Permit CITY OF TIGARD MECHANICAL PERMIT
l is .• COMMUNITY DEVELOPMENT Permit #: MEC2009 -00322
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/02/2009
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 430
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Reference Capitol Management
Project Description: Relocate ducts
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee 07/02/2009 $72.50
#300 12% State Surcharge - Mechanical 07/02/2009 $8.70
PHONE:
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:
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 $81.20
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 Notifi • -r. Tho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire •uestions to OU ` •y c, Iliaa�603.246.6699 or 1.800.332.2344.
Issu d By: / ' v AO , Permittee Sign-
CaII 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 OFFICI: I:fsE a.NI
City g Received 1 D9 dill o03a
Ci of Tigard 1 Permit No.:
114
a 13125 SW Hall Blvd., Tigard, OR 97223
- - 1 Phone: 503.639.4171 Fax: 503.598.1960
=. Plan ie other Permit:
Inspection Line: 501639.4175
��!
1: i < n r h Date Ready/By: la See Page 2 for
Internet: www.figard- or.gov Notified/Method: FM 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: $ 51,925.00
RESIDENTIAL EQUIPMENT /SYSTEMS FEES* .
0 I and 2 family dwelling ® Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑Master builder 0 Other:
Description 1 Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air
Job site address: 12909 SW 68 PKWY conditioning or heat pump
(requires site plan showing placement) 14.00
City /State/ZIP: TIGARD OREGON 97223 Furnace 100,000 BTU (ducts/vents) , 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./ apt. no.: y3 jj Project name: REFERENCE CAPITAL 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
RELOCATE DUCTS FOR NEW FLOOR PLAN
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/Moen 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: 10.00
Bncin•ss name: PROTEMP ASSOCIATES Fuel piping
Contact name: BRUCE BUTNER $5.40 for first four, $1.00 for each additional
Address: 9788 SE 17 AVE Furnace, etc.
Gas heatpump -
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 dr (
Other:
Address: MECHANICAL PERMIT FEES* •
City /StateJZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7''. 5z)
Plan review (25% of permit fee) •-79
CCB lie.: 38868 State surcharge (12% of permit fee) g- 7e
TOTAL PERMIT FEE 9 (• '
Authorized signatureie )1,/ This permit application expires if a permit is not obtained within 180
� ' � days after it has been accepted as complete.