Permit (50) CITY OF TIGARD MECHANICAL PERMIT
2. COMMUNITY DEVELOPMENT Permit#: MEC2017-00806
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2017
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Modify gas line for remodeling of deli area.
Contractor: PMSI LLC Owner: COSTCO WHOLESALE CORPORATION
21195 NW EVERGREEN PKWY#204 PROPERTY TAX DEPT 111
HILLSBORO, OR 97124 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/17/2017 $69.06
Class of Work: ALT Type of Const: IIB Plan Review 10/17/2017 $17.27
Occupancy Grp: M Occupancy Load: 12%State Surcharge-Mechanical 10/17/2017 $8.29
Stories: 1 Info Process/Archiving-Lg$2.00(over 10/17/2017 $2.00
11x17)
Project Valuation: $500.00
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 $96.62
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 50 32.1987 or 1.800.332.2344.
Issued By: _/ .- Permittee Signature:
l ..A01 r_r 1pc
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
P .Pi PL-_--71S/
Mechanical Permit Applicatfij CIE FOR OFFICE USF.ONLY
City of Tigard Date/By:Received (v / Permit N i�L9 07/ ,0�
1111 _ Ill 13125 SW Hall Blvd.,Tigard,OR 97223 ff Plan Review w
Phone: 503.718.2439 Fax: 503.598.196001.T 1 6 2017 DateBy:�t la ('( Other Per �.' /7 e/iA ,f
T i Ci A u D Inspection Line: 503.639.4175 Date Ready 1 Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: /`7//7 �� I Supplemental Information
r „ ys41 a e•14. i.
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'7 .. \` " '' # ,,,A #-'- .?\� i <s �\\\� Sal
'444. Mechanical permit fees are based on the value of the work
0 New construction ,,�Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
0 Demolition ❑Other: - Value:$ Sc D (RD
I
El1-and 2-family dwelling commercial/industrial/ ❑Accessory building For special information use checklist.
0 Multi-family ❑Master builder 0 Other: Description I Qty. I Ea. Total
Heating/cooling:
# Y ,ll stf \# •'T1#• ,, a t ( #ISI';. \•
Air conditioning 46.75
Job site address: 17850 5_ Dc.. .; .S4. . Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ;30_,,,d... OK 9 1-1)0- Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Co -k c) Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
)
h dronic 23.32
hydronic)
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
r Gas fireplace/insert 33.39
il- \... -'�'•••• l � a \33-ktj ',<\. • .,.,,,,,s \ Flue vent for water heater or gas
ilk ad . 1 .l3 3as 1 l
fireplace 23.32
A - Log lighter(gas) 23.32
�..*.� -- . • s s_ ►i Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
\ Other: 23.32
14,N2 as •# ' 0m •e i \a 'T."': \\ .:
, N ',. �. 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
�� , a # p Other23.32
Fuel piping:
Cusiness name: !119 M S'I j_C_C— $14.15 for first four;$4.03 for each additional
ontact name: �.�,,,p, S -c Furnace,etc.
-'I
•ddress: V �''^J� Gas heat pump
Wall/suspended/unit heater
ity/State/ZIP: Water heater
: Fireplace
Fax:
'hone:( ) ( ) Range
-mail: �S 0 -`• -• " Barbecue
Pka \ \. '1,, 41' »: ''I,,' Clothes dryer(gas)
i - :. ,,
Other:
Business name: ri S 1 1_L� ,4-e,1"1 'T P '. FE /�
Address: 2 1 1q V AA," EJB; v Pk,� 5-k . D(J� Subtotal CO r,der
City/State/ZIP: ))sl,„,,,„ 1 -712 Minimum permit fee($90.00) (JD
' Li Plan review(25%of permit fee) (0, "K Ci
Phone:(coS)LI cocz, r 29?1- Fax:(50�)v(06, ,-,.) // State surcharge(12%of permit fee)
CCB lie.: 5 '� �� TOTAL PERMIT FEE 1 tQ, O
This permit application expires if a permit is not obtained within 180
2�{. (? ,(�J{y days after it has been accepted as complete.
Authorized signature
` '� A,, C\J Gil�i * Fee methodology set by Tri-County Building Industry Service Board
Print name: ez)rc, ,„04....,t Se i C e0 Date: 1 Q - f),_ /7
440-4617T(ii102/COM/WEB)
I:\Building\Permits\MEC_PermitApp_ 113.doc