Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00425
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 120
Subdivision: Lot: 0
Project: Little Caesars
Project Description: Install 8'x14' walk in cooler. •
Owner: FEES •
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Permit Fee 08/14/2009 $186.50
PORTLAND, OR 97205 Plan Review 08/14/2009 $46.63
PHONE: 12% State Surcharge - Mechanical 08/14/2009 $22.38
Contractor:
D & D MECHANICAL INC
PO BOX 55395
PORTLAND, OR 97238
PHONE: 503 -849 -2930
FAX:
Type of Use: COM .
Class of Work: ALT Type of Const: VB
Occupancy Grp: A -2 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: Vent Systems: . Total $255.51
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Walk in
Duct Work: cooler
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 Notification Center. 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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: \ -- • 1 Permittee Signature: 5//
�i�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
•
Mechanical Permit Application �� q- ;,-' 1 r.= FOR OFFICE USE ONLY
� l , I , . i, . I� Received
City of Tigard - / I I� !„ Permit No.
._ Date/B No.: ( � f11 . (2:074 •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie -► G
5 . Phone: 503.639.4171 Fax: 503.598.1960 AUG 4 2009 Date/By: iSklagt C,
T 1 G A R D Inspection Line: 503.639 ate • ea.y/ y: El See Page 2 for
Internet: www.ti ard - or. ov � �1 "
g g �I OF 1�fi {,1 �1 Notified/Me r Sup lemental Inf mati 4
TYPE OF WOR COMMERCIAL F r * • HEDULE - US • CHECKLIST
Mechanical permit f- s' are based on the value of the work
❑ New construction ,Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
El 1- and 2-family dwelling RESIDENTIAL EQUIPMENT / S FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family 0 Master builder
❑ Other: Description I Qty. I Ea. I Total
JOB SHE INFORMATION AND LOCATION Heating/cooling
Job site address: 2 !' ^ Air conditioning or heat pump
l l // 0 ( '7 i 'J° 91,0 IP I 1 � (/ 14- 1 ' 7--'....1 (requires site plan showing placement) 14.00
City /State /ZIP: 11 h 4 w b t. IL-4/691)4 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: `l ,/ ` i,...-ez CA- iciThArk.5+ Gas heat pump 14.00
Cross street/directions to job site: Iw Y 14-k ti 1,Zo ,,9 Duct work 10.00
1 V 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
Subdivision: J Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
X t Gas fireplace 10.00
S T ,- - '� t "G -1,1iA4j to ((-( Flue vent for water heater or gas
ma c, D ,p fireplace 10.00
v N' Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
• ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
_ Other: _ 10.00
Name: ��S q / L4 \ � N( Environmental exhaust and ventilation
Address: Range hood/other kitchen
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
Business name: r 1P I A o� _ I J l 1C Other. 10.00
S J Fuel piping
Contact name: To 5 1UA ✓V $5.40 for first four; $1.00 for each additional
Address: 11 Zoo AL 4. 5�1 e A4' Furnace, etc.
1� ' / � Gas heat pump
City /State/ZIP: r b V -� /J /, O fz- '1, 2;2'12 Wall /suspended/unit heater
( 5 ) Z 3 3 0 I �3 2,c 3 u, 3
Water heater
Phone: Fax: ax::(
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
• Business name: n 4 � H ! c 11.04 k 'l! At- / � Clothes dryer (gas)
Y Other:
Address: p --- fjb•f. V-Fjq 6 MECHANICAL PERMIT FEES*
City/State /ZIP: 10 LrL4 ,1/4S D 2 q7 7-3 g Subtotal
yy ?co � Q p er: ( ) Minimum permit fee ($72.50)
Phone: (
" 9 U 7� - /� ! ,, / Plan review (25% of permit fee)
CCB lic.: ' 6 3 t > S 9/ t j State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: 'tiff This permit application expires if a permit is not obtained within 180
j • days after it has been accepted as complete.
Print name: 'T i y o S 1°1 Date: p 0 (' • Fee methodology set by Tri County Building Industry Service Board
I :\ Building \Permits\MEC•PermitApp.doc 01/19/07 440-4617T (I I/02/CO /WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00'or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof
Note: All new commercial buildings require 2 sets of plans.
I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2