Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00088
T�G ARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/15/2008
PARCEL: 1 S136DC -04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 ZONING: C - G
SUBDIVISION: PP1995 -013 LOT: JURISDICTION: TIG
PROJECT: WINCO
Project Description: Rooftop equipment. $18,000
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: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
WAREMART INC Description Date Amount
BY BURKE + NICKEL
3336 E 32ND ST #217 [MECH] Permit Fee 4/15/200€ $339.50
TULSA, OK 74135 [MECPLN] Plan Rev 4/15/200€ $84.88
[TAX] 12% State Surch 4/15/200€ $40.74
Phone: Total $465.12
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 652 -0884
Reg #: LIC 149200
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- 1 -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: , - ` ��� Permittee Signature
Call 503.• 5 by 7:00 a.m. for inspections that business 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.
1,0 II cG 7.5C1 ` r'— ' • -
Mechanical Permit Application , FOR OFFICE USE ONLY
City of Tigard 1 r DateB a / 4 e) Permit NciAtee t7w
Iceg�7900 ;
° 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Revie 11 �
ix _
Phone: 503.639.4171 Fax: 503.598.1960 CC - ; 1 �Un� Date/By: `> 7 Ica Other Permit:
T I G A R D Inspection Line: 503.639 ! L Date Ready /By: luris: Vi See Page 2 for
Internet: www.tigard- or.gov ,�., �Rotified/Method: � /0 a / Supplemental Information
—: , , r ,,, ciao/L.4 " a I/L4 W r CiiYY:
TYPE OF WORK ' ' r COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor overheacjnd profit.
CATEGORY OF CONSTRUCTION Value: $ /
RESIDENTIAL EQUIPMENT / YSTEMS FEES*
❑ 1- and 2- family dwelling ® 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: 7501 SW Dartmouth Street Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: Tigard, Or. 97223 Fumace 100,000 BTU (ducts/vents) 14.00
Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: l DD Project name: Winco Store #23
Gas heat pump 14.00
Cross street/directions to job site: SW 72 off Pacific Hwy Duct work 14.00
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. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: 1 S136DC04500 Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Replace refrig. case w/ frozen case. Add condensing unit on roof to run frozen Flue vent for water heater or gas
case.
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: Winco Foods LLC Environmental exhaust and ventilation
Address: P.O. Box 5756 Range hood/other kitchen
equipment 10.00
City /State /ZIP: Boise, ID. 83705 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (208)672 -2026 Fax: (208)672 -2146 toilet compartments, utility rooms) 6.80
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: BRS Architects
Fuel piping
Contact name: Melanie Schuster $5.40 for first four; $1.00 for each additional
Address: 1010 S. Allante Place Ste. 100 Furnace, etc
Gas heat pump
City /State /ZIP: Boise, ID. 83709 Wall /suspended/unit heater
Phone: (208) 336 -8370 Fax: : (208) 336 -8380 Water heater
Fireplace
E -mail: melanie @brsarchitects.com Range
CONTRACTOR Barbecue
Business name: Source Refrigeration & HVAC
Clothes dryer (gas)
Other:
Address: 5506 SE International Way MECHANICAL PERMIT FEES*
City /State /ZIP: Milwaukie, OR. 97222 Subtotal
Minimum permit fee ($72.50) `��'9. 5Q
Phone: (503) 652 -0754 Fax: (503) 652 -0449 Plan review (25% of permit fee) Al 88
CCB tic.: 149200 State surcharge (12% of permit fee) ,74
TOTAL PERMIT FEE 4 f2
This permit application expires if a permit is not obtained within 180
Authorized signature: �� days after it has been accepted as complete.
Print name: Melanie Schuster Date: 2/13/08 * Fee methodology set by Tri- County Building Industry Service Board
1: \Building \Permits \MEC- PermitApp.doc 04/06/06 440 -4617T (I I /02 /COM/WEB)
CITY OF TIGARD • ' -
BUILDING DIVISION PERMIT #: MEC2000-00098
• 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/15/2000
Phone: (503) 639 -4171 1 \∎ ' f
Inspection Requests (24 Hrs.): (503) 639 -4175 - ' ' I..
