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Permit t } CITY OF TIGARD MECHANICAL PERMIT 4 o ... COMMUNITY DEVELOPMENT Permit #: MEC2010 -00362 TIGARD: 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/23/2010 Parcel: 2S 101 AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 200 Subdivision: TIGARD TRIANGLE CENTER Lot: 0 Project: CNA Insurance Project Description: Ductwork for TI. Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount 15350 SW SE QUOIA PKWY #300 PORTLAND, OR 97224 Permit Fee 07/23/2010 $975.09 Plan Review 07/23/2010 $243.77 PHONE: 503 - 624 -6300 12% State Surcharge - Mechanical 07/23/2010 $117.01 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: B Occupancy Load: Stories: 4 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 $1,335.87 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 thr.u•h OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.3 -gi4ill1111111. Issued By: �� / Permittee Signature: Call 503.6 • . • 75 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 FOR OFFICE USE ONLY City Of Tigafrd �'� ��� y' v Date/By: 7 Permit No.: 1 3125 SW Hall Blvd., Tigard, OR 97223 � � " r i �'h f v t 'A: U II I Plan Review �h I ` Phone: 503.639.4171 Fax: 503.598. -0ti0 ���0 7 © � Other Permit: D ate /By: Inspection Line: 503.639.4175 p� T I G A R D �� V <' _ Date Ready /By: ® See Page 2 for Internet: www.tigard -or.gov j s\� ; = - , , Notified /Method: iffla Supplemental Information TYPE OF WORK A . COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction ® Addition /alteration /reptAcement 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: $ $34,700.00 RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ® Commercial /industrial • ❑ Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder 0 Other: Description 1 Qty. 1 Fa. 1 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 97223 Fumace 100,000 BTU (ducts /vents) 46.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: CNA 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 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 Relocate Duct For new tentant floor plan 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 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 ® 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 Minimum permit fee ($90.00) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: 38868 State surcharge (12% of permit fee) TOTAL PERMIT FEE j / r 7 Authorized signature: This permit application expires if a permit is not obtained wi in 180 zg, days after it has been accepted as complete. Print name: Bruce Butner Date: 7/23//10 * Fee methodology set by Tri -County Building Industry Service Board 1: \Building \Permits \MEC- Permit App.doc 10/01/09 440- 4617T(1I /02 /COM/WEB) wl P �" Building Division Over- The - Counter (OTC) Mechanical Permit T IG A R1 t 04,14 kr..".3"t14 Check List Description of Project: -n(,9 C9f.�. -- GENERAL INFORMATION Class of Work:* tt LT- Floor Furnace: Evap. Coolers: Type of Use:* 1 Unit Heaters: Vent Fans: Occupancy Group: w/o Appl.: Vent Systems: Stories: Boilers, Comp, Heat Pump, A /C: Hoods: Fuel Types: 0 - 3 HP: Domestic Incinerator. ELC / GAS / NG / OIL / OTHER 3 -15 HP: • Com. /Ind. Incinerator. Max Input: BTU: 15 - 30 HP: Repair Units: Fire Dampers: 30 - 50 HP: Wood Stoves: Gas Pressure: H / M / L >50 HP Clothes Dryer. No. of Units: Air Handling Units: Other Units: Furnace <100k BTU: 510,000 CFM: Gas Outlets: Furnace ..100k BTU: >10,000 CFM: Notes: INSPECTIONS I FEES DUE Post /beam mechanical $ t r75, C ' Permit Fee Gas line $ f i 7,01 State Surcharge Mechanical rough -in $ Z4 ' ,`Z 7 Plan Review Fee Fire damper $ Additional Permit Fee Duct work $ Additional Plan Review Fee Smoke detector $ Investigation Fee Investigation inspection $ Misc. Fee Misc. inspection $ Hourly Rate Fee Final inspection $ Hourly Rate State Surcharge $ ('! E37Totat Fees Due I . • OTHER PERMITS REQUIRED I Building Electrical Plumbing Site Work *OPTIONS: TYPE OF USE: COM = commercial; CMS = commercial manufactured structure. . CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo; FND = foundation; FPS,= fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies); REP = repair. 1:\Building\Forms \OTC - MEC.doc 09/22/06