR LESS: _ 0 - 200 amp:- PUMP/IRRIGATION:
EACH ADD'I_ 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
MANF HM/SVC/ FnR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER _BRANCH CIRCUITS _ _ADD'L INSPECTIONS_
0 - 200 amp: W/SERVICE OR FEEDER: 0 PER INSPECTION:
1
201 - 400 amp: 1st W/O SRVC OR FDR: i PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION__ _
1000+ amp/volt: — >=4 RES UNITS: > 600 VOLT NOMINAL
Reconnect only: ___-_ SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OAC:_
Owner: Contractor:
KNICKERBOCKER PROP, ING ,XIV CHRISTENSON ELECTRIC INC
BY NORRIS, BEGGS + SIMPSON Ill SW COLUMBIA
10300 SW GREENBURG RD STE 200 STE 480
PORTLAND, OR 97223 PORTLAND, OR 97201
Phone: Phone: 241-4812
Reg#: LIC 000458
SUP 3289S
PLM 2468S
ELF 26-34C
FEES — _ Required Inspections
TypeBy Date Amount Receipt Elect'I Service
PRMT GEO 12/22/199 $37 50 99-320619 Flect'I Final
5PCT GEO 12/22/199E $3 00 99-320619
Total $40.50 ORIGINAL
- — -—J
---------- I
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Specialty Codes and all othur applicable laws
All work will be done in acmidance with approved plans. This permit will expire if work is not started within 180 da s of issuance,or if work is
suspended for more than 180 days ATTENTION Oregon 12vv requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAP A52.001-9080 You may obtain ropies of these rules ordirect questions to OUNC at(503)
246.1987
PERMITTEE'S SIGNATURE ISSUED BY:
_ OWNER INSTALLATION ONLY —The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE DATE:_. .
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ` �' `" /7 y DATE:-/-
LICENSE
ATE: /LICENSE NO: _% --- --- - --- —-
Call 639-4175 by 7:00pm for an inspection the next business day
CITYOF TIGARD BUILDING PERMIT
PERMIT#: BUP1999-00498
DEVELOPMENT SERVICES DATE ISSUED: 11/23/1999
13125 SW Hall Blvd., Tipard, OR 91223 (503) G39-4171 PARCEL: 1S135AB•01002
SITE ADDRESS: 10220 SW GREENBURG RD 4TH FLOOR
SUBDIVISION: TIJ.111VCOLN-TOWN OF METZ.GER ZONING: R-12
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: _ F'_OOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: AI.T FIRST: sf N:� _ S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2FR 388 sf N: - S: E: -- W.
OCCUPANC"GRP: B TOTAL AREA: sf ROOF CONST: FIRE. RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP, RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: R_EQD SETBACKS REQUIRED _
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK UET
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR. PARKING:
VALUE: $ 12,300.00
Remarks: TI - Provide a looped 1 hour corridor. No C of 0 required. No change in occupant load.
Owner: Contractor:
KNICKER'30CKER PROP, INC XXIV M.ALIBU PACIFIC
BY NORF IS, BEGGS + SIMPSON 735 NEJACKSON SCHOOL ROAD
10300 SV; GREENBURG RD STE 100 HILLSBORO, OR 97124
P�po e NU, OR 97223 Phone: 693-9797 ORIGINAL
Reg #: LIC 059045
_—FEES RFtaIIIRFf) INSPECTIONS
Type By Date �—Amount Receipt Framing Insp
PRMT KJP _ 11/23/1995 $151.75 99-319995 Susp Ceiling Insp
PLCK KJP 11/:3/1995 $98.64 99-319995 Final Inspection
5P(;T K.IP 11!23,1199E $1? 14 99-31S995
FIRE KJP 11/23/199E $60.70 99-319995
Total $323.23
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.. Specialty Codes
and all other applicable law All work will he done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issU ance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those pules are set forth in OAR
952-001-0010 through OAR 952-vi-1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246-1987.
