Permit r F hR8 $ , �.
g n "g MECHANICAL PERMIT
a CITY OF TIGARD
° COMMUNITY DEVELOPMENT Permit #: MEC2010 -00226
r� � Date Issued: 05/18/2010
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: Relocate ducts and grills for TI
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee 05/18/2010 $525.51
PORTLAND, OR 97224 12% State Surcharge - Mechanical 05/18/2010 $63.06
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 & 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 $588.57
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 Notific. '•n Center rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct q •stions to OUN by cal . 'g 503.246.6699 or 1.800.332.2344.
Issued By: 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
Cl of Tigard -- I �� FOR OFFICE USE ONLY
Received t Permit No.: l
`.r g Date /By: � J f' D l T O O ' 000P Air
° 13125 SW Hall Blvd., Tigard, OR 972 .
N. Phone: 503.639.4171 Fax: 503.598.1 : i Y 18 2 p Ip Plan Review Other Permit: ,Q�
Date /By: �t t P a0/0 —e 1p
T I G A R D Inspection Line: 503.639.4175 CITY Date Ready /By: luris: ® See Page 2 for
Internet: www.tigard- or.gov OF TIGARD Notified /Method: Supplemental Information
BUIL DIVISIO
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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
Value: $ $17,000.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
Master builder For special information use checklist.
Multi -famil
❑ Multi-family ❑ 0 Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12909 SW 68 PKY Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard Oregon T7224 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: ACE AMERICAN INSURANCE 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 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: bruce@protmp.com Range
CONTRACTOR Barbecue
Business name: same as above
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal .5 ;5- 57
Minimum pennit fee ($90.00)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) e-.
CCB lic.: 38868 State surcharge (12% of pennit fee) gg / 6 2
57
TOTAL PERMIT FEE - Jr7
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Bruce Butner Date: 5/17//10 * Fee methodology set by Tri- County Building Industry Service Board
I: \Building \Permits \MEC- PermitApp.doc 10 /01/09 440-4617T (11/02/C064/WEB)