Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00533
T l G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2012
Parcel: 16136 DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995 -013 PARTITION PLAT Lot: 2
Project Description: Replacement of existing refrigerated case.
Contractor: ENGINEERED STRUCTURES INC A CORP OF Owner: WINCO FOOD LLC
33330 E LOUISE DR., STE. 300 ATTN: TAX DEPARTMENT
MERIDIAN, ID 83642 PO BOX 5756
BOISE, ID 83705
PHONE: 208 - 362 -3040 PHONE: 208- 377 -0110
FAX: 208 - 362 -3113
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/27/2012 $728.71
Class of Work: ALT Type of Const: IIB Plan Review 12/27/2012 $182.18
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 12/27/2012 $87.45
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 12/27/2012 $1.50
11x17)
Project Valuation: $25,000.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers 8 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 $999.84
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: refrigeration
Duct Work: case
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 Notification 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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: lA� Permittee Signature:
t�v Call 503.639.4175 by 7:00 a.m. for the next available inspection d .
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 Applic
aRE CEIVED FOR OFFICE USE ONLY
! ! Received
City of Tigard Date/By. /o /.&//,,9-- ., Permit No )4*1Fe - (:)(..q—C....6533
n 13125 SW Hall Blvd., Tigard, OR 972238 j 1 6 2012 Plan Revie r
Phone: 503.718.2439 Fax: 503.598.196 Date By: �r Id Z. �rLrOther Permit
1 t t i .\ R I Inspection Line: 503.639.4175 CITY f OF T'^ . R D D Rea )uns / H See Page 2 for
Internet: www.tigard- or.gov (Jr i �J Notified/Method 4, '-(j Supplemental Information
SUIl01NG DIVISION emmu r. - ,JtsY/FDl��l 111ue-111EZALMfg/
TYPE OF WORK 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: S $25,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
❑ 1 - and 2-family dwelling ®Commercial /industrial E Accessory building For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Fa. 1 Total
75Q / JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 7500 SW Dartmouth (requires site plan showing placement) 46.75
r - - -- Furnace 100,000 BTII (ducis/vents) 46.75
City /State /ZIP: Tigard, OR Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Winco Foods 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
Gas fireplace/insert 33 39
Replacement of an existing medium temperature refrigerated case with a new Flue vent for water heater or gas
3 -door case to include refrigeration and electrical re- connections. The existing fireplace 23.32
Log lighter (gas) 23.32
floor sink will be re -used. Wood /pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Winco Foods LLC Environmental exhaust and ventilation:
Address: 750 N Armstrong Place Range hood /other kitchen
equipment 33.39
City /State /ZIP: Boise, Idaho 83704 Clothes dryer exhaust 33.39
Phone: (208)377-0110 Fax: ( ) Single -duct exhaust (bathrooms.
toilet compartments, utility rooms) 23.32
® APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Petersen Staggs Architects LLP Other: 23.32
Fuel piping:
Contact name: Lee Lizama, Project Manager 514.15 for first four; 54.03 for each additional
Address: 5200 W. State Street Furnace, etc.
Gas heat pump
City /State /ZIP: Boise, Idaho 83703 Wall /suspended/unit heater
Phone: (208) 345 -1462 Fax: : ( ) Water heater
Fireplace
E -mail: psa@psarch.com Range
CONTRACTOR Barbecue
Business name: To Be Determined , C ilri! SS Oave Clothes dryer (gas)
� (KG 4� Other:
Address:
3 3 0 L 4_p u e Ac ` 4e. 30D ✓ MECHANICAL PERMIT FEES"
City /State /ZIP: _ _ ak ,TO $34,.(?- _ Subtotal
Minimum permit fee ($90.00)
Phone: (?o ) 36 }- N (4 - Fax: ( a•pyl Sion- 3t (3 Plan review (25% of permit fee) _
CCB lie.: 7 . i ce b 104 10 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature. This permit application expires if a permit is not obtained within ISO
g days after it has been accepted as complete.
Print name: Lee Lizama I Date: 10/15/12 ' Fee methodology set by Tn- County Building Industry Service Board
1 \Ruilding\Permits/MEC- PermitApp doc 03/ 07/12 440 -4617T (II /02,CO \s'WFB)
, e I
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.
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