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Permit (65) CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit#: MEC2016-00463 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2016 Parcel: 2S104BB07900 Jurisdiction: Tigard Site address: 14300 SW BARROWS RD Project: Albertsons Subdivision: RUSSELL'S SCHOLLS FERRY Lot: A Project Description: Alteration of refrigeration lines due to relocation of refrigeration cases. Contractor: KEY MECHANICAL CO OF WASHINGTON Owner: SPIRIT SPE HG 2015-1 LLC 19430 68TH AVE SO BY HAGGEN OPCO SOUTH LLC KENT,WA 98032 2211 RIMLAND DR, STE 300 BELLINGHAM,WA 98226 PHONE: 503-231-0731 PHONE: FAX: 503-236-5848 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 06/22/2016 $207.21 Class of Work: ALT Type of Const: Plan Review 06/22/2016 $51.80 Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 06/22/2016 $24.87 Stories: Project Valuation: $5,000.00 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 $283.88 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: Fire/Smoke Dampers: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or ' • , is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility • ification Cent- Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or.•ect questions to OUNC .y ins 503.232.1987 or 1.800.332.2344. I.sued By: Perm ittee Signature: // Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit ApplicationFOR OFFICE I,SE ONI.v E City of Tigard IVED RDate/By:eceived 6, o: l4 �-J, Permit No.: /J il t�,�t/6_00 ,g, 1111 '11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review !/y I Phone: 503.718.2439 Fax: 503.598.1960Other Permit: Q • Inspection Line: 503.639.4175 JUN 2 2 zQ�� Date/By: Aka �I�� ��� T WARD Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov CITY . .r P ARr Notified/Method:3 Supplemental Information 8IJI • I ; -,,,,a,..,:,,_,,,, w it• i''''''' E - * I , `x a.,F' '74 r .6 , , Mechanical permit fees*are based on the value of the work New construction .Addition/alteration/replacement perfonned.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit. = Value:$ eve trr /` ❑ 1-and 2-family dwelling M Commercial/industrial 0 Accessory building For special information use checklist. o Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total y.iii t c ,, Heating/cooling: `�? s'4/ /972, GLS Air conditioning 46.75 Job site address: s/7 �� S � Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 7/9 / 9'7A, Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: #4/ e. 7--5O Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or i ZYZif hydronic) 23.32 A.91 ��� j_�/1� � � Unit heaters(fuel-type,not electric), Gftie 7�17 e in-wall,in-duct,suspended,etc. 46.75 // Flue/vent for any of above 23.32 X77 /75 , Other: 23.32 Subdivision: v► //j SC Lot no.: Other fuel appliances: Tax map/parcel no.: Water heater 23.32 . I[)7.ESCRIPTI6I4 OF V41. ' Gas fireplace/insert 33.39 Flue vent for water heater or gas ,e4-f9 47L/1-T7 ,.tJ /-7 Ld1`i"�c1rd/j- fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ; t < .tel.* 4 � "' Other: 23.32 i e`, ` ,%,,,,::":„:. ' 171:1" t( 'Cr: + ) .` .. . .' Environmental exhaust and ventilation: Name: cot/ a�es y�.r S-'P H6 2 i-S -./ L,t c Range hood/other kitchen ` equipment 33.39 Address: 427,21J/ // l'1 Pt- '6 3e,c) Clothes dryer exhaust 33.39 City/State/ZIP: tie!74,,, „<1f,,r f t/%. 94 ' 6:, Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 -.:.,'.:2:::a''''')..;- c r.::a -,,,y f:,', ,b'XbNT, 4 1*410,° - Other: 23.32 Business name: �f� Fuel piping: /7 e�Ti-/LJ xCG'L $14.15 for first four;$4.03 for each additional Contact name: /¢ j eZFfe/A l4 Furnace,etc. Address: 42 $• '9 / ,5J!` Gas heat pump 33�� 7+�17/� 7 Wall/suspended/unit heater City/State/ZIP: 0,a7 6 7 9 2 3 o Water heater Phone:(s---e3 y) 073/ Fax: :( 3 _JQ 5-Y-VQ Range E-mail: kine)/2_11( /Z1/ & G7 "m// ` t6 M u Barbecue . �„ ,1 ' tl 4. r , t rr. e.,,t 4 ::`,4"--,,,.- . fi�„ Clothes dryer(gas) Business name: ),�� �-� Other: j . Address: 1/6,5 j�- ///��7`-/Y ,� y 1.". C. r� JV t� / 7 Q�` - Subtotal City/State/ZIP: /9,,,,_,4.7 S"E ' 7 3 0 Minimum permit fee($90.00) Phone:(v,) c.9 5/ D 7-3 ( r2,3 3A, 5--8-f/ R' Plan creview(25%of permit fee) Fax: 7` . State surcharge(12%of permit fee) CCB lir.: e©9 ? 4/79'..Q� TOTAL PERMIT FEE fa g5. VI This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: x * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: , ,,6 /// I:ABuilding\Permits\MEC_PermitApp_040ll 3.doc 4 -461TT(17l0/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Famil Fee Schedule: moo 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:\Building\Permits\MEC_PennitApp_0401 1 3.doc 2