Pemt
Signature: � 7 --
Issued By: ----
Call 639-4175 by 7 p.m. for an inspection the next business day
TY OF TIGARD Electrical Permit Application Plan Check#
1125 SW HALL BLVD. RECEIVI Recd By_
T!GARD OR 97223 Date Recd_-
Date to P.E
Phone(503)639-4171, x304 DEC 21 199' Date to D:'
Inspection (503)639-4175 COMMUNITY In, Print of Type Permit#C.4-e
Fax (503)598-1960 Incomplete or illegible will not be accepted Called
1. Job Address NORRIS,BEGGS,SIMPSON PROPERTY MG W. Complete Fee Schedule Below: l
Name of Development LINCOLN CENTRE Number of Inspections per permit allowed
Name(or name of business) LINCOLN III 4TH FLOOR Service Included: Items Cost Sum
Address 10220 SW GREENBURG RD CORRIDOR LOOP 4a. Residential-per unit
PORTLAND OR 1000 sq.fl,or less $ 117.75 n
Cityy/Stat@I21pp ---- Each additional 500 sq.It or
UESTIONS7 CT ROSS CROS 965 portion thereof _ $ 2s.^.5 __ i
Commercial Residential Limited Energy $ 66.00
MALIBU PACIFIC
Each ManurdHome orModular
2a. Contractor Installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit Issuance,applicants must provide contractor license 4b.Services or Feeders
Info".atlon for COT data base)). Installation,alteration,or relocation
Electrical Contractor ClIRISTEN SON ELECTRIC, INC __ 200 amps or less _ $ 84 25 2
Address 111 SW COLUMBI ,SUITE 480 201 amps to 400 amps $ 85.50 2
PORTLAND OR 9 2.0 -5 401 amps to 600 amps $ 128.50 2
City State Zip 601 amps to 1000 amps $ 192.50 2
Phone No. 503 ' -4812 Over 1000 amps or voltsE 363.75 2
Job No. 62-(J602 Reconnect only - $ 53.50 2
Elec. Cont. Lice. No. 26-34C Exp.Date` 4c.Temporary Services or Feeders
OR State CCB Reg No. 458 Exp.Date 5 03 installation,alteration,or relocation
COT Business Tax or Metro No. 5246 Exp.Date 12 00^ 200 amps or leas _ $ 53.50
_ 101 amps to 400 amps $ 80.25
401 amps to 600 amps S 107.00 z
Signature of S4r_Elec' - Over 600 amps to 1000 volts,
8 7 3 S a""b"above.
License No. _ Exp.Date 10/01 if
Phone No. 503 241- 4d.Branch circuits
4812
-- ----- New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installatio► with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b)The fee for branch circuits
without purchase of service
City State Zip _ or feeder fee.
Phone No - First branch circuit _ 1 $ 37.50 37.50
Each additional branch circuit S 5.35
The installation is being made on property I own which is not 4e.Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle _ S 4275
Owner's Signature _ A Each sign or outline lighting _ $ 42.75
Signal circult(s)or a limited energy
panel,alteration or extension S 60.00
3. Plan Review section (if required):* Minor Labels(10) $ 10700
Please check appropriate item and enter fee in section 5B. 4f.Each additional Inspection over _
4 or more residential units in one structure the allowable in any of the above
-•-- Per inspection $ 5000
Service and feeder 225 amps or more Per hour $ 5000 _
System over 600 volts nominal In Plant $ 5900 -
__ ___Classified area or structure containing special occupancy as
described in N E C Chapter 5 111. Fees:
6a.Enter total of above fees $ 37.50
Submit 2 set,of plans with application where any of the above apply. 5%Surcharge(05 X total fees) 87 S
Not required for temporary construction services. Subtotal $ 40.50
5b.Enter 25%of line ea for
NOTICE Plan Review if required(Sec .q $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZEDI Subtotal $ 40.50_
IS NOT COMMENCED WITHIN 180 DAYS.OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust ACCOUnt# _
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due g 40.50
i'dstOfiirms\cicciric doc
CITY CSF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171
CC.R T f F'.i:CA TE (.IF..
