Permit :1 - 11 CITY OF TIGARD MECHANICAL PERMIT
11 a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00175
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 1S135BA00102
Jurisdiction: Tigard
Site address: 10140 SW WASHINGTON SQUARE RD B -1
Project: Color Me Mine Subdivision: MYERS ESTATES Lot: 5
Project Description: Venting for kiln.
Contractor: OWNER Owner: RON BAUMER
4475 SATTER DR NE
SALEM, OR 97305
PHONE: PHONE: 503 - 983 -0671
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/20/2012 $69.06
Class of Work: ALT Type of Const: IIB Plan Review 09/20/2012 $17.27
Occupancy Grp: M Occupancy Load: 12% State Surcharge - Mechanical 09/20/2012 $8.29
Stories:
Project Valuation: $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: 1 Vent Systems: Total $94.62
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Kilns
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 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 ■ / I ,i i A Permittee Signature:
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.
4flV. A E': �- - C g -Is i7
Mechanical Permit Applicati ♦ E012 OFFICE USE ONLY
\ Received ,y
City of Tigard C A �� Date/By: I Permit No.:
111
13 SW Hall Blvd., Tigard, 23 1 +i y 1 I� � I U -- I.
Plan Review
Phone: 503.718.2439 Fax: 503. 98.194AGL C O s -C�� Date/BY: At I
l I G A R D Inspection Line: 503.639 Q. � `` • � � Date Rea. "y. � • ® See Page 2 for
Internet: www.tigard- or.gov `� � Notified/Method: / t Arl, II M Supplemental Information
C
TYPE OF W v C s 't ERCIAL 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 pz �
Value: $ nay. .
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPME / 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
Job site address: /0/ �o 4/4 *(//A19 S! �i�/ 12 R� /3 - / (requires site plan showing placement) 46.75
T ,, Furnace 100,000 BTU ( ducts/vents) 46.75
City /State /ZIP: / 7, ' .P/ O re q 7 Z z.3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 7 Project name: o^ , , � 40 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
taQ S h/ /1� Lam] �G 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
,, - u I , n I Gas fireplace/insert 33.39 eis , OvlkTl ) - {zjY' ki l f ..] d� ���NS V �"l Flue vent for water heater or gas
�f fireplace 23.32
- Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Ly PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: le", 1 4 A , c Environmental exhaust and ventilation:
,jam �r P Range hood/other kitchen
Address:
yy7ts �" - y � 4 # l equipment 33.39
City /State /ZIP: 6474iY! O r- 9 7 3e='--s- Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (03) 9g3 .. Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT 06,,, 7 / ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
S/tMo `t.3 a bri►le 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
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
w I Clothes dryer (gas)
Business name: 'll
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) I Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
%yJ TOTAL PERMIT FEE F9$ 4';'
Authorized signature: ‘0,,a":0 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: J,,, •! / Date: /.,-, 7, Z .,_ * Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \PermitsUMEC- PermitApp.doc 03/07/12 4404617T(II /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.
$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 ti
$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.
IABuilding\Permits\MEC- PermitApp.doc 03/07/12 2
October 24, 2012 '1
TIGARD O
City of Tigard
Color Me Mine
Attn: Ron Baumer
10140 SW Washington Square Rd., Space B -1
Tigard, OR 97223
Re: MEC2012 -00175 — Color Me Mine — 10140 SW Washington Square Rd., Space B -1
Dear Mr. Baumer:
On September 27, 2012, I contacted you regarding your check number 3019, in the amount of
$175.59, that was returned for "not sufficient funds ". This check was written to the City of
Tigard for two permits, building permit BUP2012 -00180 fees in the amount of $80.97 and
mechanical permit MEC2012 -00175 fees in the amount of $94.62. I explained to you that in
addition to the $175.59 due the city, a returned check fee in the amount of $20.00 was due, for a
total reimbursement of $195.59, in the form of cash, cashier's check or credit card payment.
On October 10, 2012, you came into the Permit Center and presented a credit card to pay for the
fees due. Unfortunately, the amount reimbursed was only for the building permit in the amount
of $80.97 plus the returned check fee of $20.00 for a total of $100.97. The mechanical permit
fee in the amount of $94.62 remains due and must be paid by no later than October 31, 2012.
Attempts to contact you by phone to 503- 983 -0671 have been unsuccessful as your voice mail
box is full and does not accept any new messages. The forms of payment that we can accept
include cash, cashier's check or credit card. For your convenience, I have enclosed a payment
authorization form for you to provide your credit card information. You may return this
completed form to me in the enclosed return envelope. This form will be shredded after the
payment has been processed and the credit card receipt is mailed to you at the above address.
If you choose to make your payment in person, our hours of operation for the Permit Center are
Monday — Thursday, 8:00 am to 4:30 pm.
As I stated before, you are currently operating under violation of the permit and subject to a stop
work order as the permit fees for your business operation have not been paid in full. If you have
any questions you may contact me at 503- 718 -2430. I apologize for any inconvenience.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
Cc: Building Official
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Payment Authorization Form
13125 SW Hall Blvd. • Tigard, Oregon 97223
T I G A R D Building Division: 503.718.2439 • Planning/Engineering: 503.718.2421
Fax: 503.598.1960 • Internet: www.tigard- or.gov
Permit No.:
Job Site Address:
Project Name:
Credit Card Information: Please print clearly.
❑ VISA ❑ MasterCard
❑ Discover (credit card account number)
Expiration date:
Cardholder name on card:
Contact phone number:
Billing address for this card:
Billing ZIP code:
Trust Account Information: For permit fees to be paid from established trust account.
Trust account number:
Contractor /Business name:
Contact phone number:
I hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or trust account provided above.
Authorized Signature:
Name Printed:
Date:
Please FAX this completed and signed form to 503.598.1960.
* ** DO NOT EMAIL THIS FORM. * **
For your protection, this form will be destroyed after your payment has been processed
I: \ Building \ Forms \PaymentAuthorization_031612.doc
CITY OF TIGARD RECEIPT
I,
: _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
•
Receipt Number: 188461 - 09/20/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2012 -00175 Permit Fee 230 - 0000 -43102 $69.06
MEC2012 -00175 Plan Review 230 - 0000 -43111 $17.27
MEC2012 -00175 12% State Surcharge - Mechanical 100- 0000 -24001 $8.29
Total: $94.62
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 3019 DADAMSKI 09/20/2012 $94.62
Payor: Color Me Mine II
Total Payments: $94.62
Balance Due: $0.00
•
Received: Sep 26 2012 10:41pm
Fax Server 9/27/2012 12:31:04 AM PAGE 2/002
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