Permit CITY OF TIGARD MECHANICAL PERMIT
0. COMMUNITY DEVELOPMENT Permit#: MEC2013 00301
T i G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2013
Parcel: 25 102AA00490
Jurisdiction: Tigard
Site address: 12085 SW HALL BLVD 120
Project: Arellano's Market Subdivision: TIGARD HIGHWAY TRACTS Lot: 13
Project Description: Replace existing hood, install gas piping for mechanical units and install refrigeration for deli cases
Contractor: ARELLANOS CONSTRUCTION LLC Owner: ARELLANO, OMAR
232 SE OAK 12085 SW HALL #120
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 971 - 645 -6825 PHONE 971- 645 -6825
FAX: 503 - 855 -4691
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/04/2013 $263.41
Class of Work: ALT Type of Const: VB Plan Review 06/04/2013 $65.85
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 06/04/2013 $31.61
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 06/04/2013 $1 00
11x17)
Project Valuation: $7,000.00
Fuel Air Handlers
Fuel Types: Natural Gas 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 $361 87
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces. Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets Other Desc:
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: 0.4r 1°�• �1 ,
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 RECEgVE . FoR OFFICE USE ONLY -
!
City of Tigard �l a / a 1� Permit N �i►�� /3 J7J!'
t �1��/
. ° 13125 SW Hall Blvd., Tigard, OR 97223 / �aeBy. (p y 3 C�
Phone: 503.718.2439 Fax. 503.5981960 JUN - 4 2��3 Date/By Review Other PemA1 , 420/2 _Maw
T I G A R U Inspection Line: 503.639.417 Date Ready/By: kris ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method _ Supplemental Information
BUILDING mow)
TYPE OF WORK 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: $ "/ if 00 0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling [[/Commercial/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 46.75
Job site address: 1 2 685 SuJ 1-1aJ/ I)ue/ Ctbk. Fumace 100,000 BTU (ducts/vents) ' 46.75
City/State/ZIP: �t GO ici O r Furnace 100,000+ BTU (ducts/vents) 54.91
n Heat pump 61.06
Suite/bldg. /apt. no.: A Project name: 1-1 re 11 r n 0 S Mu! 1k €.1 Duct work 23.32
Cross street/directions to job site: ,1G 1I 4 /1� / G C��F /C H WY Hydronic hot water system l . 23.32
Residential boiler (radiator or
hydronic) 23 32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances: .
Tax map /parcel no.: Water heater 23 32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
J-I i i 19904 -L.0 O�I Woo / C" n Q s cL10 / � G-,3 fireplace 23.32
/ / Log lighter (gas) 23.32
F 4�i e c / /ilea/ ea_se s /r ,ftS1•Qll Wood/pellet stove 33.39
P /L a p „ e - �'c4,56 'C j 5'r/�s // l ee -i �/--! / A., . Wood fireplace /insert 23.32
Chimney/liner/flue/vent d r!,rdsi lc.�.. S himney/liner /flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other. 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State /ZIP: Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: n r e 1 1t4,10s C On S ytac_ ii i,n Li. L $14.15 for first four; $4.03 for each additional
Contact name: Q MC Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( cry) ( y S , 68 ZS Fax: : ( 503 8 - Li 6 rj / Fireplace
Range .
E -mail:
Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State /ZIP: Minimum permit fee ($90.00)
'�l) 6 E./ 5... 68 as Fax: Sc Plan review (25% of permit fee)
Phone: (C1
( 8 ss.- Li 9 / St ate surcharge (12% of permit fee)
CCB lie.: 1 '3 - 7 03 / TOTAL PERMIT FEE .36 ( P7
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: Gry i - Pl G�...... • Fee methodology set by Tn - County Building Industry Service Board
Print name: C 7 n - 7 ( r n r e l l c; n n I Da G - l _ 20 l -3
1.\Budding\PerrnitsVMEC_PermitApp 040113 doe 440-4617r (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.
Note: All new commercial buildings require 2 sets of plans.
I :\Buildmg'Permits\MEC_PermitApp 040I13.doc 2