Permit CITY OF TIGARD MECHANICAL PERMIT
' 't. COMMUNITY DEVELOPMENT Permit#: MEC2023-00032
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/17/2023
TIGARD Parcel: 2S112DA01400
Jurisdiction: Tigard 1
Site address: 15350 SW SEQUOIA PKWY 260
Project: Matisse Capital Subdivision: Lot: 2
Project Description: Modify existing Ductwork and diffusers.
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
9788 SE 17TH AVE ATTN: N PIVEN
PORTLAND,OR 97222 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 01/17/2023 $393.43
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 01/17/2023 $47.21
Occupancy Grp: Occupancy Load: Plan Review 01/17/2023 $98.36
Stories: Info Process/Archiving-Lg$2.00(over 01/17/2023 $4.00
Project Valuation: $11,780.00 11x17)
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 $543.00
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desa
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: '���� / ('rr� `' , Permittee Signature: ���
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE ESE ONLY
City of Tigard ReceivedDateB : Permit No: 0„
4 13125 SW Hall Blvd.,Tigard,OR 97223 y [ 17� 4-t. (�eG,
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960other Permit:
Date/By:
T 1 GA RD Inspection Line: 503.639.4175 Date Ready/By: v r Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 1/171 3 y4.- J Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 11,780.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:15350 SW Sequoia Pkwy Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:Suite 260 Project name:Matisse Capital Duet 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
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Modify existing ductwork and diffusers for new tenant layout. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT S 23.32
Environmental exhaust and ventilation:
Name:Pacific Realty Associates Range hood/other kitchen
equipment 33.39
Address:15350 Sequoia Pkwy Clothes dryer exhaust 33.39
City/State/ZIP:Portland, Or 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
la APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Protemp Associates Inc $I4.I5 for first four;S4.03 for each additional
Contact name:Louis Leon Furnace,etc.
Address:9788 SE 17th Ave as heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland, OR 97222 Water heater
Phone:( 5085193083 Fax: :(5032389767 Fireplace
Range
E-mail:I OU Is@prOtm p.COm Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:SAME AS APPLICAN Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:38868 TOTAL PERMIT FEE J 3
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
/ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Louis Leon Date:01/17/2023
I:1Buitding\Permits\1s4EC_PermiIApp 040113.doc 440-4617r(11/02/COM/WEB)