Permit CITY OF TIGARD MECHANICAL PERMIT
III a _ COM MUNITY DEVELOPMENT Permit #: MEC2010 00423
T 1 G AR E) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/24/2010
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Bridgeport MRI
Project Description: 1.5 ton A/C unit.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee 08/24/2010 $240.93
PORTLAND, OR 97224 Plan Review 08/24/2010 $60.23
PHONE: 503 - 624 -6300 12% State Surcharge - Mechanical 08/24/2010 $28.91
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 $330.07
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: -.1%, Permittee Signature: e 2 t �z� — t�;o' 1.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application i tJlt = ►l I(1 GIs' 0-v
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City Of Tigard ��`��� Received
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g ° Date/B (� Hm No.:
U PI u 13125 SW W Hall Blvd., Tigard, OR 97223 )�l`y y' 1",,eiiiii 1I 1� lU U v a 3
g d � l an ' eve � — - / - Phdite: 503.639.4171 Fait: 503.598.1960 1 L. i - D a tei y: JP! � I O Other Pet Permit: (U `00 ( 1111 1`i t ~n t:1 r Inspection Line: 503.639.4175 r' e ' R : .y/Byi 0 Sce Page 2 for
-- - - - -. Internet: wwiv.tigairi- or.gov v -
ei �� _ . -. ethod: Supplemental Information
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TYPE OF' WORK cr COMMERCIAL PEE* SC$fEDULE — IJSE CBE CKI.IST
❑ New construction ® Addition/alteration/replacethent 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 lab overhead and profit.
CATEGORY OF CONSTRUCTION Value: $ $6,200 .
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling El Coirim- ial/inditstrial ❑ Accessory building
For special infornnalion use cliecklisl.
❑ Multi - family ❑ Master builder ❑ Other:
Description 1 Qty. I Ea. ' Total
JOB SITE INFORMATION AND LOCATION Heatitig/etiol ng
Job site address: 15755 SW SEQUOIA PKWY Air conditioning
(requires site plan showing placement) 46.75
City/ State/ZIP: Tigard Oregon 97224 Furnace 100,000 BTU ( ducts/vents) 46.75
Fumace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg: /apt: no Project name: BRIDGEPORT MRI Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
H &dine hot water s stein 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 tnap/parcel no:: Other Net appliances
DESCRIPTION OF WORD Water heater 23:32
INSTALL 14.5 Flue vent nt TON DUCTLESS SPLIT SYSTEM IN EXRAY ROOM Gas fi f 33.39
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 Other:
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- diicit eXliaiist (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments utility rooms) 23:32
® APPLICANT ►5 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; 54.03 tot eaeti additional
Address: 9788 SE 17 Ave Furnace, etc.
Gas heat pump
City/ State/ZIP: Portland Oregon 97222 Wall/sus ed/unit heater
Phone: (503) 519 -6199 Fax: : (503) 238 -9767 Water heater
Fireplace
E -mail: brueeeprotmp,com Range
CONTRACTOR Barbecue
Business name: same as above Clothes dryer (gas)
Other:
Address: MECHANICAL PERM FEES*
City/State/ZIP: Subtotal 2Ac .
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
® Plan review (25% of permit fee) (n 73
CCB lie.: 38868 State surcharge (12% of permit fee) .8 1 . (
TOTAL PERMIT FEE
Authorized sig<iature: This permit application empires if a permit is not ob ' 180
days after it has been accepted as complete-330 r ®?
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