Permit 47 CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00105
I DATE ISSUED: 3/11/2005
- 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 01 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 450
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Relocate 3 ext. heat pumps(water source). Replace ext. registers and duct as required. $12,200.00 value
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECPLN] Plan Rev 3/11/200f. $65.30
PORTLAND, OR 97224 [TAX] 8% State Surchar€ 3/11/200: $20.89
[MECH] Permit Fee 3/11/200: $261.20
Phone: Total $347.39
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97222
Phone: 233 -6911
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 copie ,= these rules or ect questions to OUNC by calling (503)246 -6699.
Issued By: � c
Y: �� Permittee Signature: �,
,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed th next 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.
Mecha • 1'Permit A FOR OFFICE USE ONLY
City of Tigard 1V .•1/ Received �/ Permit
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: it 0 ,' ' &�aUt� _,0e,/ , s-
Phone: 503.639.4171 Fax 503.598.1960 � Plan Revie' / n
r n 4 • t1i D ateB y : / dip i !
Inspection Line: 503.639.4175 "V'`'' • ° ` F'.11 Date Ready/By: . Other En Permit. E1 Se Page 2 for .
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
• CITY OF TIGARD
T I.1 lRgIl}VISION` ., . ' C.ONIIVIERCIAL..FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction 12/Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and profit. • . C CATEGORY OF CONSTRUCTION ` 'r _ Value : '/ DO -
RESIDENTIAL EQUIPME / SYSTEMS FEES*
❑ 1- and 2- family dwelling J'Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. 1 Total
':; '- f • ,., .SOB SrITE IN_ FORMATIONtihPiD LOCATION.. r _ Heating/cooling
/� f Air conditioning or heat pump
Job site address: /z
0 ' 5 C p fit 4- p j � (requires site plan showing placement) 14.00
City/State/ZIP: ! ` vh, Ic7 4 � j Fumace 100,000 BTU (ducts/vents) 14.00
no.: Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt.
\� e - 0 Project name: 1AiwN y /,)' _ Gas heat pump 14.00
Cross street/directions to job site: / Duct work 14.00 •
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. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
e t . t'r .. '" DESCRIPTION OF WORK i r t t t .., ,, Water heater 10.00
a. a. k; Gas fireplace 10.00
Re-toe-4'1 e- •-3 £. i �/ 44404 �0/>erd4 T v So j t c , ` Flue vent for water heater or gas
_g /� S fireplace 10.00
e a,...� Filth/ 4J/ / t f � 4...4.....k. 4. e .. r 0 h • Log lighter (gas) 10.00
�j' ( , ) Wood/pellet stove 10.00
Wood fireplace/insert 10.00
i.4 P tIQ';/PROPERTY ;O�1iNER`; + .. € 4, x •. , , i i.'4 Chimney liner /flue /vent 10.00
3
y�! TEFiANT t
Other: 10.00
Name: `�... Ail A �3 A ,,,.. 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
;.. " .' � ° i 1 0,PPL1CAN ' I ;' t C. ' .' CONT PERSON I t ,' 1, Attic /c fans 10.00
.r Other: 10.00
Business name: �pl 0 /dill,' 4. -SSOC /4-/ Cf ,1-ry C. / Fuel tin
P�P 1;
Contact name: 6R u G C 3 ✓ - rive , , $5.40 for first four; $1.00 for each additional
Address: 1 7 ' $' � ! 7 T ' i yJ•z Furnace, etc.
Gas heat pump
City/ State/ZIP: ?at ,. eye 97 Z Wall/suspended/unit heater
Phone: 5' 5 ... 6 / 71 ( 5 - 0 3 ) , 2 , 3 8 . . . . 9 2 Fax: : -9 7 6 J Water heater
Fireplace
E -mail: Range ,
r' p ' ' l' _ :<y ,C CTOI,. , a it ?F Barbecue
% i ��. •. t L f�� . Y. • w.<. ' Ir �.. . L' : 7.y� :.. ^. . _. c i. Fry 1: ..,.
Business name: s'4M e_ ,j 46 D�t- Clothes dryer (gas)
- Other:
Address: :Y wt;;l . . ME'CHe�i(l PER1IIIT;FEES *'
•
City/State/ZIP: Subtotal /,st7
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) 49
CCB lic.: 3 t7 s b � State surcharge (8% of permit fe 7 9
TOTAL PERMIT FEE /• ,
Authorized signature: % •�,�E, h This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
mplete.
Print name: eie? ( e /2 ✓ �e___,Z Date;3-10 Q5 • Fee methodology set by Tri- County Building Industry Service Board
i:\ Bui lding\Pemiits \MEC- Pem,itApp.doc 12/03 440.4617T (1 I /02/COM/WEB)
CITY OF TIGARD . ,„
BUILDING DIVISION PERMIT #: MEC2005.00106
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/11/2006
Phone: (503) 639 -4171 ��m °1 1�4PI� h 2 e
Inspection Requests (24 Hrs.): (503) 639 -4175 : +�- I
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7:10AM PAGE: 56
SITE ADDRESS: 12909 SW 68TH PKWY 450 CLASS OF WORK:
SUBDIVISION: TIGARD OFFICE BUILDING LOT #: TYPE OF USE:
PROJECT NAME: TRINITY UNIVERSAL INSURANCE
DESCRIPTION: Relocate 3 ext. heat pumps(water source). Replace ext. registers and duct as required. $12,200.00
value
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 233-6911
Inspection Request Scheduled For: Date: 3/21 /2005 Pour Time: ,
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 002297 -03 503.519 -6199 N
Corrections /Comments /Instructions:,
I■2' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date / r 0 5 -- ;hone #: 503
P � ) 718 -