Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MEC2013-00642
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/04/2013
Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Project: SUMMERFIELD CLUBHOUSE Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Replacing(2)existing RTU's and installing duct work.
Contractor: HYBRID HEATING&AIR CONDITIONING CO. Owner: TIGARD RETIREMENT RESIDENCE LLC
PO BOX 329 PO BOX 847
CORNELIUS, OR 97113 CARLSBAD,CA 92018
PHONE: 503-357-5663 PHONE:
FAX: 503-357-0668
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/04/2013 $1,981.23
Class of Work: ALT Type of Const: VB Plan Review 11/04/2013 $495.31
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/04/2013 $237.75
Stories: Info Process/Archiving-Sm$0.50(up to 11/04/2013 $4.00
11x17)
Project Valuation: $74,711.05
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 $2,718.29
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 2
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all o er
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not start-• within 180 day• of
iss , or i '0. • is suspended for more the 180 days. ATTENTION: Oregon law requires you to •ll. the rules - •.ted by the 0 egon
ility Notification Cen = . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00.2 ou may ob ,i,(a copy of th, rules
or direct questions to OUN. • - '• .03.232.1987 or 1.800.332.2344.
Issued By: ` � Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/
Mechanical Permit Application l OR OI FI( 1: l SE ON1.1
Received
City of Tigard EA) y Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972 Date/By: f d " /j /'��� 3-U4���(a�
Plan Review
Phone: 503.639.4171 Fax: 5 Go lO ko 1�J Other Permit: tEl L i 3` zs-
Pan Re% ��D
1 .,A i,I Inspection Line: 503.639.4175 Date Ready y: s ® See Page 2 for
Internet: www.tigard-or.gov 913 Notified/Method: 10 31113 /7,+ Supplemental Information
QICT .M hv, /f bhA H=4A 8.7;
TYPE OF WORK GOO c COMMERCIAL''EE* SCHEDULE - USE CHECKLIST
El New construction ®Addition/alterat N, :•C;�•, • - /` Mechanical permit fees'are based on the value of the work
P , performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$ °7y 7/1.0
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling . Commercial/industrial ❑Accessory building
ID ❑Master builder ❑Other: For special information use checklist.
Description I Qty. i Ea. I Total
JOB SILK L INFORMATION AND LOCATION Heating/cooling
Job site address: / Oyu Air conditioning
N ce_,--.,J N11Q r e_ 1 r (requires site plan showing placement) 46.75
City/State/ZIP: 7T A''O OK 9 7,70.-3 Furnace 100,000 BTU(ducts/vents) 46.75
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: S 1, ylt ym 412 J Heat pump 61.06
Cross sticet/directions to job site: . -M 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
Flue/vent for any of above 23.32
Subdivision: I Lot no.: Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
t Gas fireplace 33.39
- __ Aami \ST• U• ■.S F / `' Flue vent for water heater or gas
` / fireplace 23.32
•-� 1'• - �i'. 4%d s . ? - Log lighter(gas) 23.32
1
D13 "7--71-,6.' t - ' . h 41- -'•-\5 Wood/pellet stove 33.39
.4 1,. , t 'it) C.. T - Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
.E PRO` ' OWNER ❑ TENET Other: 23.32
Name: Environmental exhaust and ventilation _
Address: Range hood/other kitchen
� - /A 4 r ,- equipment 33.39
City/State/ZIP: 77 1-q✓.1 0 it q 72 3 tit\ Clothes dryer exhaust 33.39
f Single-duct exhaust(bathrooms,
Phone:(,5.) ) 3 s � ' .(50-57d b°C a- toilet compartments,utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four;$4.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: WalUsuspended/unit heater
Phone:( ) Fax::( ) Water heater
Fireplace
E-mail: Range
CONTRACTOR Barbecue
j Clothes dryer(gas)
Business name: r,q/ QJ4 1 F /1 i / Other:
Address: , O • /3-o Y- .3.-. 9' MECHANICAL PERMIT FEES*
City/State/ZIP: Co en-g /t t i' ( e) 97/) Subtotal
Phone:(5"L3) 3 c7� S?43 Fax:( p
Minimum 25%iofeermitfee)
I J�D 3 S?- t�G��3 Plan review(25%of permit fee)
CCB lic.: / o? i.9 t J State surcharge(12%of permit fee)
/ //` TOTAL PERMIT FEE
Authorized signs / II
� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: A , r , I A ,,j Date: /0 93 • Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PemdtApp.doc 10/01/09 440-4617T(11/02/COMM'EB)