Permit �f „a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00205
TfGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2010
Parcel: 1S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Subdivision: Lot: 0
Project: Winco
Project Description:
Owner: FEES
WINCO FOOD, LLC Description Date Amount
ATTN: SUSAN BUSCHE, PO BOX 5756
Permit Fee 05/13/2010 $431.53
BOISE, ID 83705 Plan Review 05/13/2010 $107.88
PHONE: 12% State Surcharge - Mechanical 05/13/2010 $51.78
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222
PHONE: 503 - 462 -4822
FAX: 503 - 462 -6555
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: M Occupancy Load:
Stories: 1
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: 1 Vent Systems: Total $591.19
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 Oregon
Utility Notificati. . enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct t .estions to O C by ca ing 503.246.6699 or 1.800.332.2344. I � ,
Issue. By: 4,4(�,� I Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busin • ss da .
This permit card shall be kept in a conspicuous place on the job site until c. • ple ion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit A I I lication ' a r * �r�ti'v 1 OR OHFlcr USE oar �11M r ,J;o _ t I x
�rrbeYr� ur.;t •S aaasi �.���r� rro .uowL.�..� s ..,.:d�,v.r u9.t;`ti3 - r'..�k �,r �x� . < 'tvt
�) , t d Received _
ipli t tig City of Tigard T NE
p- Permit No.
% " ' City g Date/By J , 5 0 tqc 2!711? — , 0 5
V? ` ° 13125 SW Hall Blvd., Tigard, 4 ,. 1 -_
{ Phone: 503.639.4171 Fax: 503.5 Plan Review,
1 }� Date /By: A vi (® Other Permit:,
e� +A r v Inspection Line: 503.639.4175 A G 9 2010 J uris:
ppT I G A R D R p Date Rea : y: 0 See Page 2 for
•
W :tai _7iff4y ,4 Internet: www.tigard - or.gov Notified/Method: 14 to ) . Supplemental Information
CITY OF TIGARD L y L )(1,q1
TY'i*lyMWFdKJIVISIOS'• COMMECIAL 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, overhead, andprofit.
CATEGORY OF CONSTRUCTION Value: $ 13 i lV! A
RESIDENTIAL EQUIPMENT / SYSTEMS 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: = r S D' S w V R/r —M 0 k'V \ 1{ A Air conditioning or heat pump
(requires p
site Ian showing placement) 14.00
City /State /ZIP: 'rte ({ V\,l\ 1..---0/.)--"1..---0/.)--"--.5 �') Furnace 100,000 BTU (ducts/vents) 14.00
1 Fumaee 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: W 11ll kA) 6.-9./ 11 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
1^ � Y � p n Gas fireplace 10.00
V 1 W } � n >�,I \ �� (� � kl l Ri --c- \ Flue vent for water heater or gas
p W\ 1 7 Vl ) W I V\ V) ; IV a, 1 f"1 �\/ 0 V_ f fireplace 10.00
Log lighter (gas) 10.00
Ol W, Ski V 1 S J Wood/pellet stove 10.00
\ Wood fireplace /insert 10.00
Chimney/liner/flue/vent 10.00
TENANT
❑ PROPERTY OWNER ❑ Other: 10.00
Name: Environmental exhaust and ventilation
•
Range hood /other kitchen
Address: equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
. ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
(..,/ Other: 10.00
Business name: V (./1„(„/ Fuel piping
-
Contact name: $5.40 for first four; $1.00 for each additional
1 Furnace, etc.
. '
Address:' `� �v1� �D I �/V
Gas heat pump _
\ �
City /State /ZIP: 1 y ` '\) t , /� I p Wall /suspended/unit heater
'1 -� .3 1 , t `_ �'' Water heater
Phone: �j ��) ( d Fax: (� 1 Y1
(�,`r�n�/� �/� ' ,ll�,^ Fireplace
E -mail: ' '10 `( V (VC U V ` vp , W V ` Range
. CONTRA TOR Barbecue
\ 1 I
Business name: Clothes dryer (gas)
V � V`l Other:
Address: 1V. Cf MECHANICAL PERMIT FEES*
- City/State/ZIP: t� Subtotal
Minimum permit fee ($72.50)
Phone: ( ) I Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 10 %Ur) a, 0// , State surcharge (12% of permit fee)
TOTAL PERMIT FEE
I
This permit application expires if a permit is not obtained within 180
Authorized signature: $ 4 /&t/( days after it has been accepted as complete.
Print name: \ �( Date: ) * Fee methodology set by Tri- County Building Industry Seice Board
1:\ Building \Peiis \\mEC- Permitp 01 " // ` 440-4617f (1 I /07JCOM/WEB) i5 /c!