Permit CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00663
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012
T [ �� A R. D 9 Parcel: 2S 110AB00200
Jurisdiction: Tigard
Site address: 14345 SW PACIFIC HWY
Project: Desserts of Distinction Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1 -4
Project Description: New compressor unit for walk -in freezer.
Contractor: GRANT REFRIGERATION LLC Owner: KOLVE, G C
PO BOX 2506 14389 SW PACIFIC HWY
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 519 -3751 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/17/2012 $142.74
Class of Work: ALT Type of Const: Vg Plan Review 12/17/2012 $35.69
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 12/17/2012 $17.13
Stories:
Project Valuation: $2,850.00
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 $195.56
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Compressor
Duct Work: for walk -in
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 -009 You may obtain a copy of the rules
or direct questions tfo/O)UNC i g 503.232.1987 or 1.800.332.2344. /r
Issued By: � { (/ / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available i ection 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 FOR OFFICE USE ONLY
City of Tigard RECEIVED 7 „ - v Permit No. ce I� / ���
Other Perm
• 13125 SW Hall Blvd., Tigard,OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 it
Ins ction Line: 503.639.4175 C ? �2 D
T I G A R D Date y. MI S See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF W ON COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Qddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor overhead, and profit.
Value: $ Fr 50 -
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ,Er-G,ommercial/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: !Li t.4 S S 1nJ P � (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: 1 t ';Cyd ( 0,,a g - 722 4- Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: J Project name: R o f O I'M Heat pump
Z7�' (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: 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
Gas fireplace/insert 33.39
—‘ — \S ' M SC oC to ..A-Y.&'K '1P cce IL- Flue vent for water heater or gas
fireplace 23.32
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: Diesa ac ts D � �_k\ J/' Environmental exhaust and ventilation:
Address: ((�� G � �* Range hood/other kitchen
F'�1 ��1, 33o equipment 33.39
City /State /ZIP: Cjacy_a s 1 OR G7 0 \ Clothes dryer exhaust 33.39
3 b 5 R F ax:
Single-duct compartments, (bathrooms,
Phone:
1 „ � � ( ) toilet corn menu, rooms ) 23.32
❑ APPLICANT ,l CONTACT PERSON Attic/crawlspace fans 23.32
Business name: 9 s c i D ,6,"\4e_4--,D Other: 23.32
Fuel piping:
Contact name: JDrA f , 5 $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZIP: Wall /suspended/unit heater
Phone: (503 )6 5 1 ( — g 3 7 B Fax: : ( ) Water heater
mail: nn r Fireplace
E -
�(k4 ∎5 P (�.Cs� 5 t7C A t51 JAL +QJ , Coo ^ Range
CONTRACTOR Barbecue
V /� � L L Other: dryer (gas)
Business name: G ran i- \Ikea:A:
Address: / . aQx v, 50 (o MECHANICAL PERMIT FEES*
City /State /ZIP: 77( , 9 - ' ,,N , 96/‘ , Subtotal
/ Phone: ( j ) y /� ! 6 6 Minimum permit fee ($90.00)
Fax: ( ) Plan review (25% of permit fee)
CCB lic.: ''1 Cil '1 , L /o /i3 State surcharge (12% of perm fee)
TOTAL PERMIT FEE /c75-: 57:, This permit application expires if a permit is not obtained within 180
Authorized signature: (� days after it has been accepted as complete.
Print name: J t 7 n 6 E k S Date: ‘ (211-711a, • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doe 09/09/10 4404617T(II /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.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Pennits MEC- Permi1App.doc 09/09/10 2
; 7 Building Division
Over - The - Counter (OTC) Mechanical Permit
1 1cGARn
Check List
Project Description: -..L b . _S F2 Y S Dr /IS 77/1/( l lc, /✓
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: K Occupancy Group: Type of Construction: 5t3 *Type of Use: Oregon Specialty Code: 2
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe: 11Ele OM r -r L ThQ (, }A Ic1/4.)
Total Project Valuation: $ FEES DUE
$ Mechanical Permit Fee
$ Plan Review
$ 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; O'IR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \Building\Forms \OTC - MEC.docx 01/13/2011