Permit rge. CITY OF TIGARD
MECHANICAL PERMIT
t ° COMMUNITY DEVELOPMENT Permit #: MEC2010 -00154
rt7i r M., i Date Issued: 04/07/2010
VI [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: Install 12 x 6 transfer grill, 8 x 8 supply air grill & 6" flex duct.
Owner: FEES
NEW ALBERTSON'S INC Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20,
Permit Fee 04/07/2010 $69.06
250 PARKCENTER BLVD 12% State Surcharge - Mechanical 04/07/2010 $8.29
PHONE:
Contractor:
A ABSOLUTE COMFORT HEATING & COOLING
INC
15886 PARK PLACE CT
PHONE: 503 - 513 -4795
FAX: 503 - 513 -0797
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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 $77.35
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: 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 Ore.. n
Utili ' a io - • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the les
or rect questions to OU ' by c. • g -$3.246.6699 or 1.800.332.2344.
/ 1� �
Is ued By: j , Pe rmittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busin"'- r .
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.
y M � 1 a� .. ��a�'.t<i'r m `�nY� � T �trirv m^ . k � � -i �i,
Mechanical Permit Application , x k . N -.! ' 1 1 111 1 . F ' ���IS' ", °�` ' � z ;I d f :a :
City of Tigard Received 7 /� Permit No.: }� �/ (�
Date/By: / /0 CD4:6 i! ii/1049 "ad l5
13125 SW Hall Blvd., Tigard, OR 97223
C Phone: 503.639.4171 Fax: 503.598.1960 D ew Other Permit: • u i�1/40 _ (�
i I i / \'R IY Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: - Supplemental Information
TYPE OF WORK . COMMERCIAL FEE* SCHEDULE'- USE CHECKLIST
•
Mechanical permit fees* are based on the value of the work
❑ New construction U Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor ov the d, and profit.
CATEGORY OF CONSTRUCTION Value: $ �� l •
RESIDENTIAL:EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling "1 Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMAT ON AND LOCATION Heating/cooling
Job site address: ii.A c46■4 Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: \�rSicen� � n CF Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: I Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
kr ,-,,,,,i 1 k 6 T 3. G J J Flue vent for water heater or gas
A I I ( 1 X �1 � ! ( I ) N ��� L fireplace 23.32
I ` N .� \ 1 (� c'`k Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
❑ PROPERTY OWNER : ' . - ❑ TENANT
Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT . 0 CONTACT ,PERSON Attic /crawlspace fans 23.32
Business name: P
� 4. ppidLU� J L/ n ' 9 i it � r\P T't l � Vw /;ooI Other: 23.32
� + d l � F uel piping
Contact name: NO 14451- V $14.15 for first four; $4.03 for each additional
Address: io k . i Furnace, etc.
11 w : ' • t Gas heat pump
City /State /ZIP: rM M�t>�5 Wall /suspended/unit heater
Phone: (563) j 3, 1 (5
Fax: : ( 03 513 6,1q Water heater
Fireplace -
E -mail: Range
' ■ CONTRACTOR Barbecue
Business name: S na\+.. As iIpp('G,� Clothes dryer (gas)
�fVyY V� r Other:
Address: • MECHANICAL PERMITFEES* . -
City /State /ZIP: Subtotal #69.
Minimum permit fee ($90.00) �-
Phone: ( ) Fax: ( )
Plan review (25% of permit fee) -e-
CCB lie.: I'3 a i 7 ' a, Jop f t v . State surcharge (12% of permit fee) p b-
Q J TOTAL PERMIT FEE 1 77. 3S
d �, This permit application expires if a permit is not obtained within I80
Authorized signature: / / AVM days after it has been accepted as complete.
Print name: 1.1 1 ��,. i FM f ' Date: • Fee methodology set by Tri- County Building Industry Service Board
r . -- - - - - - MI
I:\ Building \Permits \MEC- PermitApp.doc 10/01/09 440 -617 (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: . Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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