Permit (145) i -- 4
7 . .
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00587
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/29/2007
PARCEL: 2 S 115 BA -00100
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG
PROJECT: ALBERTSONS
Project Description: Refrigeration remodel. Value: $65,000
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: -
Owner: FEES
IBJ SCHRODER BANK + TRUST CO Description Date Amount
BY ALBERTSONS INC #565
ATTN: CORPORATE ACCTG DEPT [MECH] Permit Fee 10/29/20C $946.50
BOISE, ID 83726 [MECPLN] Plan Rev 10/29/20C $236.63
[TAX] 8% State Surcha 10/29/20C $75.72
Phone: 208 - 395 -4711 Total $1,258.85
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 652 -0884
Reg #: LIC 149200
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 follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
sued By: l 1 • A I_, Permiftee Signature: A'
Call 503.639.4175 by 7:00 a.m. for inspections that business day/
This permit card shall be kept in a conspicuous place on the job site until comp! on of the project.
Approved plans are required on the job site at the time of each in ection.
I 6 a S 03Ham \ - C. in
Mechanical Permit A n El FOR OFFICE USE ONLY
1111 City- o g rTi a nd - ` I 4 Received / LL
Dat : • . (7 Permi J •
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie � •
Phone: 503.639.4171 Fax: 503.59ZOg6� 0 2007 Date ev �u-� Cl Other Permit: _ - tPCO
TI G A It D Inspection Line: 503.639 Date Re. c y: (J Juris: ® See Page 2 for
Internet: www.tigard or.go�T9 y ur . 1 i�A� Notified/Method: 0 / ?) P I Supplemental Information
DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $6,5;0r0
RESIDENTIAL EQUIPMENT 7 SYSTEMS FEES*
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building /
❑ For special information use checklist.
Multi - family Master builder 0
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /6e720-0 Air conditioning or heat pump
, uJ • � j Ft'
t L kw l./ (requires site plan showing placement) 14.00
City/State /ZIP: '�7 a f� ` Fumace 100,000 BTU (ducts/vents) 14.00
5 lr Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: A Q Ea. / S SLO 5 Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
•
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
e-e.y -tit; �p�t yt
� Q ?- 1 23M.00 / 41.1... Flue vent for water heater or gas
a v,J fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet Compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: 50-1jro_ iZe Fri .4 to Y Fuel i io
PP >;
Contact name: j $5.40 for first four; $1.00 for each additional e Furnace, etc.
Address: s'-s-n (e S E =n-�•€� I\u 4 i � ce I � A Gas heat um
j pump
City/State /ZIP: l I Wnv i',€._ D 97 Wall/suspended/unit heater
Phone: ` (5) 8 ,1 _ 6Sg a Fax:: (J7) 142. eotkiNG1 Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: li j rc _ o _ et i. r . 1 q �.,�(,�0 Other:
Address: She (Q vi' € =�, r tri Aki‘ovt 4 9 6.1 MECHANICAL PERMIT FEES*
City/State /ZIP: i t l 4 k P Q I.- (i7 ,9.a-a- / Subtotal
Minimum permit fee ($72.50)
Phone: ( 03 g v - 'g e Fax: ( ) Plan review (25% of permit fee)
CCB lic.: /y49 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: ,, /�,, t This permit application expires ifs permit is not obtained within 180
f/tA • t days after it has been accepted as complete.
Print name: y1/1 „„ t' y ._ f - I Date: / 7 • Fee methodology set by Tri- County Building Industry Service Board
I: Building \Pennits\MEC- Permi1App.doc 01/19/07 / 44 61 7T I /02/COM/WEB) /
Mechanical Permit Application - City of Tigard k.
Page 2 - Supplemental Information -
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION #: MEC2007- 005f37
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2912001
Phone: (503) 639 -4171 � �Mp��h 4 ,,l1 l � 1
Inspection Requests (24 Hrs.): (503) 639 -4175 IL
INSPECTION WORKSHEET FOR DATE: 719008 TIME: 7:05AM PAGE: 550
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ALBERTSONS
DESCRIPTION: Refrigeration remodel. Value: $65,000
OWNER: al SCHRODER BANK & TRUST CO, PHONE #: 208 - 395 - 4711
CONTRACTOR: SOURCE REFRIGERATION & HVAC IN Y PHONE #: 503 - 652 - 0884
Inspection Request Scheduled For: „ Date: 2/1212Q08 fli Pour Time:
Code # Inspection Description Confirm # Contact # Mess.:
699 Mechanical final 064851 -01 503. 819.9297
Corrections /Comments /Instructions:
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ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W/I Date: 2 Phone #: (503) 718 - 2-4
CITY OF TIGARD * - A
BUILDING DIVISION / 6 PERMIT #: MEC2007 -00687
13125 SW Hall Blvd., Tigard, OR 97223 Alb (( DATE ISSUED: 10/29/2007
Phone: (503) 639 -4171 e4 °� k
Inspection Requests (24 Hrs.): (503) 639 -4175 °'I�I a-2-' .
INSPECTION WORKSHEET FOR DATE: 11/19/2007 TIME: 7 :01AM PAGE: 5
SITE ADDRESS: 16200 SW PACIFIC HWY Z. - ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SOUARE LOT #: TYPE OF USE:
PROJECT NAME: ALI3ERTSONS
DESCRIPTION: Refrigeration remodel. Value: $65,000 ,
OWNER: IF;J SCHRODER BANK + TRUST CO, PHONE #: 208 - 396-4711
CONTRACTOR: SOURCE REFRIGERATION & HVAC IN PHONE #: 503 - 652 -0804
Inspection Request Scheduled For: Date: 11/19/2007 Pour Time: I ' ,
Code # Inspection Description Confirm # Contact # M: sage -/.
615 Mechanical rough-in 059930 -01 503-79 ' n Y / i
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Corrections /Comments /Instructions:
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❑ S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\1L p Inspector: 1./ V � Date: N 1 tb‘ 1 Phone #: (503) 718 - 171 211
CITY OF TIGARD a
BUILDING DIVISION P PERMIT #: MEC2007- 00587
13125 SW Hall Blvd., Tigard, OR 97223 � DATE ISSUED: 10/29/2007
Phone: (503) 639 -4171 041611 i n Or
Inspection Requests (24 Hrs.): (503) 639 -4175 F_ ..
INSPECTION WORKSHEET FOR DATE: 11/i 5/2007 TIME: 7 PAGE: 4
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALI3ERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ALI3ERTSONS
DESCRIPTION: Refrigeration remodel. Value: $65,000
OWNER: IF3J SCHRODER BANK + TRUST CO, PHONE #: 208-395-4711
CONTRACTOR: SOURCE REFRIGE: ; • `;�:s HVAC IN PHONE #: 503 - 652 -0884
Inspection Request Scheduled Fo . , ' • : te: 11/15/2007 I Pour Time:
/ .
Code # Inspection Descri • 0 f onfirm # Contact # Mes- : ge
695 Misc. inspection 059733-01 503 - 793-8379 Y
Corrections /Comments/ Instructions:
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0 75 - A - ss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `� (/ `, D ate: l 1. L 0 Phone #: (503) 718 - 1