Permit . .
,,.
C ITY OF TIGARD MECHANICAL PERMIT
�l n, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00662
A II 13125 SW Hall Blvd., Tigard, OR 972 (503) 639 -4171 DATE ISSUED: 10/4/2004
PARCEL: 2S 112DC -00201
SITE ADDRESS: 15865 SW 72ND AVE BLDG -C
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: 003 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: Relocating ducts & grilles.
Project Value: $700
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 10/4/200 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchart 10/4/200 $5.80
Phone: Total $78.30
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -6911
Final Inspection
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. ll __2g......___
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application • FOR OFFICE USE ONLY
City Tigard
'6f Received -6C4W
g Date /By: Iv O
Plan Review Permit No.: ,/ • `ter
13125 SW Hall Blvd., Tigard, OR 97223 Other Permit: �,uQ ,.� ,
Phone: 503.639.4171 Fax: 503.598.1960 ( Da /B ,`[
Inspection Line: 503.639.4175 ■ L 1 1 , L Date Ready /By: ® See Page 2 for
Internet: www.ci.tigard.or.us s Notified/Method: 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: $ 7 .O(
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist. .
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / 5 2 Z� Air conditioning
fires plan or showing pump )
/ �I! (requires site I showin placement) 14.00
City /State /ZIP: f S �
a �� Furnace 100,000 BTU (ducts/vents) 14.00
�
^, Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: C . teA, tics r Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
AO, 11 A C-S,f //+A.h 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
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
AID I/d.-i 00 L"-- 1.-.1 D,t- fe--- A , � D y am, 7 ! 1.61 Flue vent for water heater or gas
fireplace 10.00
/1. n1D./_ /�// 2 t ,f, /%�f e...4001- n o �n�s' Log lighter (gas) 10.00
J Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: ( L, __ r Environmental exhaust and ventilation
�� e /}, Range hood /other kitchen
Address: S' r ck/... 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
Business name:
/2 ,, , » A 0G //4i ?_ .1s✓C- Fuel piping
Contact name: A�C� 7 ? ���� $5.40 for first four; $1.00 for each additional
8 , g s / � 1 2 �/ Furnace, etc.
)
Address: / s I �i ,40e.... Gas heat pump
City /State /ZIP: pe -64.4 " "�
(i5-D, a� Wall /suspended /unit heater
�"'
Phone: j) 0 S -41 S 9 Fax:: v 1) 23,9,_ 5 5 1 Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
c^/400-e` A ( � Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 3 Ff , d State surcharge (8% of permit fee)
TOTAL PERMIT FEE 72_,
This permit application expires if a permit is not obtained within 180
Authorized signature:�i �� days after it has been accepted as complete.
Print name: 8 R (da.` 4, ..---- j e Date: /(j y .. 0 y * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits \MEC- PermitApp.doc 12/03 • 440- 4617T(II/02/COM /WEB)