0CC:I.1pANCV
PE RtI (T '1111 . . . . . . 1 EUP96-04 79
A{lDRE'.5S. . : W::OO SW GRE7CNNt3RG PC) #_31+6'.1
-.1BDIVISION. . . . orlVF" I. INCOLN 7ONING1(7 -F'
C)(;K. . . . . . . . . . : LOT.. . . . . . . .. . . . . . .. JURISDICTION: 1'I15
;..Oss Or WCIRV..
PE" Or, USE. COM
I YPE OF' CONS TR c+R
OCCUPANCY GRP. :S
0U—UPANr,'Y I-OAU: Ecl
TENANT NO . . . :MEAT R J x.
Pemarl".� 1 Plat),] 1'.I (..o�1Htr�.ii.:t. �, ar ricin+ , :.nteriur wGr1 t , aa.nc.i t,re '4k r U o
K,N I C:IAIF RSOC,14E R PF1OPER7 I E.S' INC
C/!:i NORR J.S, SE•:GG G & S I MF'SON
10300 ';W GREENBURC3 RD 0200
TIOAPI., OR
MALIBU PACIE'IC
r3`_', NE .JACKSON 9C:4IOOL. ROAD
HILL.^,T3ORO OR 971.24•
Tha $ ;;er•tific:3ate 11r.ants ocr,(pcarICY of the Above r•erfrrenced ht.tilrltrg or ;lur.titmn
thelr•eof And confirms that the builcliny leas been trisperr_i-omd for r_crmpl icanr.e wi +
the State of Or,grn Spec,iolty Coder, for the groUp, ocf. Apal-iCy, artci 1_t*e +.incivy.
which the r efwrenc,erd permit was i3sI_rerr..1.
AU1L 1l 11d' E.cr6r, _. SUIL.bINt3 OF'f"ICIAL
POST IN CONSPICUOUS PLAC'C
CITYO F T I^VARD BUILDING PERMIT
T r- PERMIT#: BIJP1999-00520
DEVEI_OPME_N'f SERVICE DATE ISS'1ED: 12/10/1999
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 PARCEL: 1S135AB-01002
S4TE ADDRESS: 10220 SW GRE.ENBLIRG RD 4TH FLOOR
SUBDIVISION: >]; -TWf .O'_N-TOWN OF METZGER ZONING: R-12
F_
BLOCK- LG
.OT: 009 JURISDICTION: TI
REIS—St 1E: _ FLOOR AREAS — E_XT_ERIOR WALL CONSTRUCTION
CI ASS OF WORK: FPS �^ FIRST: _ 3f N: V S: E: W:
TYPE OF USE: COM SECOND: 0 PROJECT OPENINGS? _
TYPE OF CONST: 2FR sf W S: E: W:
OCCUPANCY GRP: B TOTAL AREA: ,f ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT : MEZZ?: _ READ SEI BACKS _ REQUIRED
FT
FLUOR LOAD: psf LE : _ _ ft RGHI: _ �ft F!R SPKL: _ SMOK DET:
DWELLING UNI 15: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SIIRFACE: PRO CORR: PARKINCI:
VALUE- R 845.00
Remarks: Modificatio,i of$1 sprinkler heads for TI
Owner: Cc ntractor:
KNICKERBOCKER PROP, INC XXIV Fir^,ESTOP CO
BY NORRIS, BEGGS + SIMPSON 9384 SW ;CAR,) ST
10300 SW GREF_NBURG RD STE 200 rIG.ARD, OR 97223
P��PJT ND, OR 97223 Phorre: 620-6140
Reg#: LIC 00063846
FEES REQUIRED INSPECTIONS
Type By fate Amount +Receipt Sprinkler Rcugh-In
PRMT DEB 12/09/199 Y$50.00 99-320292~ Sprinkler Final
5PCT DEB 12/09/199E $4.00 99-320292
— Total $5400 ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law 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 the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR y52-001-1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987.
