Permit CITY T I G A R D MECHANICAL PERMIT
PERMIT #: MEC2001 -00255
DEVELOPMENT SERVICES DATE ISSUED: 7/30/01
= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13560 SW PACIFIC HIGHWAY STARBUCKS
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: • VENT FANS: 2
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 2
FURN > =100K BTU: <= 10000 cfm: 2 GAS OUTLETS: 1
> 10000 cfm:
Remarks: Mechanical TI
Owner: FEES
STARBUCKS COFFEE COMPANY Type By Date Amount Receipt
2401 UTAH AVE S PRMT CTR 7/30/01 $72.50 2720010000
SEATTLE, WA 98134 PLCK CTR 7/30/01 $18.13 2720010000
5PCT CTR 7/30/01 $5.80 2720010000
Phone: 503-318-1575 Total $96.43
Contractor:
BEWLEY MECHANICAL
5591 SW ARCTIC DR
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 626 -8986 Mechanical Insp
Reg #: LIC 63582 Duct 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 -0080. •
You may obtain • •ies of these rules or direct questions to OUNC / by callin• (503)246 -91 ;9.
Issue By: 4111P Permittee Signature: J _ ; � �i „- •
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
.. ,,
Mechanical Permit Application
Date received: 7 9 D/ Permit no.:tf
;i i': i City of Tigard Project/appl.no.: Expire date: •
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Paymenttype:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family • 0 Tenant improvement
0 New construction XAddition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: I'35 SIfJ . Pa (.16'(, ii 1 1 - 11 . 14 1 61a Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: — Suite n ).: value of all mechanical materials, equipment, labor, overhead,
Tax mapftax lot/account no.: 0 profit. Value $ — I Si 0 _ .
Lot: /" IBlock: I Subdivision: *See checklist for important application information and
Project name: 9F 419 LS ') j �1/d rfla1i �aC jurisdiction's fee schedule for residential permit fee
City /county: fl N D�� ZIP: q ?223 1 & 2FAMILI DWELLING PERMIT F •E SCHEDULE
Description and lohAtion of work of premises: ,A s , , • AND CO3131ERICAL/INDUSTR1AL EQL•IP1 ENTSCHEDU.E
'h t)4S Conif t/ (4 AEI LA,1,t 1 4 bi. Fes(ea.) Total
Est. date of r etion/inspection: q . ). u Desa'ption Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: U- i 2sve
Is existing space heated or conditioned? ()riles 0 No
Air handling unit l'70-7.- CFM !V Z
Air conditioning (site plan required) —
Is existing space insulated ?'Yes O No
Alteration of existing HVAC system --
MECHANICAL CONTRACTOR Boiler /compressors
- State boiler permit no.:
Business name:
s : i, . e HP Tons BTU/H •:• —
Address: S,5 / r *Z-TI C /v t< Fire /smoke dampers /duct smoke detectors a
City: 2 /,_. _ I StatepQ I ZIP: c1 7DD rS Heat pump (site plan required) —
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU/H
CCB no.: (p3GjB Including ductwork/vent liner O Yes O No
Install/replace/relocate heaters - suspended,
City/metro lic. no.: wall, or floor mounted —
Name (please print): Vent for ap other than furnace _,
CONTACT PERSON RehigeraMom
Absorption units BTU/H —
Name: 'eve E Chillers HP —
Address: 105 Zi aAje 7/ d Compressors HP —
FEnvironmental exhaust and ventilation:
v
City: ff (A I State: 14 ZIP: qS I d I c Appliance vent i
Phone: , . , Z , Fax: .. 2s' - . E-mail: — Dryer exhaust _
O X11 ER Hoods, Type U II/res. kitchen/hazmat _
Name: sf U �(1C Cp I hood fire suppression system
r.ovvT1�1 Exhaust fan with single duct (bath fans)
Mailing address: 2 0 1 ututi .uP S , Exhaust system apart from heating or AC —
City: SP CA-t Q I State:VJ I ZIP: Gjg 13'f J Fuel piping and disMbution (up to 4 outlets)
ype: LPG ✓ NG Oil 1
Phone: 'Lo . t t ' . s Fax: — E -mail: Fuel piping each additional over 4 outlets —
Processpiping(schematicrequired) —
Name:'r�/� k e..4i- Number of outlets _
Other listed appliance or equipment:
Address: `L7p2 ' t4 * 3 1 Decorativefireplace .
City: Taco tvt o- State: u ZIP: qg e}6 q Insert - type _
Phone: 253 . 412.3300 I Fax: g25•y'12.34N1 E -mail: -- Woodstove/pelletstove —
Other.
Applicant's signature: ����(�Q tF}k . I Date: - 7.s. 0 I Other
Name (print): 1 Nip_ 1�1, b P.v,3 '
(Not alt jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This ermit a lication
❑ Visa O MasterCard P pP Minimum fee V 1 3
expires if a permit is not obtained $
Credit card number. / / Plan review (at %) $
Expites within 180 days after it has been State surcharge (8%) $
Name of cardholder as shown on credit cars S accepted as complete. TOTAL $
signature Amount 440 -4617 (6100/COM)
MECHANICAL PERMIT FEES ..
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) ;
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and Including including ducts & vents 17.40
• $10,000.00. Floor Furnace "
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) including vent 14.00
$1.54 for each additional $100.00 or Suspended heater, wall heater
fraction thereof, to and including 4) 14.00
$25,000.00. or floor mounted heater
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and '4F CHeck al that`apply; $8p CAS r r r s ,s v.. w
$1.20 for each additional $100.00 or or i see .;„ x 4;o _,�; , Pump a 1C�ond , "
fraction thereof. :Corn `.. ' , ! `� "'
��fo'�tes belOw:Y�; � p - ' . . ,
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3-15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30-50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace induding vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU -
15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1 , `,f1 6.80
�
101k to 500k BTU `( 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 �� appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU •
5,725 18) Domestic incinerators 17.40
>50 hp; absorb. unit,
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 I 2 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, inducting wood stoves
Non - portable evaporate cooler r 656 10.00
Vent fan connected to a single duct 446 (I 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: '`" '"' ""
Commercial or industrial incinerator 4,590 t, , ; :_ e'∎ ,
Other unit, including wood stoves, 656 8% State Surcharge T ° .., . $
inserts, etc. 6? ��
Gas piping 1-4 outlets
360 25% Plan Review Fee (of subtotal) ' gip; „ .h�„ $
_
Each additional outlet 63 Required for ALL commercial permits only r, ..' '> "
TOTAL COMMERCIAL y x,•
: , %� - 8 TOTAL RESIDENTIAL PERMIT FEE: � y# : 'I $
VALUATION: ; ;, ( ; j :, $ I I :: ., .?' ,
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
i :ldsts\forms\mech- fees.doc 10/11/00