INSPECTION WORKSHEET FOR DATE: 4/29/2008 TIME: 7 :00AMVM PAGE: 20
SITE ADDRESS: 07501 SW DARTMOUTH s f 100 ASS OF WORK:
SUBDIVISION: PP199E -013 �— LOT #: TYPE OF USE:
PROJECT NAME: WINCO
Rooftop equipment. $18,000
OWNER: WAREMART INC, I ll. PHONE #:
CONTRACTOR: SOURCE REFRIGERATION I;, HVAC IN PHONE #: 503.652- 06:34
J
Inspection Request Scheduled For: Date: 4/29/21108 Pour Time: 44,
•
Code # _ Inspection Description Confirm # Contact # Mess:' •- � f� •
609 Mechanical final 069001301 503-793-8379 ( v Y
Corrections /Comments /Instructions:
S kic 1 / jt
I ❑ PA❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES A ESUED.
Inspector: Date: .( [ o Phone #: (503) 718- 2-Y2-'-(
City of Tigard, Oregon O 13125 SW Hall Blvd. ° Tigard, OR 97223
I1
September 11, 2009
Duane Amyx
316 E. Main St.
Emmett, ID 83617
•
Re: Permit No. MEC2008 -00088
Dear Mr. Amyx:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 7501 SW Dartmouth St.
•
Project Name: Winco Foods
Job No.: N/A
Refund: ® Check #100498 in the amount of $310.24.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as scope of work changed and was completed under another
permit (MEC2008- 00210). Retain plan review fees for plan review already completed;
refund permit fee less $62.50 (hourly rate) for one inspection completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
•
I: \Building\ Refunds\ Admini stration \Ltrltcfund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
CITY OF TIGARD RECEIPT
q
c 1 31 25 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 175182 - 09/11/2009 •
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2008 - 00088 $ 310.24
Total: $- 310.24
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 100498 DHOWSE 09/11/2009 $- 310.24
• Payor: Duane Amyx
Total Payments: $ - 310.24
Balance Due: $310.24
•
Page 1 of 1
CITY OF TIGARD 1/14/2009
,1 13125 SW Hall Blvd.
• 9:14:28AM
Tigard, OR 97223 503.639.4171
TIGARD
•
Receipt #: 27200800000000001243
Date: 04/15/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2008 -00088 [MECH] Permit Fee 245- 0000 - 431010 339
MEC2008 -00088 [MECPLN] Plan Rev 245- 0000 - 433050 84
MEC2008 -00088 [TAX] 12% State Surcharge 100- 0000 - 207020 40.74
Line Item Total: $465.12
Payments:
Method Paver User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard DUANE AMYX CONST / BTT 015525 In Person 465.12
DUANCE AMYX
Payment Total: $465.12
cReceipi.rpi page I of I
- V City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Duane Amyx DATE: 8/20/09
316 E Main St.
Emmett, ID 83617 REQUESTED BY: Dianna Howse
/
TRANSACTION INFORMATION: zi ktr 1; 7 . 7
Receipt #: 2008 -1243 l Case #: MEC2008 -00088
Date: 4/15/08 Address /Parcel: 7501 SW Dartmouth St.
Pay Method: Cre and ' Project Name: Winco Foods
EXPLANATION: Per applicant's request as scope of work changed and was completed under another
permit (MEC2008- 00210). Retain plan review fees for plan review completed; refund
permit fee less $62.50 (hourly rate) for one inspection completed.
;`RI iF.ON.WIN.FORMAT : 0? � : =';`r
: :
- •LL:
F.e
esc'r'i
on Fro -
'- R�cei`
..R .,. ..� ...........� - .... .... .. Exaiii "le:�•245'.0000 =432 [MECH] Permit Fee 245 0000 - 431010 $277.00
[TAX] 12% State Surcharge 100- 0000 - 207020 33.24
TOTAL REFUND: $310.24
APPROVALS:
If under $500 Professional Staff i
If under $7,500 Division Manager '$t, i ,J\
9 fit..
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
0-16 C ;g•I SYSTEM ADMINIST
Refund Request Reviewed: Date: ;f:/,,,,:/44.,5,) By:
Case Refund Processed: Date: .07 % By:
I: \Building \Refunds \RefundRequest.doc 04/13/09
0/13/2009 15:25 5036520449 t- n .p i; SOURCE PDX
' . PAGE 01/02
� . -. APCIFIVFD
$11 1 . ( :, "; :,�y, C ommunity Development ...