Pemnitee .
Signature:
l
Issued By: ------
Call 639-4175 by 7 p.m. for an inspection the n,,<t business day
Fire Protection Permit Application Plan C ��# -- _
CITY OF TIGARD Commercial or Residential Recd I�y 1._,-Z
13125 SW flAL' BLVD. Date Recd /!,lL —
TIGARD, OR 9't.,_. Print or Type Date to P.E. _ -- -
(503) 539-4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST
Permit# _
CalledZ114u -oo5
JOb�- im of De Plopment/Pr ject ' �._-3 `.
�, 9 t��� ►�� Type of System (Comp A old as app6.able)
Address
Address —`
O` A.)Sprinkler Wet —� ' Dry D
N
,AT N Standpipes T
_ _
Owner Mailing Address Additional Hazard Group —
—- City/State zip Phone Information Density `-
Name 49
��o�a� /�B Design Area --_
Occupant Malling Address
City/State zip Pfwne �� A.1) Sprinkler Project Valuation $ tn�
--- -- �>
Contractor Nam�fimfkl
B.) Fire Alarm
(Sprinkler or U ___
10 ---
Alarn company) Maili,�tress Submittal Shall Include Battery Calculations YF Prior to permit ( y;? 64-,(0 Jr • I
issuance,a 6ty7siaatte �1/y� I� Zip /Phoonne �//� Individual Component YES❑
copy G/ 'U Vl� /7M la-w-4 4o — --- �uoject
t Sheets
et an licenses _B.1) Fire Alarm Project Valuation $
are required if State Const.Cont. Board Lic.# Exp Date
expirsd in COT3�¢� ���, Project Valuation Subtotal (A dr or B)
_database
Name --_.�— — -- --- —
Permit fee based on valuation $
Architect Mailing Address (see chart on back,
7% Surcharge $
City/State Zip Phone - - — 40% of P'Lan Review 40/o of Permit $ ,
Describe work — -----
A.)New 0 Addition 0 n a
to be done --- " TOTAL $ f
H.) Modification to sprinkler heads only: —=-•— ---- ---- ---_ ——
1 1-10 heads=No plans required Plars required. Submit three sets of plans,'ncluding a vicinity map and
2. 11-Plan review required the location of the nearest hydrant.
I hereby acknowledge that I have read this application,that the infomratlon given is
Number of a )inkier heads:
correct,that I am the owner or authorized agent of the owner,and that plans submitted
are in compliance wi h Oregon State laws
Additional Description of Work:
Signature of Ow /Agent Date
A.)In Existing Building New Building ❑ 77—_
Building Co1�?ft�,ua�c�'t��Person Name �.�1 Phonc
Data B.) Commercia Residential ❑ _'� �r • �F �W
FOR OFFICE USE ONLY:
No, of stories: Plat# Map/TL#: —
Sq.Ft:
Notes
Occupancy Class Type of Construction
is\&ts\farms\ftresupr.doc 7/2/99
CITY OF TIGARD ____MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC1999-00546
13,125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/09/1999
PARCEL: 1 S135AB-01002
SITE ADDRESS: 10220 SW GRF_ENBURG RD 4TH FLOOR
SUBDIVISION: TKAITEMMIK,;OLN-TOWN OF METZGER ZONING: R-12
BLOCK: LOT: 009 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: 0 _ BOILER S_/COMPRESSOR_S_ 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 B1'U: AIR HANDLING UNITS
FURN >=100K BTU: <= 10000 cFn: GAS O: AS OUTLETS:
R UNITS: 1
> 10000 cfm:
Remarks: Extending return air duct though cc,,ri0or wall. Fire caulk for T. penetration.
