Permit I
CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2001 -00368
5,44- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/24/01
PARCEL: 1 S134BC -00300
SITE ADDRESS: 12220 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
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: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS: 20
> 10000 cfm:
Remarks: Replacement of 20 manufactured refrigerated cases.
Owner: FEES
BPP RETAIL LLC Type By Date Amount Receipt
BY BURNHAM PACIFIC PROPERTIES PRMT CTR 10/24/01 $196.55 2720010000
ATTN: JOHN WATERS 5PCT CTR 10/24/01 $15.75 2720010000
SAN DIEGO, CA 92101
Total $212.30
Phone:
Contractor:
SHEPLER REFRIGERATION
PO BOX 12146
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 282 -7255 Final Inspection •
Reg #: LIC 00092342
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 folio rules - dopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-10111 thro 4 ; h OAR
952 -01 -1 / ;1. ou may • :t, i copies of these rules or direct questi l)ns o OU ( C by calling
rtin 94R -511 RU
I-sue By: \ " %i ]��..�L jjj 4 ' Permittee Signature: , 11 44 4 - Call (503) 9-4175 by 7:00 P.M. for inspections needeVe next business day
', 1
Mechanical Permit Application , , ' -',
Date received: // Permit no.: /lf e , i0 100534j .
� ».pry 'Y. I ,, •
�I,L .� I City of Tigard Project/appl. no.: Expire date:
Ciry ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 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: 1 ZZZO S t&.) SC'ti ILLS TERRY (Lc 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 $ /( /490
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: LAM (,'S M AR T jurisdiction's fee schedule for residential permit fee.
City /county: 'T I C=> AR D I ZIP: 61722 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: ' • _ _ AND COM MERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
9 UC.Q. :e • A -f a M. t __•,_, • t j crTur es • Fee(ea.) Total
Est. date of completion/inspection: — Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? l 'Yes ❑ No
Air conditioning (site plan required)
Is existing space insulated? ®'Yes ❑ No Alteration of existing HVAC system
-, 111ECI1ANICAL CONTRACTOR. e p Boiler/compressors t bilerpmt I ____ S j I G _ FC&���Tc o HP Tons BTU /H fate boiler permit no.:
Business name: Address: :Act 6 t /4 IA) ( A M$ A1/ Fire/smoke dampers/duct smoke detectors
City: ? (ZTL_ NI l I State: DR) ZIP: g 7 22_1 Heat pump (site plan required)
Phone063) 25 Fax: 2$21c6'1I E -mail: Install/replacefurnace/burner BTU /H I -
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 61 2,3 4 Install/replace/relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: ,3 f 4 4 M A- KR ( S Chillers HP
Com.ressors HP MI
Address: S dek e - Environmental exhaust and ventilation: ■
City: I State: I ZIP: Appliance vent
Phone: 2. 7 2S Fax: E -mail: Dryer exhaust IMI O
Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel I i , ing each additional over 4 outlets
ENGINEER ' rocesspip I g (schematic required) 1=MIMIN MIMI
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: ' . ; : I, - mail:
Woodstove/pellet stove ME
Applicant's signature• %TI�� Date: Othe __„,_ �� CA
Name (print): vJa4 4-n) M to t &J S .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
CI Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace 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 Fumace
$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
$1.45 for each additional $100.00 or 6.80
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: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit '
Minimum Permit Fee $72.50 SUBTOTAL: $ / 9 5 -< - to 100K BTU 14.00
�P 8) 3 -15 HP; absorb
8% State Surcharge $ 6-. 7 2 unit 100k to 500k BTU 25.60
9) 15-30 HP; absorb
25% Plan Review Fee (of subtotal) $ unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ 2 7 unit 1 -1.75 mil BTU 52.20
o 11) >50HP: absorb
unit >1.75 mil BTU 87.20
12) Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APP LIANCE: 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
Fumace > 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 applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 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 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656 -
appliance permit Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 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 $72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimun
inserts, etc. charge-one-half hour) $72.50 per hour
Gas piping 1 outlets 360
Each additional outlet 63 *State Contractor Boiler Certification required for units >200k BTU.
"Residential NC requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION:
i:\dsts \forms\rnech- fees.doc 08/06/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 6-MST
(� ,��� BUP
Received Date Requested "- - -- A AM PM 15.� BUP �}
Location / �- �Z- v -& F`� uite 1 0 d / ee.-&?S
Contact Person ''49"--/I/14.—,/ Ph ( 1 ) a1. STS PLM
Contractor r Ph ( ) SWR
BUILDING Tenant/Owner (i - 't'L(. 6-s- ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: aO ,n 4 . ' , SIT
Post & Beam
Shear Anchors ceeS -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall .
Fire Sprinkler
Fire Alarm r c 9-- Susp'd Ceiling `, (
Roof
Other: _
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In 1A'Z'
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Z S PART FAIL
E RICAL
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: 0 Unable to inspect — no access
Fire Supply Line q / , l ADA 2-�/ 0 Ins ector Est Approach/Sidewalk rrr "`"' P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL