Permit CITY OF TIGARD
MECHANICAL PERMIT
"1 `B . COMMUNITY DEVELOPMENT Permit#: MEC2015-00692
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015
Parcel: 2S 101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST
Project: Tigard Retail Center,Retail#2 Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Gas piping to RTU's for future tenants.
Contractor: LEED CORPORATION MECHANICAL CONTRACTOR Owner: WAL-MART REAL ESTATE BUSINESS TR
PO BOX 896 BY PROPERTY TAX DEPT STORE 5935-00
BATTLEGROUND,WA 98604 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-723-0180 PHONE:
FAX: 360-723-0327
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/14/2015 $271.64
Class of Work: ALT Type of Const: VB Plan Review 10/14/2015 $67.96
Occupancy Grp: M Occupancy Load: 12%State Surcharge-Mechanical 10/14/2015 $32.62
Stories: 1 Info Process/Archiving-Lg$2.00(over 10/14/2015 $14.00
Project Valuation: $7,250.00 11x17)
Fuel Air Handlers
Fuel Types: Natural Gas Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $386.42
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: 3 Other Desc:
Duct Work:
Fire/Smoke Dampers:
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 the 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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 . 4.
Issued By: A....._.,.__}..„ Signature: C
Call 3. 9.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application •IS9 FOR OFFICE USE O,NI.I
Received
CI of Tigard Permit No d/t ��' ���jjj/�(
`J g �O` Date/By: !O fl j 7 A I IIL5�f r)(4�
13125 SW Hall Blvd.,Tigard,OR 1"J
Phone: 503.718.2439 Fax: 503.5 60 Plan Review
Date/By: Other Permit t.q7,5
'�� y: oZU�.�tln t`
TIGA RD Inspection Line: 503.639.4175 O to Ready/By_ rues' ® See Page 2 for
Internet www.tigard-ocgov Oda r�P9 Q tified/Method: Supplemental Information
promo
""' _ '• Mechanical permit fees°are based on the value of the work
®New construction ❑Addition/alter. on/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$7,250.00
- CORY OF CONSTRUCTION
RESIDENTIAL EQD, w PEES'
❑ 1-and 2-family dwelling ®Commercial/industrial Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
rsp,y OP
, TION AND LOCATION Beafing/cooflnt;:
' Air conditioning 46.75
Job site address:7500 SW Dartmouth St. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Walmart Outbuilding 42 Duct work 23.32
Cross street/directions to job site:Dartmouth Hydronie hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,induct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no,: Water heater 23.32
, t. +HIP`1'f Ba, gxsii..ifigyInfitlinaniiiiiiiii1RWRIDI Gas fireplace/insert 33.39
Flue vent for water heater or gas
Gas Piping ran for future Tenants fireplace _ 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERI Other: 23.32
t _
� Environmental exhaust and ventilation:
Name:Wal-Mart Stores,Inc. Range hood/other kitchen
equipment 33.39
Address:2001 SE 101°St. Clothes dryer exhaust 33.39
City/State/ZIP:Bentonville,AR 72716 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawispace fans 23.32
® APPI TCANT Other: 23.32
Fuel piping:
Business name:Leed Corportion Mechanical Contractors,Inc. $14.15 for first four;$4.03 for each additional
Contact name:Drew Johnson Furnace,etc.
Address:PO Box 896 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Battle Ground,WA 98604 Water heater
Phone:(360)723-0180 I Fax::(360)723-0327 Fireplace
Range
E-mail:drew@leedcorporation.com Barbecue
, >- t ' Clothes dryer(gas) _
Business name:Leed Corporation Mechanical Contractors,Inc. Other:
MECHANICAL PERMIT FEES'
Address:PO Box 896
Subtotal 270.44
City/State/ZIP:Battle Ground,WA 98604 Minimum permit fee($90.00)
Phone:(360)723-0180 Fax. __... Plan review(25%of permit fee) 115.03
(360)723-0327
State surcharge(12%of permit fee) 32 45
CCB lic.:181012 TOTAL PERMIT FEE 417.92
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name:Drew J Date:10/13/15
tlBuildingAPewitsiMEC_PnmitApp_040113.doc 440-4617T(11/02/COMIwEB)
11111 _ Building Division
•
Over-The-Counter (OTC) Mechanical Permit
TIGARD Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of-Work: Occupancy Group: Type of Construction: ,10
*Type of Use: Oregon Specialty Code:
Number of Stories:
FUEL FURNACES
Type: Furnace< 100K BTU Furnaces>= 100K BTU
Gas Pressure: 10 Lai) Roof Top Unit(RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units> 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler(BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire/Smoke Dampers Other Mechanical Units—Describe:
Total Project Valuation: $ 71 Z FEES DUE
21(44 ^ $ Mechatrical Permit Fee
674.4 - $ Plan Review
- f,4 — $ 12%State Surcharge
ov $ Info Proc/Arch,Lg(over 11x17$2.00)
$ Info Proc/Arch,Sm (up to 11x17$0.50)
$ Misc.Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff: 2 / I0
Date/Time: $ 1(/ _ OTAL 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:1Building\Forms\OTC-MEC.docx 01/13/2011