Permit i h CITY OF TIGARD MECHANICAL PERMIT
t
, r DEVELOPMENT SERVICES PERMIT #: MEC2000 -00331
Ai! DATE ISSUED: 8/16/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110CD -07600
SITE ADDRESS: 15705 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: 5
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:
3 - 15 HP: 5 COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 0
> 10000 cfm:
Remarks: Refrigeration for grocery store
Owner: FEES
TOBIAS INVESTMENT CO Type By Date Amount Receipt
300 SE SPOKANE ST PLCK DEB 8/16/00 $34.81 0004528
PORTLAND, OR 97202 5PCT DEB 8/16/00 $11.14 0004528
PRMT DEB 8/16/00 $139.25 0004528
Phone: Total $185.20
Contractor:
REFRIGERATION CONTRACTORS, INC
P.O. BOX 661
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Mechanical Insp
Phone: Cooling Unt Insp
Reg #: LIC 47971 Final Inspection
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 -0 01 through OAR 952 - 001 -0080. You may obtain copies of these ru es or direct questions to OUNC by
calli (503)246-918'. /
'' / , 4,,, Permitt Signature: , ‘ - '61 Issu By: , ,!a0 , _
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next
Plan Che
CITY OF TIGARD Mechanical Permit Application Rec'd By
13125-SW HALL BLVD. Commercial and Residential Date Rec'd 8
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit M . Dry Do3 j
P,ed -0oSi(p Incomplete or illegible applications will not be accepted Called /2)14/4 P C(.. i�"
Name of Development/Pro' f Description (Z91... /��
�= coce( cU_f (e Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fee VP_ 16.00
/ Address (6 '() l t 6 A" 1) Furnace to 100,000 BTU
including ducts & vents see footnote 1,2 9.65
Bldg# City /State Zip 2) Furnace 100,000 BTU+
617 ZZq including ducts & vents see footnote 1,2 12.00
Name (or name of business 3 ) Floor Furnace
Owner c rOC ✓ .4 uU - ( - including vent see footnote 1,2 9.65
Mailing Address ( 4) Suspended heater, wall heater
I� or floor mounted heater see footnote 1,2 9.65
?COO C l t4� J l 5) Vent not included in appliance permit 4.75
City/State Zip Phone S 1 0 Check all that apply: *Boiler Heat Air
&rke(e CA 4( `7oc( - 6Szc( For items 6 -10, see or Pump Cond Qty Price Amt
Name (or name crousiness) footnotes 1 , 2 Com
i1 6) <3HP;absorb unit to
• v 100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit r
100k to 500k BTU J 5 17.65 ' S
City/State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name 9) 30 -50 HP; absorb
l /' unit 1 -1.75 mil BTU 36.00
ee rt 1. ercrhO V1 CE:V traC +ors 10) >50HP; absorb unit
/ Prior to permit ailing Add �� I >1.75 mil BTU 60.15
issuance, a copy n 11 Air handling unit to 10,000 CFM
of all licenses city/state Zi Phone ..503 7.00
are required if cIrcstilawl OP R D 25 `F3b 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Li . Exp. Date 1 1.85
database q7 7 ( (9 ''(Zb / O L 13) Non - portable evaporate cooler 5 c
Architect Name 7.00 35
14) Vent fan connected to a single duct
or Mailing Address 4.75
15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip' Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17) Domestic incinerators --
12.00
New: Repair 0 Replace with like kind: Yes O No O 18) Commercial or industrial type incinerator
Residential 0 Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove /gas FP /other units /clothe dryer /etc.
7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 L�{
3�T6
Type of fuel: oil 0 natural gas 0 LPG 0 electric O 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL _ -.
I hereby acknowledge that I have read this application, that the information 8% SURCHARGE
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL = " ;
Required for ALL commercial permits only '
the owner, that plans submitted are in compliance with Oregon State laws. TOTAL'
«"'
Sign ture of Owner /Agent Date
2
r/' ` 8 /z7 J Other Inspections outside and Fees:
�i 1 .1 1. Inspp ections outside of normal business hours (mininum charge -two
Contact Person Name Phone hours) $50.00 per hour
' / 2. Inspections for which no fee is specifically indicated (minimum
_ (.c. oerFl (n! TO4 S3 /Z -861ce charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge -one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical el e eft '/34, Qf
t
t
t
•Stae Contractor Boiler Certification required
units. - ,
Il, I V
1 + ** Residential A/C requires site plan showing placement l
I:Ur,echperm.doc rev 7/19/99 i 4tt.. L-
T �
CITY OF TIGARD BUILDING INSPECTION DIVISION
6 /).)
