Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00257
%TIG 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2008
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG
PROJECT: H MART
Project Description: TI. Adding new gas line to kitchen equipment. NO PLAN REVIEW REQUIRED.
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:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAP ADVISORS
38345 W TEN MILE RD, STE 170 [MECH] Permit Fee 5/21/200E $59.90
FARMINGTON HILLS, MI 48335 [TAX] 12% State Surch 5/21/200E $28.75
Phone: Total $88.65
Contractor:
RELIABLE GAS SYSTEMS LLC
810 COLUMBIA DR
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 679 -4529
Reg #: LIC 179399
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 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 40 1111 . Permittee Signat /
Call 503.639.4175 by 7:00 a.m. for inspe tions that busine s day.
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 f; ` ; ' -r, , ,t ' '"� w lat , 'a- *'
�, r1 O R OFF• igg , 01L � i e4 `'
`� City of Tigard C Received C
� .�
t }t 1• .1� v 13125 SW Hall Blvd., Tigard, OR 97223 ^O PlateBy: / (7 r itNo.:� �a �{ 2
F a b _ q Plan Review V
Ph one: 503.639.4171 Fax: 503.598.1960 1. OW/By: Other Permit:
4f G�A RD� Inspection Line: 503.639.4175 P�
i l e Ready/By: luris: ®See Page 2 for
It "fiiz�3nszsst Internet: tvww.tigard or.gov Ole 11 .01 , " Notified/Method: Supplemental Information
0
TYPE OF WORK , COMMERCIAL FEE* SCHEDULE. - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction , Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION - - . Value: $ /G, 7
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
❑ 1- and 2- family dwelling ,21 Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
- JOB SITE INFORMATION • AND. LOCATION • • • • Heating/cooling
Job site address: /,36 d S t� Air conditioning o heat pump
��r>t•L / (requires site plan showing placement) 14.00
City /State /ZIP: 7, ? G 2 97 2,0 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: s frfe, Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Flue /vent for any of above 6.80
Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
A. v
_ J J r �1 ('e / ,, Gas fireplace 10.00
4/ 6 , .*9 $ 70 /c4c /4# 4 F_ (>< uiI'vem 0- Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER • . ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name:
reek., Environmental exhaust and ventilation
Range hood/other kitchen
Address: / 3 G U G s PRcr•(••C )*/,y equipment 10.00
City/State /ZIP: 7i G,t.ed OIL 9 2,2 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( FV we- G 3 7 Fax: ( )
Li
toilet compartments utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Atticicrawlspace fans 10.00
Business name: Other: 5�'� /Aft-- / 10.00 (��
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: !te /e'a4 it 6-,45 S n fetes
Clothes dryer (gas)
Other
Address: g /() GO / 1/f t f c.. 4) '95 MECHANICAL PERMIT FEES*
City /State /ZIP: / O f ?4::03,:y Subtotal
(S Minimum permit fee ($72.50) 78 Phone: 7 i f) a7 er ys °I F ax: ( ) Plan review (25% of permit fee)
CCB lic.: / 721,3 91 State surcharge (12% of permit fee) (9:8% i ( TOTAL PERM w ithi • IT FEE G s-
Authorized stgnatu a This permit application expires if a permit is not obtaine n rov
days after it has been accepted as complete.
Print name: ,, 01 Op re & A Date: V2/Oy • Fee methodology set by Tri- County Building Industry Service Board
1\Building\Permits C- PermiWpp.doc 01/19/07 440 -4617T (I 1/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: •
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1 \Building\Permits\MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD �,
BUILDING DIVISION PERMIT #: MEC2008.00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/21/2000
Phone: (503) 639 -4171&
Inspection Requests (24 Hrs.): (503) 639 -4175 `
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:OOAM PAGE: 17
•
SITE ADDRESS: 13600 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: TIGARD MARKETPLACk. LOT #: TYPE OF USE:
PROJECT NAME: 11 MART
DESCRIPTION: TI. Adding new gas line to kitchen equipment. NO PLAN REVIEW REQUIRED.
OWNER: 13600 PACIFIC CORP, PHONE #:
CONTRACTOR: RELIABLE GAS SYSTEMS LLC PHONE #: 503- 678.4528
Inspection Request Scheduled For: Date: 5/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 070446-01 503- 783 -3874 N
Corre ' ns /Comments /Instructions: .
(2
A
i�'l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAI ) ill CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
• ��//!f
Inspector: _ / / ..— Date: r G8 Phone #: (503) 718 - L._!o
I