Permit . a CITY OF TIGARD MECHANICAL PERMIT
; '11 ° COMMUNITY DEVELOPMENT Permit #: MEC2009 -00326
Date Issued: 07/06/2009
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Relocate (1) supply diffuser, add (1) new diffuser & (1) new exhaust grille. New grilles connected
to existing system.
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
Permit Fee 07/06/2009 $72.50
BOX 35547 12% State Surcharge - Mechanical 07/06/2009 $8.70
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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 $81.20
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 if . • • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No' cation Center. • •se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a cosy oft - rules
or dire• questions to OUNC b •: ing •03 •6.6699 or 1.800.332.2344.
Issue. =y: / ' 0/ � � Pennittee Signature: 11 I
Call 503.639.4175 by 7:00 a.m. for an inspection that busine
This permit card shall be kept in a conspicuous place on the job site until corn • • n of the project.
Approved plans are required on the job site at the time of each inspection.
'Mechanical Permit Application roll OFFICE U S E O\ Ll
City of Tigard Received 7 b 09' , Permit No.: f/ 1 j _
■ 13125 SW Hall Blvd., Tigard, OR 97223
0 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit: aP��'�i ego
DateBy:
T I G A R D Inspection Line: 503.639 Date Ready/By: heis: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction 4 Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead,
l ov t
�erhead, and profit.
CATEGORY OF CONSTRUCTION Value. $ 9 1 1 V VD
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2-family g Ps Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 11 S VS S V\) Pox C , 1 L k V v V Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/Z1P: { & 1 OIQ c I Furnace 100,000 BTU (ducts/vents) 14.00
VII., VA J
Furnace 100,000+ BTU (ducts/vents) 17.90
Slrite/bldgfapt. no.: Project name: (k ` 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: I 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
gqA.) W'R 1 ;� l �� / � t Gas fireplace 10.00
1 AA) Flue vent for water heater or gas
%, I. C n y - t I ' v D, p � fireplace 10.00
V. w e Ol c Gott NIA. _ 0 �
► ` f S - L - f}' V ) Log Wood/pellet (gas) 10.00
.J ` J � ) � Wood/ Ilet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /nue/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 IR C ONTACT PERSON Attic/crawlspace fans 10.00
Business name: \.\J AL' 1 A- F u e l 10.00
Piping
Contact name: o k ` $5.40 for first four; $1.00 for each additional
Address: S l?..11 MAj1 V lAgi 69)....0.., Furnace, etc.
Gas heat pump
City/State/ZIP: f�t I W 4t : 0 �, " _ Wall/suspended/unit heater
Phone: 1503) vl t 14,1 Fax:: (S (,,{ J0' (15 Water heater
CD Fireplace
E -mail: "1 O Ok\ j l (VO N�(J U �n C,D t Range
CONTCTOR Barbecue
Business name: VA L rc JAL, Clothes dryer (gas)
Other.
Address: a ��� A � MECHANICAL PERMIT FEES*
5
City/State/ZIP: l/Uy v — t � J �
Subtotal
Minimum permit fee ($72.50)
Phone: ( ) I Fax: ( ) Plan review (25% of permit fee)
CCB lic.: St, D State surcharge (12% of permit fee)
I TOTAL PERMIT FEE D l ,
Authorized signature `' T his permit application expires if a permit is not obtained within 180
r • days after it has been accepted as complete.
L Print name•, J' r II ' t I Date: 7 (^ 1 0 ( I * Fee methodology set by Tri- County Building Industry Service Board
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