Permit r
CITY TIGARD MECHANICAL PERMIT
Ajj DEVELOPMENT SERVICES PERMIT #: MEC2002 -00516
- 13125 SW al d l vd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/16/03
PARCEL: 1S136DC-04500
SITE ADDRESS: P7 0U W DARTMOUTH ST 100
SUBDIVISION: PP1995 -013 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
Remarks: TI Refrigeration case replace.and rooftop unit.
Owner: FEES
WAREMART INC Description Date Amount
BY BURKE + NICKEL
3336 E 32ND ST #217 [MECH] Permit Fee 1/16/03 $148.50
TULSA, OK 74135 [MECPLN] Plan Rev 1/16/03 $37.13
[TAX] 8% StateTax 1/16/03 $11.88
Phone: Total $197.51
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL 'WAY
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone: 503 Mechanical lnsp
Final Inspection
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 -00
/ 1 4. l -
Issued By: ( i ,/ �� Permittee Signature:
Call (513) 639 -4175 by 7:00 P.M. for inspections needed the next bu Hess day
Mechanical PR ME -s�'on
w Date received: - '-O . Permit no. :i � J /.) - o 5'/6
tt 00
,,., �� Cit of Tigard NOV N� Y 1 2002 8 projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Bl , D]�X7��3 Date issued: By: i Receipt no.:
Phone: (503) 639 -4171 BUILDING f
Fax: (503) 598 -1960 ,1 � � 29 Case file no.: Payment type:
Land use approval:
V Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ■ Addition/alteration/replacement ❑ Other:
. JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: _ v /per i ffl i M, P . - Q I Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: ' I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ (0)00C) •
Lot: 'Block: 'Subdivision: *See checklist for important application information and
Project name: 1v. , .0 4 jurisdiction's fee schedule for residential permit fee.
City /county: ' i ^ aw ZIP: -1 & 2 FAMILY DWELLING PERMIT °FEE SCHEDULE
Description and location of work n remise �iCaa► AND, COMMERICALIINDUSTRIALEQUIPMENTSCHEDULE p
P P rt,� .. _.
eke -Y O LeANscA.k� Me ! c + Fee(ea.) Total
Est. date of completion/inspection: IYl I A (2ec- . tJ L Description Qty. Res. only Res. only
Tenant improvement or change of use:
HVAC:
Is existing space heated or conditioned? CI Yes CI No Air handling unit CFM
space insulated? ❑ Yes ❑ No
Air conditioning
rati o of existing plan HVAC Is existing system
g P Alteration of existing HVAC system
iii Irk "' < .MECHA • I • • • I Boiler /compressors • i State boiler permit no.:
Business name: j LI Ce_ e..ie (i W - f oil,. ,� HP Tons BTU /H
1, e
Address: 550c, S G "t/vA. l o v'cJ Fire/smoke dampers /duct smoke detectors
City: I Y\1 tta k e_ State ZIP: Ilia, Heat pump (site plan required)
Phone:a) 53 -51541 Fax:53- 652.-044 jE -mail: InstalUreplacefurnace / burner BTU /H
1 ,� n Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 44"" \Z Install /replace /relocate heaters - suspended,
City/metro lic. no.: q' wall, or floor mounted
Name (please print): P i • e.✓• u C v Vent for appliance other than furnace
-- CONTACT PERSON Refrigeration:
Absorption units BTU/H
e' Chillers HP
Name: p , I c ,• rtdtr� (�Sor -1 Compressors HP
Address: 65,0c, 65,0c, 6 , ` �
-- t4 , ( 1 ov.„..A ^
Environmental exhaust and ventilation:
City: 1NV I it -.i L. I Staten - I ZIP: 4 1 12.1- Appliance vent
Phone: Fax:50/6 2, 0 " E -mail: Dryer exhaust
• OWNER -
Hoods, Type U IUres. kitchen /hazmat •
` - hood fire suppression system
Name: W 1 N Lo Thocic Exhaust fan with single duct (bath fans)
Mailing address: 400 S.. W/Cf A, - Exhaust system apart from heating or AC
City: W vh Dc�.l! State c ZIP: q-/D-71 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil •
l Phone: 5 3 -9437 • "I Fax: E -mail: Fuel piping each additional over 4 outlets .
ENGINEER Process piping (schematic required)
�1 Name: Number of outlets
+ � Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I E -mail: Woodstove/pellet
Applicant's signal e: ate t, —� �i ®L Other:
Other: .
Name (print): (2- i C I C "(/ 7.-.. j "%�
Not all jurisdictions accept credit cards, please can jurisdiction for more information. Permit fee $ C
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $ •• 13
Expires within 180 days after it has been State (8%) surcharge 8% )
Name of cardholder as shown on credit card accepted as complete. TOTAL $ _ ? • • 5
Cardholder signature Amount 440-4617 (GIRO /COM)
•
MECHANICAL PERMIT FEES .. . ' ' `
•
COMMERCIAL FEE SCHEDULE: 1' & 2 FAMILY DWELLING FEE SCHEDULE:
TO.TAL VALUATION: -:"- '_ Description I. .Price Total
$1.00 to $5,000.00 Minimum fee $72.50 -iT,at l`'e' 1A chanical,.Code, _ . 4 .:Qty.- i.- "':',.(Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit 6.80
$1.45 for each additional $100.00 or
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check =all that;apply V Boiler =;.;Heat"; = ,- :Air :i ,-4„;
$1.20 for each additional $100.00 or Foritems 7'1;1; see '',:e.'" o
r Pump Cond`
fraction thereof f be low t
mp i
-,..r b __. -. w . ,, ar," • ' + F:,,, 'e ,e 0 4: am - , !, # ;.1
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb
unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb
unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30-50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87
A.SS U.MEDsVALU N WARP. APP ,:4
LIANCE , . . 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
- ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater - 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 u „ -
>1.75 mil. BTU Minimum Permit Fee $72.50 SUBTOTAL . z ; $
Air handling unit to 10,000 cfm 656 e r, `°
Air handling unit >10,000 cfm 1,170 8% State Surcharge ' : -. " $
Non - portable evaporate cooler 656 : .;' ',
Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: ; $
Vent system not included in 656 .;-_ , = =s
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge- one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL =
** Residential NC requires site plan showing placement of unit.
', � " $
VALUATION: ,1 ` ,': `': . ', All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms\mech- fees.doc 02/11/02
CITY OF TIGARD 24 -Hour
BUILDING _ Inspection Line: (503) 639 -4175
INSPECTION DIVISION • ' Business Line: (503) 639 - 4171 MST
BUP
Received late Requested / •v• 1 AM PM BUP
Location S b ' :' T . ,d44 Suite j, MEC ° OD Sl,
Contact Person S Ph ( ) �? 9a 0 PLM
Contractor Ph ( ) SWR
•
BUILDING . Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling ? � /�� / ;�
Roof /C
Other:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
(-
Storm Drain
Shower Pan
Other: ■
Final
• FAIL
Rou
Gas Line
S., • - Dampers ()V
CO PART FAIL
• TRICAL
Service
Rough -In •
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL