Permit (143) C ITY OF TIGARD MECHANICAL PERMIT
a -:660lk DEVELOPMENT SERVICES PERMIT #: MEC2002 -00045
II DATE ISSUED: 1/29/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BA-00101
SITE ADDRESS: 16200 SW PACIFIC HWY Y
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 2 VENT FANS:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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: Supply and return air ducts and smoke detectors only. No new units installed. Relocate 2 unit heaters.
Owner: FEES
BIT HOLDINGS LTD PARTNERSHIP Type By Date Amount Receipt
BY FORUM PROPERTIES INC PRMT CTR 1/29/02 $102.90 2720020000
FIVE CENTERPOINTE DR STE 290 PLCK CTR 1/29/02 $25.72 2720020000
LAKE OSWEGO, OR 97035 5PCT CTR 1/29/02 $8.23 2720020000
Phone: Total • $136.85
Contractor:
PROTEMP ASSOCIATES INC
807 NE COUCH
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911 Final Inspection
Reg #: LIC 38868
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 .pies of these ru es or direct questions to OUNC • calli (513)246 -9189.
Issue By. AO/ _ v� � Permittee Signature: ¶,VJ i
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the e xt business day
- Aki. Mechanical Permit Application
Date received: j - ._cr _ 2 Permit noW ,6a _ 5 --
'';I!ii' City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, a ;_ ' 223 Date issued: By: O3 I Receipt no.:
Phone: (503) 639 -4171
OW Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 31) L 70/ ' d 0 ii 4, U Building permit no.:
TYI'E OF P :RMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /4„20(-7 � G(FlC, L I Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: y value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ /� 0400
Lot: Block: ISubdivision: *See checklist for important application information and
Project name: ,e. 7,, -4.- jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FIT, SCHEDULE'
Desc tion and location of work on premises: D, s7 ', Runo'✓ AND COMMERICAL. /INDUSTRLAL EQUIPMENT SCI IEDULE
t e... LT QA.Z, Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res.only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned ?1a Yes 0 No Air conditioning (site plan required)
Is existing space insulated? es ❑ No Alteration of existing HVAC system 3
MEnI AN ICAL CONTRACTOR Boiler /compressors
Business name: (e,74 17 Asset, _Z- . State boiler permit no.:
HP Tons BTU /H
Address: •'p 7 tir Fire/smoke dampers/duct smoke detectors
City: t-arlt- TGaA.,p Stater , I ZIP:of 7.23.2 Heat pump (site plan required)
Phone: a33 _ , /! I Faxe73r 9x71 E - mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner O Yes O No
3�$'ea� e\ Install/replace/relocate heaters -suspended,
City /metro lic. no.: S' S wall, or floor mounted
Name (please print): — y j Vent for a liance other than furnace
e era on:
Absorption units BTU/H
Name: ]; �G �t y 1."„....-r Chillers HP
A cr_ `
Compressors HP
Address:
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone:a33- fl j F - 3o. 774,7 " E -mail: Dryerexhaust
Hoods, Type IUres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
_
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets 1
Process piping (schematic required)
Number of outlets
Name: - Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: `E -mail: Woodstove/pellet stove
fir
Applicant's signature : /1 Date: / 02. — Mi r
Name (print): " / / ,t,r
Not all jurisdictions accept credit cards, please call jurisdiction for more information.' Permit fee $ /( _ )
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
credit card number: / / expires if a permit is not obtained Plan review (at %) $ a 5.'7 ,-
Expires within 180 days after it has been State surcharge (8%) .... $ ? .a 3
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ i �o. S
Cardholder signature Amount 440-4617 (61001COM)
MECHANICAL PERMIT FEES •, .
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT 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
fr ?ction 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
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal 9) 15 30 HP; absorb
$
Required for ALL commercial permits only unit .5 1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 - 50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >5OHP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 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
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445. 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, ' 1,700 20) Other units, including wood stoves
-
101 k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446 -
Vent system not included in 656 - -
appliance permit
Hood served by mechanical exhaust 656 - Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1
$62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 - • $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge-one-half hour) $62.50 per hour
Each additional outlet 63 *State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ ** Residential A/C requires site plan showing placement of unit.
VALUATION:. All New Commercial Buildings require 2 sets of plans.
i:\dsts\formslmech- fees.doc 12/26/01
Over - The - Counter (OTC) Mechanical Permit
Mechanical Check List
City of Tigard
Description of Project:„} -�`�`
GENERAL INFORMATION
Class of Work:* . Floor Furnace: Evap. Coolers:
Type of Use:* Unit Heaters: (2) Vent Fans:
Occupancy Group: NV\ Vents w/o Appl.: Vent Systems:
Stories: Boilers, Comp, Heat Pump, A/C: Hoods:
Fuel Types: 0 - 3 HP: Domestic Incinerator:
ELC / 6A / NG / OIL / OTHER 3 - 15 HP: Com./lnd. Incinerator:
Max Input: BTU: 15 - 30 HP: Repair Units:
Fire Dampers: 30 - 50 HP: Wood Stoves:
Gas Pressure: H / M / L >50 HP: Clothes Dryer:
No. of Units: Air Handling Units: Other Units:
Furnace <100k BTU: 510,000 CFM: Gas Outlets:
Furnace ?l00k BTU: >10,000 CFM:
Notes: �._ t'r •�--�� 2. L,..,,. 4 A•ve.L cx,., St, 0- L .
tJw_.•.J e.) •
INSPECTIONS, FEES DUE
Post/beam mechanical $ j o Z. C) b Permit Fee
Gas line $ Q , Z . State Surcharge
Mechanical reasglin $ 2,6". 'IL Plan Review Fee
Fire damper $ Additional Permit Fee
Duct work $ Additional Plan Review Fee
Smoke detector $ Investigation Fee
Investigation inspection $ Misc. Fee
Misc. inspection $ Hourly Rate Fee
Final inspection $ Hourly Rate State Surcharge
$ Total Fees Due
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK: ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs,
awnings or canopies); REP = repair.
i:\dsts \forms \OTC - MEC.doc 01/03/02
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTI N DIVISION Business Line: (503) 639 -4171 MST
// BUP
Received Date Requested 'T ZZ— AM BUP II
Location I 7 nc) - 4.0 J Suite MEC ZovZo
l0 9
Contact Person 9//14-yry, Ph ( ) 2 3 ft PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ti ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall > j ������..�7i ►— ;;:
Fire Sprinkler '�'
p � �� % !% . r% i / ., ci
Fire Alarm .4 =� �L
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
PASS PART FAIL
I-rANlAtI,
Rough -In
Gas Line
Si ; Dampers
i1VV1 PART FAIL
0 p CTRICAL
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 J
ADA Approach/Sidewalk Date L " � In spector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL