Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00315
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
T [ G'`�.R.17 9 Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Project: Summerfield Retirement Kitchen Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Replace Rooftop HVAC unit
Contractor: OREGON HEATING & AIR CONDITIONING Owner: TIGARD RETIREMENT RESIDENCE LLC
PO BOX 241 PO BOX 847
DUNDEE, OR 97115 CARLSBAD, CA 92018
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/13/2012 $370.57
Class of Work: ALT Type of Const: VB Plan Review 06/13/2012 $92.64
Occupancy Grp: A -3 Occupancy Load: 12% State Surcharge - Mechanical 06/13/2012 $44.47
Stories: Info Process /Archiving - Sm $0.50 (up to 06/13/2012 $13.00
11x17)
Project Valuation: $10,900.00
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 $520.68
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
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 no started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r l es adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Yo ma obt•'n a copy of the rules
or direct questions to OU C by calling 503.232.1987 or 1.800.332.2344. .,,
Issued By: Permittee Signature:
I �1
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 usi ONLY
PI Received Pe rmit No
City of Tigard Date/B : / el 13 1. kige.20 . D a bs -- 1
a 13125 SW Hall Blvd., Tigard, OR 97 2 4Js 'a plan Review�,� C Phone: 503.718.2439 Fax: 503.598.1960
Dat 1 •'
T I G n R D Inspection Line: 503.639 JUN 1 3 2012 Date Rea. runs: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: - Supplemental Information
CITY OF TIGARDD
TYPE OF EVADING 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, I r, ov T9bfld profit
Value: $ /0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /j�1 STEMS FEES*
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ForspedalInformation use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
_ Air conditioning
Job site address: // ? S 10,,t �� (requires site plan showing placement) 46.75
City/State /ZIP: Furnace 100,000 BTU ( ducts/vents) 46.75
/ Furnace 100,000+ BTU (ducts/vents) , 54.91
Suite/bldg. /apt. no.: ' Project name: eii) Heat pump
cAukfift , • '' (requires site plan showing placement) 61.06
Cross street/directions to job site: f Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
J'VI+,, Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK � / /� JU Water heater 23.32
il-p4/14- l V / Gas fireplace/insert
33.39
z (/ yli Flue vent ant for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation: _
Address: . Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
fr APPLICANT 9 CONTACT PERSON Attic /crawlspace fans 23.32
�,V1 • Other: 23.32
Business name: / y- �-/,f� Fuel piping:
Contact name: C , vi � 7f" ' 'C%r - , ' $14.15 for first four; $4.03 for each additional
Address: ( � t � ` Furnace, etc.
• - Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: (V �f �`? Fax: : ( ) Water heater
Vic / r , Fireplace
E -mail: /� -' I_ e J �(�C /it C a) n ,�}7' 1/4 47,1 t t�� Range
(f ONTRACT fR Barbecue
Business name: i 71-1. 4 4 C_--- Clothes dryer (gas)
r � 24 Othe Address: MECHANICAL PERMIT FEES*
City /State /ZIP: /?jam g // i 5 Subtotal
) G� /.,G Fax: (( ) / Minimum 25% fee r mit fee
Phone: (
629/ 6 (�/ ! ! Plan review (25% of permit fee)
CCB lie.: /l 79 ( l State surcharge (12% of permit fee) /
[ v`f TOTAL PERMIT FEE r .IB�
Authorized si attire: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. t i
Print name: C— ��° , I,� , . ,f/ `1,K4 V I Date: (,//3/ 7� • Fee methodology set by Tri County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp..doc 03/07/122 / 44 7TCOM/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 1 ,
$2.54 for each additional $100.00 or 4
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. 1
$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
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1:\ Building \Pennits\MEC- PermitApp.doc 03/07/12 2
I o Building Division
Over- The - Counter (OTC) Mechanical Permit
ric.nliD Check List
Project Description: -c .D 1 .)- op 3 V.S
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: ALT Occupancy Group: i Type of Construction:
*Type of Use: ('S:51tik Oregon Specialty Code: Op In
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) I Tons IC)
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units — Describe:
Total Project Valuation: $ 1oper) FEES DUE
$ 0 t ' 7Mechanical Permit Fee
$ `2. Plan Review
$ • r 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ 1 Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ 520.( TOTAL FEES DUE
*OP'TIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
1:\Building\Forms \OTC - MEC.docx 01/13/2011