Permit CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00442
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: Installation of walk -in cooler
Contractor: GRANT REFRIGERATION LLC Owner: FW OR- GREENWAY TOWN CENTER LLC
PO BOX 2506 PO BOX 790830
TUALATIN, OR 97062 SAN ANTONIO, TX 78279
PHONE: 503 - 519 -3751 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Misc Administration Fee 08/28/2012 $2.00
Class of Work: ALT Type of Const: Permit Fee 08/28/2012 $263.41
Occupancy Grp: Occupancy Load: Plan Review 08/28/2012 $65.85
Stories: 12% State Surcharge - Mechanical 08/28/2012 $31.61
Project Valuation: $7,000.00 Info Process /Archiving - Sm $0.50 (up to 08/28/2012 $1.00
11x17)
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: 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 $363.87
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Walk -in
Duct Work: cooler
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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N• : V•1 Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir: t questions t• •UNC b : .ng 03.232.1987 or 1.800.332.2344.
Issu -d By: At/ / I Permittee Signature: C (
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Mechanical Permit Application FOR OFFICE: USE ONLY
City of Tigard � j Date/By: frm Permit No.: . / a49 �fy
II
a 13125 SW Hall Blvd., Tigard, OR 9722 �I../1 r 1J� Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TI G A R D Inspection Line: 503.639 AUG 2 3 2 012 Date Ready/By: kris: 53 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITYOFTIt;ARI)
TYPE OF MIMING DIVISION COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work -
❑ New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $ 1. lOO "
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ 1- and 2- family dwelling ❑ 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:
� Air conditioning
, hw
Job site address: / Z28 6 SC( -OL-L �`ey✓ .
, I J(T/1-a -D (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts
/vents) ( ?Cr it40 O z S 7. 2.? (ducts/vents) 46.75
'2
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: /l 77 el Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
ar� / v.✓ l r G✓ - r,4 C>� - 9 .a X (3� Gas f Flue vent f for w 33.39
/ ent or water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: ei caN- rE-f(--s (Gozr-iv w q -77,,, � �) Environmental exhaust and ventilation:
9 / Range hood/other kitchen
Address: 4'.Q. o� 71 3 equipment 33.39
City /State /ZIP: S 4 4 70 D , TX • "78 2 71 Clothes dryer exhaust , 33.39
Phone: ( ) p3 ■ 'r"1 Ot7 Fax: Single -duct exhaust (bathrooms,
(p �f ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: -
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue _
Business name: 6 -- - �(.�:cyt Clothes dryer (gas)
✓i Pr Other:
Address: P .0 , a o� 2S MECHANICAL PERMIT FEES*
City /State /ZIP: uA Lihl % 0) t9 IL. 9-70 Z Subtotal `
! Minimum permit fee ($90.00)
Phone: ( S) 3) 5)q -3/57 Fax: ( )
Plan review (25% of permit fee)
CCB lic.: l VI 7 2-7 / 2.//t//3 State surcharge (12% of permit fee)
a TOTAL PERMIT FEE
Authorized signature: A " This permit application expires if a permit is not obtained within 180
v _ days after it has been accepted as complete.
Print name: M e L.- A N I Date: 8 ) / * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building 'Permits\MEC- PermitApp.doc 03/07/12 4417T (II COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
• $5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 2
CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00442
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: Installation of walk -in cooler
Contractor: GRANT REFRIGERATION LLC Owner: FW OR- GREENWAY TOWN CENTER LLC
PO BOX 2506 PO BOX 790830
TUALATIN, OR 97062 SAN ANTONIO, TX 78279
PHONE: 503 - 519 -3751 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Misc Administration Fee 08/28/2012 $2.00
Class of Work: ALT Type of Const: Permit Fee 08/28/2012 $263.41
Occupancy Grp: Occupancy Load: Plan Review 08/28/2012 $65.85
Stories: 12% State Surcharge - Mechanical 08/28/2012 $31.61
Project Valuation: $7,000.00 Info Process /Archiving - Sm $0.50 (up to 08/28/2012 $1.00
11x17)
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: 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 $363.87
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Walk -in
Duct Work: cooler
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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N• : V•1 Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir: t questions t• •UNC b : .ng 03.232.1987 or 1.800.332.2344.
Issu -d By: At/ / I Permittee Signature: C (
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.