Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00342
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/05/2012
Parcel: 2S110DC00500
Jurisdiction: TIGARD
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW -BROOK -FARM Lot: 17
Project Description: HVAC Systems
Contractor: JET INDUSTRIES INC Owner: CDBK PROPERTIES LLC
PO BOX 7362 11565 SW DURHAM RD BLDG F 100
SALEM, OR 97303 TIGARD, OR 97224
PHONE: 503 - 363 -2334 PHONE:
FAX: 503 - 363 -2622
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 07/02/2012 $721.09
Class of Work: NEW Type of Const: VB 12% State Surcharge - Mechanical 07/02/2012 $86.53
Occupancy Grp: B Occupancy Load: Plan Review 07/02/2012 $180.27
Stories: 1 Info Process /Archiving - Lg $2.00 (over 07/05/2012 $6.00
11x17)
Project Valuation: $24,700.00 Info Process /Archiving - Sm $0.50 (up to 07/05/2012 $8.50
11x17)
Fuel Air Handlers
Fuel Types: Natural Gas 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: 1 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 12 Vent Systems: Total $1,002.39
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: diffusers and
Duct Work: 1 grills
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 • . • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili , otification Cen . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or : irect questions to OW i cal ' g 503.232.1987 or 1.800.332.2344.
I. sued By: , - _ __ _ _� • Permittee X j , ! / /`�/
7 �
Call 503.639.4175 by 7:00 a.m. for the next available inspec • • n date.
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicatio lc
E•i VE
FOR OFFICE USE ONLY
City of Tigard E areY: �l �- f i o ( Permit No�,(EA SOI z- 0
2 111 1 q 13125 SW Hall Blvd. Ti and OR 97223
g
Phone: 503.718.2439 Fax: 503.598.1960 Other Pe
Date/By 7! l J t Jo a_ - OOQ�
JUL
Inspection Line: 503.639.4175 2 2012 Plan Revi
T I G A RD Date Re Allis: ® See Page 2 for
Internet: www.ti ard - or. ov
g g C �TYOF1iGAR� NNotified/Method: 7/b / 2. / 1 ( c Supplemental Information _
TYPE OF WO CO MERCIAL FEE* HEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
IT 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: $ o' N 700 .00
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
1 / 1 16 - 5 ----
/J J JOB SITE INFORMATION AND LOCATION Heatinp,/cooling:
Air conditioning
Job site address: 44 S(.1411 arcie l ,L�( (requires site plan showing placement) 46.75
i�� Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: -1-,, J .n y / Ole 91 2._2 (4 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Or &1114.)t./1.00- Heat pump
(requires site plan showing placement) 61.06
Cross stree irections to job site: Duct work 23.32
S (D Dui haarr. Z-1 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: I 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
H V l G SI/ 5 5 Flue vent for water heater or gas
J fireplace 23.32
- Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER 1 ❑ 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
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 23.32
04 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
J Other: 1 23.32 I
Business name: 0-0- Tod us- r-l'Q -5 . . ha . Fuel t m
P g:
Contact name: /Ail G e l $14.15 for first four; $4.03 for each additional
Address: f73 Si l V e. -er7 4 AJE Furnace, etc.
Gas heat pump
City /State /ZIP: s2 yyt ,, OlZ 9 730 / Wall /suspended/unit heater
Phone: (5p3 34,3- ? 3 �J Fax: : (&.D3 ) 36 3 _ d � 2 2 Water heater
E -mail: /yl e%. ' 1 [ 1 Range
- f `Q �1���Q."7�1(�G� I'12.� Range
f CONTRACTOR Barbecue
Business name: aj- aks tr7` -S i Zno. Clothes dryer (gas)
Other
I �j
Address: /135 3i1 v �4 »- of. . 44 z MECHANICAL PERMIT FEES*
City /State /ZIP: Sette.1 4 .730) Subtotal 7al t 0
-
Minimum permit fee ($90.00) all
Phone: (503)34,3_ 23 3(- Fax: Plan review (25% of permit fee) 170, /CB lic.: 3c7i f `7 5 ► / State surcharge (12% of permit fee) /
TOTAL PERMIT FEE g'-7, 99 ,
Authorized signature T his permit application expires if a permit is not obtaine within 180
days after it has been accepted as complete.
Print name: --reranc'7 - n n Date: ecir. $ l • Fee methodology set by Tri- County Building Industry Service Board
I: \Building\Permits\MEC- PermitApp.doc 03 /07/12 440- 4617T(11 /02 /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. Q �j DD 00
0
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and v �/
$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. ÷ L)57 r ( 2.5 -J )</20)
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and _ q
$2.49 for each additional $100.00 or tP g
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 FEE AND PAYMENT HISTORY
N _a
I it 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
MEC2012 -00342 - 11455 SW SUMMERFIELD DR, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee 230- 0000 -43102 $721.09 $721.09 $721.09 7/2/12 Check 187414 $0.00
12% State Surcharge - Mechanical 100 - 0000 -24001 $86.53 $86.53 $86.53 7/2/12 Check 187414 $0.00
Plan Review 230 - 0000 -43111 $180.27 $180.27 $180.27 7/2/12 Check 187414 $0.00
Info Process /Archiving - Lg $2.00 (over 230 - 0000 -43135 $6.00 $6.00 $6.00
11x17)
Info Process /Archiving - Sm $0.50 (up to 230 - 0000 -43135 $8.50 $8.50 $8.50
11x17)
Totals for Fees $1,002.39 $1,002.39 $987.89 $14.50
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
187414 Check 10600 Jet Industries Inc 07/02/2012 $987.89
Total Payments: $987.89
1
Balance Due: $14.50