Permit C ITY T O F TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00382
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/23/2008
PARCEL: 2S 110AC - 01101
SITE ADDRESS: 11290 SW BULL MOUNTAIN RD ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: SHELL
Project Description: Add ice machine head unit to soda fountain with remote unit on roof condensing unit. $3,500
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOERS:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
PAC WEST ENERGY LLC Description Date Amount
3450 COMMERCIAL CT
MERIDIAN, ID 83642 [MECH] Permit Fee 7/23/200€ $107.00
[MECPLN] Plan Rev 7/23/200€ $26.75
[TAX] 12% State Surch 7/23/200€ $12.84
Phone: Total $146.59
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 652 -0884
FAX 503- 652 -0449
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.
Issued By: ` I Permittee Signature:
Call 503.. . • 5 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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
/ �/ % ,�
Meell l Permit Appl ti" a L _ , FOR OFFICE USE ONL
City g Of Tigard t ' WE
Date Recei B ved y: 1' F _Alta. t
��i. 'ennit No.: C �0f(J , � A Q�(T
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13125 SW Hall Blvd., Tigard, OR 9,M3 c� Plan Review, A Other Permit.
Phone: 503.639.4171 Fax: 503.558JI461Xr 2 2008 Date/By: / /�® Ii
T I G ARD Inspection Line: 503.639.4175 Date Ready /By: Juris ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 7 0 (517 Supplemental Information
BUILDING DIVISION tly.0 4 , ‘ A' 1 ,{.PA4,1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE. CHECKLIST
❑ New construction . Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: C Ll + mechanical materials, equipment, labor; overhead, -and profit.
CATEGORY OF CONSTRUCTION . Valu :'$ 33 V )
RESIDENTIAL EQUIP NT %SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
•JOB SITE ,INFORMATION AND LOCATION Heating/cooling
�®� Air conditioning or heat pump
,4
Job site address: /7 290 SL) , // //q,9 u,... .,`,.. /'� (reQuires site plan showing placement) 14.00
' City /State /ZIP: (t s ,,,, --L 0-r-e . 972 L Furnace 100,000 BTU (ducts /vents) 14.00
d l Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: A c, ) i s\ -S 3v Gas heat pump 14.00
Cross street/directions to job site: . j 7p /J 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.: oqsr'', e Q`/ ® i Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�
{ Gas fireplace 10.00
r« u -.s..x L. � T
l%
e ea l . te,,,_• - 4-. Sc)r(w ...v.-�a.r v. [..->/ Flue vent for water heater or gas � v fireplace 10.00
/fitti
t o ,- LA-v.. f I- n, ,.._ re> e. 4 r,.2 ,.,c r 4/ Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00 _
PROPERTY OWNER • _ ❑ TENANT. Chimney /liner /flue /vent 10.00
Other: 10.00
Name: Pct.L w e-5i- Et,..c.r5 y L LC Environmental exhaust and ventilation
Range hood /other kitchen
Address: 3 9 Sp C w+ , c 1 J e�, equipment 10.00
City /State /ZIP: /M Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
•
❑ APPLICANT' MCONTACT PERSON Attic /crawlspace fans _ 10.00
Other: 10.00
�}
Business name: So c... -tc e , � r-- t..00'G Fuel piping
Contact name: /(. (/t/(,,., lcs L $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 5-co c, Se t.,,L, /,,,�{ e �1,,.c.,( Lie,,/ Gas heat pump
City /State /ZIP: , `w �w4 .c G rt✓ 9 722 Z Wall /suspended/unit heater
Water heater
Phone: ( S 6 3) .j'72 - /,3 / O Fax: : (CO3) G SZ " O c /
Fireplace
E -mail: p
Range
CONTRACTOR • Barbecue •
Clothes dryer (gas)
Business name: SO u ,/`tit " , -u �.L'ow t-- t{U 44. Other:
Address: : f0 ( S a ,, ,,��t. ( t.uc,r MECHANICAL PERMTT.FEES* -
4 City/State/ZIP: / Subtotal
y t r� �t e V Y 97222- Minimum permit fec ($72.50)
Phone: (gob) G 77- z w s $ Fax: (s-c 3 ) ( Sz 0 q Li Plan review (25% of permit fee)
CCB lie.: / ti /g z 0 CJ State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 4�c w 7Kw j , C.ca. Date: '7-22-68 * Fee methodology set by Tri- County Building Industry Service Board
I: \Building\Permits \MEC- PermitApp doc 01/19/07 440 -4617T (11/02 /COM/WEB)
•
Mechanical Permit Application - City of Tigard
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 $100.00 or
. fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
l:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ME C2008-00382
OtJ3$
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/2008
Phone: (503) 639 -4171u A l�woil
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 815/2008 TIME: 7:00AM PAGE: 19
SITE ADDRESS: 11290 Slid BULL MOUNTAIN RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SHELL
DESCRIPTION: Add ice machine head unit to soda fountain with remote unit on roof condensing unit. $3,500
OWNER: PAC WEST ENERGY LLC, PHONE #:
CONTRACTOR: SOURCE REFRIGERATION & HVAC IN PHONE #: 503-652-0884
Inspection Request Scheduled For: Date: 8/512008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 073739 -01 503-209-7671 0
l
•
Corrections /Comments/ Instructions:
. PA
IRTIAL APPROVAL n CANCEL n NO ACCESS
I I FAIL LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: _ 4/////b Date: 0 e Phone #: (503) 718 - 9
IIIPP