Permit CITY OF TIGARD MECHANICAL PERMIT
II
• ■ • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00239
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Refrigeration only
Contractor: DANCO REFRIGERATION INC Owner: FRED MEYER INC
90697 HUNTLEY CT 3800 SE 22ND AVE
EUGENE, OR 97408 PORTLAND, OR 97202
PHONE: 541- 484 -5291 PHONE: 503 - 232 -8844
FAX: 541 - 683 -1876
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/05/2012 $2,783.91
Class of Work: ALT Type of Const: Plan Review 06/05/2012 $695.98
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 06/05/2012 $334.07
Stories: 1 Info Process /Archiving - Lg $2.00 (over 06/05/2012 $4.00
11x17)
Project Valuation: $106,000.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: 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 $3,817.96
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Coolers
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 I:OR OFFICE USE ONLY
City of Tigard C EIVED Received / Permit No.: /� O
Date/By: S /L{ (y p(/��DO p
to 13125 SW Hall Blvd., Tigard, OR 9, Plan Re
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ,reiir { ( ( -2— e'er Permit:
TIGARD Inspection Line: 503.639.4175 MAY 1 4 2 01 Date Ready/By: Juris: Page for
Internet: www.ti ardor. ov Notifie ethod , S ee P e 2
g g G y �2 i Supplemental upplemental Information
CITY OF TIGARD U) lei : l
TYPE ellitiNitiG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* 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
Value: $ (gy �yyD "C�
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ 1- and 2- family dwelling KCommercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: G (requires site plan showing placement) 46.75
City/State /ZIP: ��� Furnace 100,000 BTU ( ducts/vents) 46.75
( ( Q J� 1 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: 1 , 1 U,o, _ i — Heat pump
VC (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
l
°� Gas fireplace/insert 33.39
f r 0. vay,<v, ( v-An U Flue ve for water heater or gas 23.32
1 Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32 _
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
• Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
IA APPLICANT ,°! CONTACT PERSON Attic /crawlspace fans 23.32
Business name: �� �7 Other: 23.32 _
M f � �L�` (i V h t/t Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
AA Address: Q�/��/ /.f ,(� Furnace, etc.
1� A v� T r `(�� ` `t Gas heat pump
City /State /ZIP: L Pa/a 1 , of Wall /suspended/unit heater
Phone: (9 I )L pivi -59 Fax: : (9f )(3. —(g-,, Water heater .
Fireplace
E-mail: AAe ire/V41 , C -Z)VoI Range
CONTRACTOR Barbecue
Business name: ^ 'r Clothes dryer (gas)
I l i t Other:
Address: fin'., t/\ /L MECHANICAL PERMIT FEES"
City/State /ZIP: G� PA. M 1 ,, Subtotal
Phone: �1 � Minimum permit fee ($90.00)
�) ( ` 5 - T ..- ( Fax: e ( 3 - k p Plan review (25% of permit fee)
CCB lic.: qkigittci4V . t �� 3/7„..4145 State surcharge (12% of permit fee)
1 TOTAL PERMIT FEE
Authorized signature:4 < ,'4
- -17. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: � rn M i Date: 5 [ _ • Fee methodology set by Tn County Building Industry Service Board
1:\ Building \Pnits\EC•PermitApp.doc 03/07/12 440..4617T(I1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or •
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 '$1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
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Note: All new commercial buildings require 2 sets of plans.
L.
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