Permit !pl CITY OF T I G A R D MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00043
T I c A It n 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/27/2009
PARCEL: 2S112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK III LOT: 040 JURISDICTION: TIG
PROJECT: T MOBILE
Project Description: (1) 2 -ton ductless split a/c unit for laundry room. Project Value: $5,300
NO PLAN REVIEW REQUIRED PER DAN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [MECH] Permit Fee 1/27/200. $146.90
[TAX] 12% State Surch 1/27/200c. $17.63
Phone:
Total $164.53
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -519 -6199
FAX 503- 238 -9767
Reg #: LIC 38868
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued : � if Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections 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 ON'L1'
City of Tigard Received / Mb am Permit No.: M , 40/1 Li
II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 Date Ready /By: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: SupplementalInformatlon
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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: $ $5,300.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description j Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
ND Air conditioning or heat pump
Job site address: 158 IC" SW 72 AVE
(requires site plan showing placement) 14.00
City/State/ZIP: TIGARD OREGON 97224 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: T- MOBILE Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
1 -2 TON DUCTLESS SPLIT A/C UNIT FOR LAU ROOM
Flue vent for r water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00
Other 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
® APPLICANT ® CONTACT PERSON Attic /crawlspace fans 10.00
Other
Business name: PROTEMP ASSOCIATES 10.00
Fuel piping
Contact name: BRUCE BUTNER $5.40 for first four; $1.00 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: a
CONTRACTOR Barbecue
Business name: SAME AS ABOVE Clothes dryer (gas)
Other
Address: MECHANICAL PERMIT FEES*
City/ State/ZIP: Subtotal
Minimum permit fee ($72.50) fI4' •
Phone: ( ) Fax: ( )
Plan review (25% of permit fee) -1®"
CCB lic.: 38868 State surcharge (12% of permit fee) / 7. !,3
TOTAL PERMIT FEE /(o y. r 1
Authorized signature This permit application expires if a permit is not obtained within 18
days after It has been accepted as complete.
Print name: BRUCE BUTNER I Date: 1/27/09 • Fee methodology set by Tri- County Building Industry Service Board
I: \Building'Perm its \MEC- PcmitApp.doc 01 /19/07 440 -4617T (1 I/02 /COM/WEB)
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CITY OF TIGARD
BUILDING DIVISION / PERMIT .. ii
: mEc2009
13125 SW Hall Blvd., Tigard, OR 97223
A DATE ISSUED: 1/270009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 -
It
INSPECTION WORKSHEET FOR DATE: 1/28/2009 TIME: 7:01AM PAGE: 14
SITE-ADDRESS: 16895 SW 72ND AVEBLDG B 100 CLASS OF WORK:
, . SUBDIVISION:
OREGON BUSINESS PARK III LOT #: 040 TYPE OF USE:
PROJECT NAME: T MOBILE
DESCRIPTION: (1) 2-ton ductless split,a/c unit for laundry morn. Project Value: $5,300
' NO PLAN REVIEW REQUIRED PER DAN
OWNER: PACIFIC REAL:IY ASSOCIATES, , . PHONE #
CONTRACTOR: PROTEMP ASSOCIATES-INC PHONE #: 503.519..6199
Inspection Request Scheduled For: Date: 1/28/2009 Pour Time:
Code # Inspection Description Confirm # Contact #, Mess-
699 Mechanical final 080068-03 50a-619-6199
Corrections/Comments/Instructions:
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41110 --qty
riti -i i h PARTIAL APPROVAL
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11 0 CANCEL
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/ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
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0 NO ACCESS
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Inspector: w A ,. _. ._-■1 111011111P : . Date: ? Phone #: (503) 718-
411111 ,
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