24-Hour Inspection Line: 639 -4175 Business Li e: 6 :-4171
Date Requested qC / PM UP BLD
Location I ?O S sui !/t Al Suite EC - 35(
Contact Person / < ft Ph Sc? -g(4 e PLM
Contractor Ph SWR
BUILDING Tenant/Owner a ro 'C -Jt-/ ?�,� ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: Y C� `
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ��\
Susp'd Ceiling 1
Roof
Misc:
Final
PASS PART FAIL
(
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
CM
eam
Rough In
Gas Line
Smoke Dampers
' ' ART FAIL
• ICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date i' ` / /s
& Inspector , v Ext 5 1 `
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
A Ee - 2000 - oc
REFRIGERATION CONTRACTORS INC.
Temperature Controlled Systems/General Contractors
5031257 -8668 FAX 5031255 -4581
Sales Office: Mailing:
17246 NE San Rafael PO. Box 661
Portland Or 97230 Gresham Or 97030
September 28, 2000
Rick Bolen, Ext 319
City Of Tigard
Development Services
13125 SW Hall Blvd
Tigard OR 97223
RE: Letter of Declaration or Refrigeration work at the Grocery Outlet — King City Store
As per our discussion the following is my letter of declaration on Refrigeration work at the Grocery Outlet — King
City Store located at 15705 SW 116'" Ave, King City OR.
i, Scott R Worthington, due here by declare by way of this letter that I have met or exceeded the requirements set
forth for the pressure testing of the refrigeration piping as set forth n Chapter 11 of the Mechanical Code. For our
testirg process we used nitroger and tested the piping, both low and high, at 400 lbs. PSIG for a minimum cf 24
hours. The refrigerant used within this system is R -404A (Pentafluoroethane.1, 1 1,Trifluoroethane, 1 1, 1 2 —
Tetraflucroethane) •
On 8118100 — The Underground piping for System A -4 & A-5 were tested and inspected the pressure in the
piping was 400 lbs and was maintained within the piping until the additional overhead piping was connected to
the portion of piping
On 9/1800 — The overhead piping, the refrigeration unit. discharge piping and the cases for System A -1 a & b.
was pressurized to 400 lbs with dry nitrogen. After this system passed our tests, we called for and had an
inspect:on done by your office, having passed both inspections we then removed the nitrogen and evacuated
the system and charged the unit with 65 lbs R -404A and started system.
On 9!1800 — The overhead piping, the refrigeration unit. discharge pipirg and the cases for System A -2 was
pressurized to 400 lbs with dry nitrogen. After this system passed our tests we called for and had an inspection
done by your office, having passed both inspections we then removed the nitrogen and evacuated the system
and charged the unit with 100 lbs R -404A and started system.
On 9/1800 — The overhead piping, the refrigeration unit, discharge piping and the cases for System A -3 was
pressurized to 400 lbs with dry nitrogen. After this system passed our tests, we called for and had an inspection
done by your office having passed both inspections we then removed the nitrogen and evacuated the system
and charged the unit with 100 lbs R -404A and started system
On 9119100 — The overhead piping, the refrigeration unit, discharge piping and the cases for System A -4 vies
pressurized to 400 lbs with dry nitrogen. After this system passed our tests, we called for and had an inspection
done by your office, having passed both inspections we then removed the nitrogen and evacuated the system
and charged the unit with 140 lbs R -404A and started system
;_ . ..
On 9/19/00 — The overhead piping, the refrigeration unit and discharge piping for System A -5 was pressurized to
400 lbs with dry nitrogen. After this system passed our tests, we called for and had an inspection done by your
office, having passed both inspections we then lowered the nitrogen pressure in the system to 125 lbs as the
line -up of cases was deleted for the time being and may still be added at a future date. The unit will be left with
the nitrogen holding charge, the unit is not wired electrically and cannot be accidentally started, however the unit
is labeled with the holding chare and the date it was pressurized
By my signature below I am stating that the information given above is true and factual
September 28, 2000 -
Scott R Worthington Date
Project Manager
Refrigeration Contractors, Inc.
CITY OF TIGARD BUILDING INSPECTION DIVISION
R,,24 -HOur Inspection Line: 639 -4175 Business Line: 639 -4171 M
�7 J // BUP
Date Requested % —� 0 AM // c < PM B
Location / 5 5 �S u' // , i /(..0 Suite 410 -o1l 3 3 /
Contact Person Ph z...5-7 0 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear _ _ S I
Framing _ _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
— Post & Beam
Rough In /2e .
