Permit (40) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00478
Date Issued: 07/28/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9625 SW WASHINGTON SQUARE RD FC01
Project: Sarku Japan Subdivision: None Lot: None
Project Description: Walk-in cooler installation.
Contractor: WOODBURN CONSTRUCTION CO Owner: PPR WASHINGTON SQUARE LLC
PO BOX 129 PO BOX 847
WOODBURN, OR 97071 CARLSBAD, CA 92018
PHONE: 503-981-9504 PHONE:
FAX: 503-981-9504
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/28/2016 $191.86
Class of Work: ALT Type of Const: Plan Review 07/28/2016 $47.97
Occupancy Grp: A-2 Occupancy Load: 12%State Surcharge-Mechanical 07/28/2016 $23.02
Stories: Info Process/Archiving-Sm$0.50(up to 07/28/2016 $3.50
11x17)
Project Valuation: $4,500.00
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 $266.35
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: walk in
Duct Work: cooler
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. f� �
Issued By: Permittee Signature: �vU K
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1'
.4 �� � � ,�^1 FOR OFFICE USG ONLY
111 City of Tigard - it
Received /"_^,i Date/By: (�7 , ��' PermitNo.:u �13]25SWHallBlvd.,Tigard,OR 97223 �� �r 74r
s50 PlanR to464.00:11:11‘r.'"� Date/B 4 4 �� Other Permit:
f I
GA R D Inspection Line: 10 :1 e �l' '�
Internet: Line:g 503.639.4175rd-or.gov Date Rea��: Juris: El See Page 2 for
i, Votified/Method: •
r 1 f _ �jMr
^ Supplemental Information
Su le
.;a::;.6It
❑New construction Addition/alteration/replacement - echanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
ei. a(c e�
jLh Value:$ .r41.?
40000 iYs y . A •, - .07-700E-010- t-0. Y. 000 .-;_0_, 00, r -:fes o 6 ': t?. t:
❑ 1-and 2-family dwelling Commercial/industrial " li f t *fir.;
0 Accessory building For special information use checklist.
❑Multi family Master builder 0 OtherDescriptiona
"-` "� Qty. I E . I Total
,, . I *;Mil;,, o IV ati N .. Heating/cooling:
Job site address: ( `` L 41-
j
�j � Air conditionin
I✓a . / r Gtu g 46.75
����f of 6� " i�/�` Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1�j'''' ( i 0 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.:d t Project name: // Heat pump 61.06
iA
Duct work 23.32
Cross street/directions to job site:
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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater
- � 1 �;`4''' 4 � 23.32
max' -r.,44 D.-E6. '14N',OF *Q K # Al. ';„ 4 Gas fireplace/insert 33.39
= „,. `# Flue vent for water heater or gas
1k- fll (06)/e4/ fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
7 T' d r `
.. �fi ®„ a ' , *t .I £.. -v Other: 23.32
.,41"' £ '<u',.., Environmental exhaust and ventilation:
Name:
Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:( ) toilet compartments,utility rooms) 23.32
Fax ( )
Attic/crawlspace fans 23.32
. ittAttemit \ tC N PE F rat# ,. Other:
� ,.x. . ��� 23.32
Business name: //((� Fuel piping:
JCL�,'Wi..c� Lc�s.iy,, 4-114-t. (.0
(�� $14.15 for first four;$4.03 for each additional
Contact name:
*r`- i- ✓�r.f itoic;,1 ad Furnace,etc.
Address:6 0., 1-.LL. i t Gas heat pump
�`���hiil�� Wall/suspended/unit heater
City/State/ZIP:
(Z. Water heater
Phone:( 3) (-ls-3 Li Fax: :( ) Fireplace
E-mail:bgy`/Wi),AW,tt ahctt/JG 1•l�l� Range
�. �W. Barbecue
, .-,6.",,o,.., . : ,:4-=,a , 4 as ",. Clothes dryer(gas)
Other:Business name: Sco,,f- /q1pV
.,.I1 �I C rAr
;Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%ofpennit fee)
Phone:( ) I Fax:( )
State surcharge(12%of permit fee)
CCB lie.: 2 3�� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized sign re: a` days has been acceptedding as complete.
L_ ` * Fee methodology
after set byit
Tri-County BuilIndustry Service Board
Print name: Z p✓U��U" I Date: /�S�/���
I:A Budding\Permits'uMOC_PermitApp 040113.doc 440-4617T(t1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi Family Fee Schedule:
$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:ABuilding\Pennits\MEC PennitApp_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9625 SW WASHINGTON SQUARE RD FC01,
TIGARD, OR, 97223
Commercial - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00478
Chip Barnett
Violation Summary:
Inspector Contractor