•
�' Request for Perm Action ° 2`., :': '�
6 .@ h �!� 1 Q�d1
OF TIGAYtD II! g11?�1,(q 1��I9®
TO: CITY «
Building Division Services Coordinator �E V ED
�
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov i 1. ; ; ,�
FROM: ❑ Owner [] Applicant ig Contractor ❑ City individu StaGfff, @n
� ,Y p p O � F- �g
(check ono) ��P14.91V� 9JCV 9�!`
INVOI CE TO'
REFUND OR Name: 1h N C D r00 U
INVOICE (Rush' al) / DS � �}T7 A! : TOM L ! 711.6 1_
Maihalg Addze3s: PO. 30 5 756
Cit /State /Zip: 13015E ,, = D 3705 57� ( O .—
Phone No.: 2 o$ — ¥S � - 7fo 0
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
ri CANCEL PERMIT APPIJCATION.
.01 REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: A l Ee 2 00e — C i'O ?V
Site Address or Parcel #: 7501 D4RTMOvT+ ST ? ,`o R 97 . 3
Project N ame: W i NC c) Fo OD 5
Subdivision Name: ,g '0/ Lot #1
k Lookv1 gait_ taN -cam 4.e- a'eX>$-Pe
EXPLANATION: 0 ' /C N4C P Kµ 1 r 10P 'OOFTDP r viP , --- ...
s • T • ' • r - • z . _,r w6 a. :, . _ ' " ry Ciea MIA L. ;s .
• 0 'torn)" - t► OI QM E r ; /0 ta► F ' III/-S [ k it
Signature:
-----0 Datc: / — / 3- 69
Print Name: ---P2--- R I�CC DAor �.�.
adiadisfazt
1. The Director oe Building Official :nay authorize tlto reboil of.
a) any Cm couch was casaricoudy paid or collected.
b) rot mote darn R419% of the Ivtd one application fcc when an application is withdrawn or cmceled before any review effort has been otprndcd.
c) not mdse than BO% of the land use application for Car iss ued permit/
e) not more than BO% of the building plan trriew fee when an Application in Canceled before any plan review effort has beet c'epcedcd.
e) not more rhn++ R0% of the building permit fee Cot Issued permits prim to any inspection emotes.
2. Womb /01 be returned to rho anginal Payer in me tame method in which payment was revived, Please allow 1 -2 wcele for proocadng refunds.
•
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Rte to • Admit": Date gal ] Rte to ilk �dtnln: Date ' 42111111M - =11
Eakin
Refund Processed: Date fff C gY.' Invoice Processed: Date
Permit Canceled: Dare ,1jfrd Date QINEM
UlrItiall Date
1:`79uildingWorms RegPcomtACtioo.doc Rev 07 26/07 .
"Kid et. Pr 4 Rer - t/AV 3
111/13/2009 15:25 5036520449 SOURCE PDX PAGE 02/02
r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2000.00088
• 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/15/2006
Phone: (503) 639 -4171 <, � „ Y "�' �'ffl�j •
Inspection Requests (24 Hrs.): (503) 639 -4175 :;!-
INSPECTION WORKSHEET FOR DATE: 4/29120(18 • TIME: 7 :00Alvl PAGE: 20
SITE ADDRESS: 07601 SW DARTMOUTH ST 100 =Ass OF WORK:
SUBDIVISION: P1 r` LOT #: ' \ i TYPE OF USE:
PROJECT NAME: WNCO 16,00 �} .
DESCRIPTION: Rooftop equipment. $0 -- 1)
OWNER: WAREIMIART INCA � � PHONE It:
CONTRACTOR: SOURCE REFRIGERATION & HVAC IN PHONE 4: 503-652-0834
Inspection Request Scheduled For: Date: 4129l0U8 Pour Time:
V
Code # Inspection Description Confirm # Contact # Mess -f. - •
G09 Mechanical final 069000.01 603- 793 -6379 a 1< 0
Corrections/Comments/Instructions:
., • ..... f...Z_ 4101. I / -- krt.:J:1
0
•
•
_______
____
[] PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ' ❑ ADDITIONAL FEES A ESSED.
Inspector: Z (h..,-------
`- _ Date: 4 2 � Phone #: ( 503) 716 -