Gas Line
Smoke Dampers
Final
PASS de FAIL
ELECT
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 9 V a L Other Date / Inspector Ext�
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested � / 0 AM PM g
Location /570 ) Suite 5 -2' I ir
Contact Person Wog, Ph 961 -Z 2 ! Z PLM
Contractor Ph SWR
_.3.1 Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Insulation
Drywall Nailing
Firewall // /
Fire Sprinkler ?? / ‘ CO s /Pc /
Fire Alarm
Susp'd Ceiling
Roof
Misc:
F'
PASS . PART FAIL
*WAGING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
FAIL
ICAL ,p
Post & Beam a �' �/ c Pl�.4C �J C)!� - ( .,,e� '� v 4 (72
Rough In CO /1-7 O /
Gas Line
Smoke Dampers ' so/
Fin -
'ART FAIL
• - - ICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call f r reinspection RE: [ ] Unable to inspect - no access
A 71)--\‘? Apppp roach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
• 1 •
BUP - Building Permit EL C - Electrical Permit
4 Inspection Description Date Passed By I Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing . 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing a — D U 33 I
MFG - Structure set -up MrE Mechanical Permit
Insulation
Drywall nailing - 4 Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final 9 /�d r)
Structural observation -< 1
Final inspection
PLM - Plumbing Permit
Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm fmal Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
CITY OF TIGARD MECHANICAL PERMIT •
DEVELOPMENT SERVICES PERMIT #: MEC2000 -00331
DATE ISSUED: 8/16/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CD -07600
SITE ADDRESS: 15705 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: 5
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:
3 - 15 HP: 5 COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 0
> 10000 cfm:
Remarks: Refrigeration for grocery store
Owner: FEES
OBIAS INVESTMENT CO Type By Date Amount Receipt
00 SE SPOKANE ST PLCK DEB 8/16/00 $34.81 0004528
ORTLAND, OR 97202
5PCT DEB 8/16/00 $11.14 0004528
PRMT DEB 8/16/00 $139.25 0004528
Phone: Total $185.20
Contractor:
EFRIGERATION CONTRACTORS, INC
.0. BOX 661
RESHAM, OR 97030 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: Cooling Unt Insp
Reg #: LIC 47971 Misc. Inspection
Final Inspection
ri ft
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9189. w
Issue By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
8/21/00 Activities for Case #: MEC2000 -00331 _
3:08:25 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECC007 Application received 8/2/00 DEB RECD No Hold GWL 8/14/00
MECC008 Permit created 8/14/00 GWL DONE No Hold GWL 8/14/00
MECC011 Routed to Plans Examiner 8/14/00 GWL DONE No Hold GWL 8/14/00
MECC014 Plan checked /Approved by P.E. 8/15/00 8/15/00 8/15/00 GWL DONE No Hold GWL 8/15/00
MECCO50 (F) Ready to issue 8/15/00 GWL DONE No Hold GWL 8/15/00
MECC706 Mechanical Insp No Hold GWL 8/15/00
MECC720 Cooling Unt Insp
No Hold GWL 8/15/00
MECC799 Final Inspection No Hold GWL 8/15/00
MECC090 (F) Issue permit 8/16/00 DEB DONE No Hold DEB 8/16/00
MECC750 Misc. Inspection 8/18/00 TLP PASS No Hold TLP 8/18/00 refrigeration lines under slab
400# test
MECA075 (F) Reprint Permit 8/21/00 ZZZ DONE No Hold ZZZ 8/21/00
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ /
BUP
Requested l - 9 9 AM PM BLD
Location ($ 2 0 J S C Suite MEC 1- 4 0 - G 0 3 /
Contact Person j Ph 2S7 66 5 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing �
Firewall .— ,�—t'r 6C(6- Pal 0�t s y /75 1i-v
Fire Sprinkler T , / 5
Fire Alarm
Susp'd Ceiling n `�
Roof � t e I /�� �1J / rc /' E
Misc:
Final
PASS PART FAIL _ �{
PLUMBING � S r e3 . 5YS �
Post & Beam / /`
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ctINECRXMAL,
Post & Beam
Rough In
Gas Line
Smoke Dampers
tb PART FAIL
""=
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
I/ in
Backfil r Gad g
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other ( Date 7 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.