Owner: FEES
KNICKERBOCKER PROP, INC XXIV Type By Date Amount Receipt
BY NORRIS, BEGGS + SIMPSON PLCK T BON 12/09/194 $12.50 99-320294-
10300 ✓ GREENBURG RD STE 200 PRMT BON 12/09/194 $50.00 99-320294
PORTLAND, OR 97223 5PCT BOA! 12/09/194 $4.00 99-320294
Phone: _Total $66.50
Contractor-
NORTH PACIFIC HEATING
33700 SE DUOS RD
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Mechanical Insp
Phone: Duct Inspection
Reg #:LIC 00063746 Final Inspection
n Nr"� 1 _
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080
You may obtain copies of these roles or direct questions to OUNC by calling (503)246-9189.
Issue By: l r �� �4���l Permittee Signature:
Call (50-i)639-4176 bV 7:00 P.M. for inspections needed the next business
Pi.-Checkk$ '� � 7C
CITY OF TIGARD Mechanical Permit Application Recd B L.�l�r
13125 SW HALL. BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(5031 639.417'1, x304 eM - Date to DST •--
Print or Type Permit#
q Incomplete or illegible applications will not be accepted _ called - -
Name of Develop VPro)ecl Description
Table to Mechanical Code _ _ of Price _Amt_
A
Job Street Address Suaew A) Permit Fee - - v 16.00
Address t r 1) Furnace to 100,000 BTU _ h"
including ducts&vents _ 9.65
BldgkytSte e ztP 2) Furnace 100,000 BTU+
including ducts&vents y 12.00
If Name(or name of business) 3) Floor Furnace
Owner including vent 965
a nq A rare 4) Suspended heater,wall heater
or floor mounted heater 9.65
fci 5) Vent not included in appliance permit 4.75
City/state Zip Phone Check all that apply: 'Boiler Heat Air
JJ For Items 6.10,see or Pump Cond Qty Pn r.- Amt
v ame(or name of business) footnotes 1,2 Com
/ C L,l 8.40
�� 8)Repair units
OccupantMailing ss -L 7)<3HP;absorb unit to
100K B_TIi 9.65
Cay/StateIp hone 8)3-1511P;absorb unit
� P 100k to 300k BTI) 17.65
Contractor Name 9) 15-30 HP;absorb
unit.5-1 mil BTU 24.15
HP;absorb
Prior to permit Mal
10)30-5t,ng Address unit 1-1.75 mil BTU 36.00
issuance,a copy ,.. 11)>50HP;absorb unit>1.7�mil BTU
of all licenses qay/Stat tip Phone 60.15
are required H Ow )) 12)Air handling unit to 10,000 CFM
expired in COT Oregon Const.Cont Bo-r34 Exp Date 7.00
database fi 2,1 _ Y- 13)Air handling unit 10,000 CFM+
Architect Name _ 11.85
14)Non-portable evaporate cooler
Or Meiling Address - 7.00
15)Vent fan connected to a single duct
4.75 _
Engineer Cay/stale zip Phone - 16)Ventllrjtlon system not Included In
appliance permit 7.00
Describe work to be done17)Hood served by mechanical exhaust
7.00
New O Repair 0 Replace with like kind. Yes O No 0 18)Domestic incinerators
Residential 0 Commercial Modification O 12.00
19)Commercial or Industria';roe incinerator
Additional Informs Ion or de cription of work: le 48.25
y �l'LYv tX tr1 C�C�G 'f� 20) Other units,including wcod stoves e c
7.00 i
N TE: For Commercial projects only;Units over 400 lbs.,located on the 21)Gas piping one to four outlets
roof,require structural talcs.prepared by licensed engineer. _ 3.75
Type of fuel oil O natural gas O LPG O electric O 22)More than 4-per outlet(each) .75
I hereby acknowledge that I have read this application,that the information Minimum Permit Fee$60.00 SUBTOTAL- o - ----
