Permit CITY TIGARD MECHANICAL PERMIT
10 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00336
,.� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 • DATE ISSUED: 8/12/03
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY 17 OLD CNTRY BUF
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A2.1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 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: 1 OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Mechanical work associated with remodel of dining room and buffet.
Project Value: $50,000
Owner: FEES
OCB RESTAURANT CO. Description Date Amount
1460 BUFFET WAY [MECH] Permit Fee 8/12/03 $72.50
EAGAN, MN 55121 [MECPLN] Plan Rev 8/12/03 $18.13
[TAX] 8% StateTax 8/12/03 $5.80
Phone: 651 365 - 2142 Total $96.43
Contractor:
NORTHWEST MECHANICAL SPECIALITIES
2130 NE GRIFFIN OAKS ST.#200
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone: 503 Hood Inspection
Duct Inspection
Reg #: LIC 121328 Duct Inspection
Misc. Inspection
Final Inspection
•
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
Issued By: ce4g ZX/D Permittee Signature: C92 GL 2,1_24PQ-,,[��72-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
I - q or c 7--10 i SJ3
Mechanical Permit Application OFFICE USE ONLY
Date received: (A ( �f 03 Permit no.:}1tt Aoa5. en33<4
Aka
` +` City of Tigard
..?� ^'__.. City b Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223.
Phone: (503) 6394171 o Date issued: Bz Receipt no.:
Fax: (503) 598 -1960 ,-i ' ' - Case file no.: Payment type:
Land use approval: . Building permit no.: •
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory ❑ ommetciaVindustrial 0 Multi- family ❑ Tenant improvement
O New construction ►- : ddition/alteration /replacement ❑ Other:
JOB SITE INFORMA'T'ION COMMERCIAL VALUATION SCHEDULE
Job address: /3500 5 VV 7 /r /e.— if f y Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: . I Suite no.: I �I value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: ��f 4 -62)) profit. Value $ .`� • w .
Lot: Block: Subdivision: *See checklist for important application information and
Project name d■I� w •rT' 7'S' jurisdiction's fee schedule for residential permit fee.
City/countyy ,q 7 a/awl/ 6v S IP: 7aa3 I & 2FAMILY DWELLING PERMIT FEE SCHEDULE
Description and loc. on of work on premises: AND COJ1MERICALIINDUSLRIAL EQUIPMENI'SCHEDULE
OF 73/Alin/ (freT �E E / Fee (ea.) Total
Est. date of completion/inspection: y6 / b Description Qty. Res. only Res. only
Tenant improvement or change of use: H AC:
Is existing space heated or con toned? Yes ❑ No Air handling unit CFM
Is existing space insulated? Yes ❑ o Air conditioning (site plan required)
Alteration of existing HVAC system
IV ECIIANICAL CONTRACTOR Boiler /compressors
Business name: ., Wiwi' • State boiler permit no.:
HP Tons BTU/H
Address: c , l 3 p N E G 4 144-1 A f)4 k5 . OO N IV Fire/smoke dampers/duct smoke detectors
City: ' I I- J. 0 0 State: Q, . ZIPref7 /Z tvy.t• Heat pump (site plan required)
Phoneo3 gyy t/7ge" Fax: Hif 'TSzei E -mail: Insta 'rep ace mac- .urner BTU
CCB no.: Z 1 L Including ductwork/vent liner O Yes O No
Install/replace/relocate heaters - suspended,
City/metro lic. no.: . • wall, or floor mounted
Name (please print): a ...I C (G- 3 R ! r, 11 S Vent for appliance other than furnace
CONTACT' PERSON Refrigeration:
Absorption units BTU/H
Name: /f/ , j //' 0/jf7 Chillers HP
Address: j f -7 -- W/ Compressors HP
City: �' State: ZIP: 537271 exhaust and ventila on:
ty: . - 53 / Appliance vent
Phone l,365'a/y_ Fax:" / - E-mail. ►'atcri G.fx/moc21T Dryer exhaust
OWNER Hoods, Type If Illres. kitchen/hazmat
En hood fire suppression system
1► rI ;��� L _> Exhaust fan with single duct (bath fans)
Mailing address: t 1p 6 ,f er 4 Exhausts stem a.art from heating or AC
13 VA Fuel piping and d . bution (up to 4 outlets)
•r - .. Type: LPG NG Oil III
Phone ,i0 A � .W. I ' Fue pipino eac a. . tnon • over 4 out ets
ENGINEER Process piping (schematic required)
Name: A • = �� Number of outlets
M e?j - -a ii/ PPJ f i e �i c er I e o ■ fireplace
ance or eq pment:
Address:
Me?, Decorative fire lace
Ci 7 . 0 - State. ZIP• / -am , Insert - type
Phon. - _t. kif -d: r. At i s7 /( M DA YA' `t t oo• tove pe et stove
Other:
�,(�
Applicant's signa, i , / `,� 0 er:
T �� _ ` Mal , , ,
Name (print):
- �. /L`l1 7A
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Minimum fee %) $
Credit card number: / / Plan review (at _ /o) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Namc of cardholder as shown on credit card accepted as complete.
$ TOTAL $ 1
Cardholder signature Amount
440-4617 (6/00 /COM)
■
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received _ Date Requested —/ S AM _> PM BUP
Location / 3 5I. MEC 3 o a 33 e
Contact Person 4,11X1. Ph ( ) g4f `i' 7 A'# PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner [ad/ - ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL \
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date -! , / / /dl.! /) 3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL