Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 - 00073
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/24/2005
PARCEL: 1S136DC-04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO
SUBDIVISION: PP1995 - 013 ZONING: C -
BLOCK: LOT: JURISDICTION: TIG •
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
Remarks: Relocate evaperator coil, remove & replace 8' dairy case. Valuation: $7000.
Owner: FEES
WAREMART INC Description Date Amount
BY BURKE + NICKEL [TAX] 8% State Surchaq 2/24/200E $14.20
3336 E 32ND ST #217 [MECH] Permit Fee 2/24/200E $177.50
TULSA, OK 74135
Phone: Total $191.70
Contractor:
SOURCE REFRIGERATION & HVAC IN
5506 SE INTERNATIONAL WAY REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97222
Phone: 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.
A
Issued By: � f( Xj� Permittee Signature: / 6 /a
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bu i�day
fir'
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Mechanical Permit Application FOIL OFFICiE USE ONLY t ..
`t Qf Tigard Received .(� permit No. �V c r) f d1 G 71
13125 S Hall Blvd., Tigard, OR 97223 Date/By: " 5/ 0 . S - 1�.1--
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 - /i t gi t ' 0l �, '{ 1 _ ` D
Inspection Line: 503.639.4175 - _ _'_I Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
•
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El 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: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 7 orre)
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2 - family dwelling Commercial /industrial ❑ Accessory building
❑ Multi - family For special information use checklist.
❑ Master builder ❑ Other:
Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 760-n Ar-f -gy j -+- (C � , Air conditioning or heat pump
/ K (requires site plan showing placement) 14.00
City /State /ZIP: - 5 ar 0 D 'R Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: (� v-- CO -Frock Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
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. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
• DESCRIPTION OF WORK Water heater 10.00
p r/ ^ D Gas fireplace 10.00
(1 2c.C'2 [) ' (IJ? F i, V) 1 ( j Y �.QJ 1 l , t i } R ..eavt f/ v�� Flue vent for water heater or gas
O "" l +(� ^ n _ 1 ( trot f D 0. i ir '•; fireplace 10.00
"� lG `� ` Loog g l 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: w n e v to_e.eL S Environmental exhaust and ventilation
Address: �p O !�� Range hood/other kitchen
/� equipment 10.00
City /State /ZIP: itJgoj, .b ti - r -0 Q fZ g 7 0 7 ( Clothes dryer exhaust 10.00
Fax: Single -duct exhaust (bathrooms,
Phone:
G3 ) y'02 - c(9 ? ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
�p ,/
Business name: rCfe iv &4l UV1 #lJ ( - ,_,-,1c_ , Fuel piping
Contact name: k ti -v t V- $5.40 for first four; $1.00 for each additional
Furnace, Address: c t"t`C/l, (tom t U P c ( - Gas heat p um
M pump
�
City /State /ZIP: U i t 1 1)00t.A) k 1 €... n ig 7 � , , L Wall /suspended/unit heater
Phone: (Sp 3) 8 LI 9 _ 02 . 5 ,E b Fax: : 0503) 6 �a _ Q (.,i ( 4 9 Water heater
� Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: \) r D rl n 0. `
1 j � l) �� -J Clothes dryer (gas)
Other:
Address:,c---n--'0 6 5 i= :� � t � � 61) MECHANICAL PERMIT FEES*
City /State /ZIP: 1 l t/oA,.t rk( 9 7 , - ;-Q- Subtotal / 77.E
Phone: _` JU 3) _ 615
�a ,-Q �1 1 Fax: ( o3) 6 t . Minimum permit fee fee)
CCCCCUJJJJJ ! �i p Plan review (25% of permit rmit fee)
CCB lic.: ,�,. State surcharge (8% of permit fee) j y. l- d
TOTAL PERMIT FEE
Authorized signature: 2 This permit application expires if a permit is not obtained within 180 A
/.-A ` days after it has been accepted as complete. / 5'/
Print name: l l / 1 A 2.K i3 - cr Date , a Li ... * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- PennitApp.doc 12103 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.
•
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: IVIEC2005-00073
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 811512005
Phone: (503) 639-4171 .Ad
'
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 7:06AM PAGE: 88
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 W1NCO CLASS OF WORK:
SUBDIVISION: PP1995 LOT #: TYPE OF USE:
PROJECT NAME: VANCO
DESCRIPTION: Relocate evaperator coil, remove & replace 8" dairy case. Valuation: $7000. 8-15-2005 Adding
relocation of 8' dairy case. $2000
OWNER: WAREMART INC, PHONE #:
CONTRACTOR: SOURCE REFRIGERATION & HVAC IN • PHONE #: 503-652-0884
,
Inspection Request Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 023573-01 503-849-6580 N
Corrections /Comments/ Instructions:
I
u .
ASS I I PARTIAL APPROVAL fl CANCEL n NO ACCESS
I I FAIL 7 CALL FOR INSPECTION I I ADDITIONAL FE S ASSESSED
Inspector: Date: (6
______ZAL _____
hone #: (503) 718-
i ,