given is correct,that I am the owner or authorized agent of 8%SURCHARGE
PLAN REVIEW 25%OF SUBTOTAL C-6
the owner,that plans submitted are in compliance with Oregon State laws Required for ALL commercial permits only L i"
Signature of Owner/Agent Date TOTAL
Other Inspections and Fees
i Contact Person Name Phone
I ,nspections outside of normal business hours(minimum charge-two hours) $50.00 per hour
` �� J 2. Insper.Trons'it which no fee is specifically indicated (minimum charge-half hour)
Foonotes of r commercial prof only: $50.0operhour
3. Additional plan i°view required by changes,additions or revisions to plans(minimum
1. Provide full schematic of exisft and proposed gas line and pressure charge-one-half hour)$50 00 per hour
2 Provide drawings to scale showing existing and proposed mechanical *State Ccntractor Poiler Certification required
4nRs "Residential A/C equires site plan showing placement of unit
I Vnechperm doc rev 11/1/99
OVER-THE-COUNTER (OTC) PERMIT
COMMERCIAL MECHANICAL PERMIT CHECK LIST
Description of Project:
010-01-1
Class of Work- Floor Furnace-. Evap Coolers:
Type of Use: -Z-:!S Unit Heaters: Vent Fans:
Occupancy Grp: Vents w/o Appl, Vent Systems:
Stories- Boilers/Comprsrs- Hoods-
FuelTypes - 0 - 3 HP. Repair Units:
3 - 15 HP. Wood Stoves:
Max Input: _Btu: Air Handling Units Gio Dryer:
Fire Dampers: 10000cfm.. .- -- Oth Units:
Gas Pressure-, H / M L > 10000 cfm Gas Outlets,—
No. Of Units-,
Furn < 100k Btu.-
urn -- 100k Btu:
NOTES:
COMMERCIAL INSPECTION ACTIONS FEE: MENU
F
Gas Line Inspection $ Permit Fee
Mechanical Inspection $ 3-i—" Plan Review
Cooling Unit Inspection $ 8% State Surcharge
Shaft Inspection $ Additional Permit Fee
Hood Inspection $ Additional Plan Review Fee
Fire Suppr Inspection $ Inspection Fee
Duct inspection $ Miscellaneous Fee
Fire Alarm Inspection l 5,
Fire Damper Inspection REMARKS:
Miscellaneous Inspection
Fire Alarm Inspection
Final Inspection
FOR OFFICE USE ONLY:
TYPE OF USE OPTIONS(COM=commercial;CMS=cornry ercial manufactured stnicture)
CLASS OF WCRK OPTIONS FOR ALL PERMITS(NEW=new;ADD=additicn;ALT=0eration;ACS=accessory;
FND=foundation;OTH=other,DEM=demolition;REP=repair-FPS=fire Protection system.NOTE=USE OTH FOR FENCES,RETAINING
WALL,DETACHED DECKS,SIGNS, AWNINGS,CANOPIES)
11:/dst/fornis/otunech.doc 9199
i.\dsts\fonns\otc-mech.doc9/99 I
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CITY GF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 635-4175 Business Line: 639-4171 MST
BLIP
___-___ Date Requested_ ld-1a"7 AM_ _PM -_ BLD
Location ����� r ��/� Suite MEC 4�- —V~--
Contact Person .�t�SS ��1 ✓ S�E� -L� C(fr Ph -(o c/G'J PLM _
Contractor Ph SWR
BUILDING - Tenant/Owner ELC [l y " T&-7 YL
Retaining Wall -- ELR
Footing Access:
Foundation FPS
Ftg Drain --
Crawl Drain Inspection Note �, SGN _
Slab - -------- �� ( ,��("�i✓/�tir SIT
Post& Beam ---._-_.__.. -
Ext Sheath/Shear
Int Sheath/Shear --
Framing
Insulation
Drywall Nailing
Firewall -- ------- - - -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _--
Roof ---------_.._._
Misc: --------- --- ---
Final
PASS PART FAIL --------_--- ---_ ---- ---- ---_.__.. ------_._._...
