Permit l' CITY OF TIGARD MECHANICAL PERMIT
a
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00138
T G AR1rf 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2010
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Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Relocate grills for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee 04/02/2010 $112.04
12% State Surcharge - Mechanical 04/02/2010 $13.44
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: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers 8 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 $125.48
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
Utili • • 1'cation : •ter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0100. You may obtain a copy of the rules
• direct questions to O b ' • • tiling 503.246.6699 or 1.800.332.2344.
Issued By: / / Permittee Signau ,
iL Signatur s ir L
.
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 Application FOR OFFICE USE ONLY
CI of Ti and Received J ¢ / Permit No.: �e��o
114 `.1 g Date /By: 7 /3g
1 3125 SW Hall Blvd., Tigard, OR 97223
Plan Review
s Phone: 503.639.4171 Fax: 503.598.1960 Date/By: ther Permit6 , •�� ..o. Ins
Inspection Line: 503.639.4175 y
T I G A R D p Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK 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: $ $1,900.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12909 sw 68 pkwy Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard oregon 97223 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: 460 Project name: AMTRUST
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
Subdivision: 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 33.39
Flue vent GRILLS FOR NEW FLOOR PLAN ice ent 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 I ❑ 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
IS APPLICANT ® CONTACT PERSON Attic,'crawlspace fans 23.32
Other: 23.32
Business name: PROTEMP ASSOCIATES
Fuel piping
Contact name: BRUCE BUTNER $14.15 for first four; $4.03 for each additional
•
Address: 9788 SE 17 AVE Furnace, 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: Range
CONTRACTOR Barbecue
Business name: SAME AS ABOVE
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal ,ff /a. Of
Minimum permit fee ($90.00) _—
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) -
CCB lic.: 38868 State surcharge (12% of permit fee) t a . q �
TOTAL PERMIT FEE 6c
Authorized sign /k4'4"‘-- This permit application expires if a permit is not obtained within 180
gn d ays after it has been accepted as complete.
Print name: BRUCE BUTNER Date: 4/2/10 * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Perrnits \MEC- PermitApp.doc 10 /01/09 440- 4617T(1I /02 /COM/W