Permit r
CITY OF T MECHAN I CAL
•1 'jht1oilh�l\ DEVELOPMENT SERVICES PERMIT #PERMIT • MEC97 -0205
_-_,A1 Tigard, 6 DATE ISSUED: 06/20/97
PARCEL: 25110DC -02200
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING: C —G
BLOCK • LOT •11 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 1 DOMES. INCIN: 0
:ELE 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 100K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 0
FURN > =100K BTU: 1 > 10000 cfm: 1
Remarks: In -store bank. Mechanical TI
Owner: FEES
SAFEWAY type amount by date recpt
15570 SW PACIFIC HWY PRMT $ 25.00 DRA 06/20/97 97- 296286
TIGARD OR 97224 PLCK $ 6.25 DRA 06/20/97 97- 296286
5PCT $ 1.25 DRA 06/20/97 97- 296286
Phone #:
Contract or:
ALLIED MECHANICAL CONT
1300 NE 48TH AVE
STE 1000 $ 3 TOTAL
HILLSBORO OR 97124
Phone #: 693 -7553
Reg #..: 005807
REQUIRED INSPECT IONS
This peruit is issued subject to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This peroit 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 by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 001 -0010 through OAR 952- 001 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
/.
Issue B Permittee Signature. /
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ ++
Call 639 -4175 by 6:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
City of Tigard MECHANICAL PERMIT Planck/Rec. # 06
1 SW. Hall Blvd. APPLICATION Permit # 0_-(1
Tigard, OR 97223 c G -i9 -11
(503) 639 -4171 � 069 i 5 7-
lm %l',/ -19 er-0
Name of Onrelopmem Description .
r -
r;..7�•i r Table 3A Mechanical Code QTY PRICE AMT
Adore
Job 1 g'7O S kV Pact rl c tith 1) Permit Fee -0- -0- 10.00
Address c,ty ale
7-164(632 9 27_ 7 2) Supplemental Permit 3.00
Name for name of busnnsl Furnace to 100,000 BTU
a
CA-FEt t// 1) incl. ducts & vents 1 6.00 to
Mating Address one Furnace 100,000 BTU +
Owner I 7O (lAl r/X't ti C. I, 41..01 2) incl. ducts & vents 4 7.50
ut rSlate Zaa Floor Furnance
11644,9 3) incl. vent 6.00
Name (a name of business) Suspended heater, wall heater
• 4) or floor mounted heater 6.00
Madurg Address Phone Vent not incl. in
Occupant 5) appliance permit 3.00
ury15lale =o Repair of heating, refrig.
6 • , absorption unit 6.00
Name Boiler r co eat pun it cond.
prl.l..f C.49 7) to 3 ; abso Unit to 100K BTU / 6.00 /y
' Malang Address ?time I er or comp, heat pump, air cond.
Contractor , ao N' 'B 8) 3 -15 HP; absorp unit to 500K BTU 11.00
yo Stale :+o Boiler or comp, heat pump, air cond.
`A1 ed/a/ W 9) 15 -30 HP; absorp unit .5 -1 mil BTU 15.00
allele Regavaaan No. Cay Bus. at No. Boiler or comp, heat pump, air cond.
GC tvi&rpo an 10) 30-50 HP; absorp unit 1 -1.75 mil BTU 22.50
I hereby acknowledge that I have read this application, that the Boiler or comp, heat pump, air cond.
information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with Air handling unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State Air handling unit
registration, please give reason below.) 13) 10,000 CTM + 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected
15) to a single duct 3.00
Ventilation system not
16) included in appliance permit 4.50
Signature fawner a agent) uate Hood served by
17) mechanical exhaust 4.50
Describe work new O addition O a eration 1v repair O Commercial or industrial
to be done residential 0 non - residen la' 18) type incinerator 30.00
Existing use of — Other i.e., woodstove, water
building or property 19) heater, solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
21) More than 4 -per outlet (each) 2.00
Type of fuel - oil 0 natural gas 0 LPG 0 electric 35iC
NOTICE
Minimum Fee 525.00 SUBTOTAL pJ
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL �
AFTER WORK IS COMMENCED.
j TOTAL ' IZ
Special Conditions
Date issued by
H: \LCGIMOSTSSMECHPM r
OVER- THE - COUNTER (OTC)
4.
COMMERCIAL MECHANICAL PERMIT CHECK LIST
Permit #: Date: a (1-1(47
Project Name: liliEa.0., Fro
Site Address: 710 5 Pa, (
Description of Project: — r -
Class of Work: Ai_ Floor Furnace: Evap Coolers:
Type of Use: C vv, Unit Heaters: Vent Fans:
Occupancy Grp: $ Vents w/o Appi: Vent Systems:
Stories: Boilers /Comprsrs: Hoods:
Fuel Types - 0 - 3 HP. It Repair Units:
/ / / / 3 - 15 HP. Wood Stoves:
Max Input: Btu: Air Handling Units Clo Dryer:
- Fire Dampers: < = 10000 cfm: Oth Units:
Gas Pressure: H / M / L > 10000 cfm: t Gas Outlets:
No. Of Units:
Furn < 100k Btu:
Furn > =100k Btu:
NOTES:
COMMERGIAE'. INSPE.GTIGN`
Permit Extension 26 Permit Fee
Gas Line Inspection Plan Review
Mechanical Inspection 5% State Surcharge
Heating Unit Inspection Supplemental Permit
Cooling Unit Inspection Additional Permit Fee
Shaft Inspection Additional Plan Review Fee
Hood Inspection Inspection Fee
Fire Suppr Inspection Miscellaneous Fee
Duct Inspection
Fire Alarm Inspection
Fire Damper Inspection REMARKS:
X Miscellaneous Inspection
Fire Alarm Inspection
Final Inspection
FOR.OFFICE. SE ONLY:
U E OPTIONS COM : eommeraat :CMS red ru' • E •• S . .
• C ASS OF WORK : ;OPTIONS FOR ALL PERMITS (NEW . new: • ADO a dd�tion A LT a�erabon ACS accessory
F13D foundation 0TH = OEM demolition: REP repair FPS .. protection system NOTE USE 0TH FOR FENCES.
GAINING WALL;:DETACHED DECKS, SIGNS. AWNINGS. CANOPIES}..
is \ovrcntr.doc (dst) 2/97
1
1/21/00 Activities for Case #: MEC97 -00205
4:28:23 PM
Assigned Hold Updated '
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECC007 APPlication received 6/17/97 JD OTR BON 6/19/97
MECC011 Routed to Plans Examiner 6/17/97 JD OTR BON 6/19/97
MECC014 Plan checked /Approved by P.E. 6/17/97 RDP APPR BON 6/19/97
MECC015 Reviewed Plans Routed to DSTS 6/17/96 RDP APPR BON 6/19/97
MECC799 Final Inspection 8/20/97 RC FAIL ROC 8/21/97 SECURE DIFFUSERS TO
GRID
MECC750 Misc. Inspection 6/19/97 BON 6/19/97
MECC016 DST Post - Review Completed 6/19/97 B PASS BON 6/19/97
MECCO50 (F) Ready to issue 6/19/97 B MEMO BON 6/19/97 CCB expired
MECC090 (F) Issue permit 6/20/97 DRA PASS DST 6/20/97
MECC799 Final Inspection 1/30/98 1/30/98 RC PASS JT 1/30/98 per conversation with Ron
Church this date. Approved
MECC800 Case Finaled 1/30/98 JT 1/30/98
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