PLUMBING
Post&Beam -- - - -- ---_ __�-.
Under Slab
1 op out -
-�---- --..-.- _ -----------
Water Service
Sanitary Sewer - ---- -- _—_� __—__---
gain Drains
I lnal -- -- -- __
PASS PART FAIL
MECHANICAL —`-----`
Post& Beam _--
Rough In —
Gas Line - -- -------- ---------- - - ------ _ _
Smoke Dampers
Final ----------------- - ------___
TrA5 T FAIL_
_-- ---
ELECTRICAL`
Rough In —
UG/Slab _
I ow Voltage :-- -
m
ASS PART FAIL
STM
Backfill/Grading -----------------—--- ---- _
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call fc•reinspection RE T —� [ I Unable to inspect-no access
ADA
Approach/Sidewalk CithprDate -_ — Inspector _ _ Ext
--
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 J r � ►
CB:
Date Requested (A VC& _AM '` PM
-) l y -vim S2 rrt
Location L �- - - gaite tri, rEC
A
Contact Person _ [ �( c_T _ Ph rtx PLM _
Contractor NI, -210 -S N�,e 2 SWR
11L WC; Tenant/Owner ELC
Retaining Wall ELR
Footing Access-
Foundation FPS
Flg Drain —
Crawl Drain Inspection Notes: SGN —
Slab - . _ --- — ----- — _— SIT
Post&Ream — --
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _._-._ —_ ----- ---- — - - — —- _._.
F irewall
F Q- r' y., -
Fire Alarm
Susp'd Ceiling - ---- — ---- _ - -
Roof
Misc: -- ------
in
AS PART FAIL
@ING�
Ilosl&Beam --- -- — --
Under Slab
Top Out -Water Service
Service
Sanitary Sewer --
Rain Drains
Final
PASS PART FAIL
M CRANI '�.')
Post&Beam -- -- — --
Rough In
Gas Line
Smoke Dampers
9PART_ FAIL
TRICAL -_--- ---- '
Service _
Rough In
UG/Slab _
Low Voltage _
Fire Alarm
Final -- __..------
PASS PART FAIL —
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before r.,A inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( )Please call for reins ection RE: ( J Unable to inspect-no access
ADA
Approach/Sidewalk J f D 7
Other Date _ ' 0 Inspector / (J' 1�- - ------rxt
Final
PASS PART - FAIL_ DO NOT REMOVE this inspection rea:ord from the job site.
UNIFIED SEWERAGE AGENCY OF WASHINGTON COUNTY
FIXTURE UNIT RATINGS
TOTAL TOTAL
FIXTURE VALUE NUMBED, NUMBER
BAPTISTRY/FONT 4
BATH TUB/SHOWER 4
JACUZ/%NPL 4
CUSPIDOR/WATER ASP I
D I SHWASHLR - COMMER 4 ~-
DOMEST 2
DR 1 MC 1 NG FOUNTA I N I
FLOOR DRAIN 2 INCH 2
3 1 N!.H 5
4 INCH 6
GARBAGE DISPOSAL
DOM (TO 3/4 Hp) 16
COMM (TO 5 I iP) 32
IND (OVER 5 HP) 48
OIL SEH (GAS STA) 6
SHOWER - GIAG I
STALL 2
S 1 li( BAR —�_ 2 _-�
BRADLEY 5
COMMIERC.I AL
SERVICE 3
WASHER, CLOTHES 6
WATER EXT 6
NATER CLOSET 6
F I NAL 6 —•
i
DATE ` �`T i I NSP /_- TOTAL "n
} EDU
BUSINESS ' r+� �Ut t�..� - L�__stit.�t��✓
ADDRESS ��� cJ G '�O• PF,RM N).
TAX MAP/Lor %L t- J 4t LS TLC', 7, ` ( COUNTED FROM
'3. 25 R83