Permit MECHANICAL PERMIT
la �° CITY OF TIGARD
z s V
. , COMMUNITY DEVELOPMENT Permit #: MEC2010 -00189
Date Issued: 04/29/2010
[ 6 AR b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112DD00700
Jurisdiction:
Site address: 15780 SW UPPER BOONES FERRY RD
Subdivision: OREGON BUSINESS PARK II Lot:
Project: Professional Eye
Project Description: Relocate duct.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee 04/29/2010 $84.41
12% State Surcharge - Mechanical 04/29/2010 $10.13
PHONE: 503 - 624 -6300
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222
PHONE: 503 - 233 -6911
FAX: 503 - 238 -9767
Type of Use:
Class of Work: Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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 $94.54
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 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 . '. • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or .' ect questions g OUN • calling 503.246.6699 or 1.800.332.2344.
Is- ed By: , // / ` L �` Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Applic. -, 1 • cpi‘IFn FOR OFFICE USE ONLY
"�
Received �/ D
City of Tigard Date /By: 7 0"9� PennitNo.: Mee / .. m/f`9
° 13125 SW Hall Blvd., Tigard, OR 97223AT 2 9 2010 Plan Review C ` l
Phone: 503.639.4171 Fax: 503.598.1960 . Date/By: Other Permit:
T I GA RD Ins Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard or.gov DIVIS Notified /Method: Supplemental Information
6UILDING V S
TYPE OF WOR 61 "I COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
Value: $ 51,000.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 15780 SW Upper Boones Ferry Rd Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard Oregon Fumace 100,000 BTU (ducts /vents) 46.75
Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Professional Eye Care Heat pump 61.06
Cross street /directions to job site: 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: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Relocate Duct For new tentant space Flue vent 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 ❑ 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
® APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Protemp Associates Fuel t to
Pp g
Contact name: Bruce Butner $14.15 for first four; $4.03 for each additional
Address: 9788 SE 17 Ave Fumace, etc.
Gas heat pump
City /State /ZIP: Portland Oregon 97222 Wall/suspended/unit heater
Phone: (503) 519 -6199 Fax: : (503) 238 -9767 Water heater
Fireplace
E -mail: bruce @protmp.com Range
CONTRACTOR Barbecue
Business name: same as above
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal ge-i, 4/
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) e9"
Plan review (25% of permit fee) - —
CCB lic.: 38868 State surcharge (12% of permit fee) ,
TOTAL PERMIT FEE Sy
Authorized signature: This permit application expires if a permit is not obtained within 180
fte� days after it has been accepted as complete.
Print name: Bruce Butner Date: 4/29/10 * Fee methodology set by Tri- County Building Industry Service Board
1: \ Building \ Permits \MEC- PermitApp.doc 10 440- 4617T(11 /02 /COM/WEB)