Permit CITY OF TIGARD MECHANICAL PERMIT
Illi rt , , COMMUNITY DEVELOPMENT Permit#: MEC2019-00604
I t r1 p D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2019
T-
Parcel: 2S 102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Berg's Rebel Fit Subdivision: Lot: 4
Project Description: Venting(2)exhaust fans,transfer grills and more duct to new floor plan.
Contractor: PROTEMP ASSOCIATES INC Owner: BSM REALTY LLC
9788 SE 17TH AVE BY RITE AID
PORTLAND, OR 97222 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/15/2019 $240.93
Class of Work: ALT Type of Const: Plan Review 08/15/2019 $60.23
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 08/15/2019 $28.91
Stories: Info Process/Archiving-Lg$2.00(over 08/15/2019 $2.00
Project Valuation: $6,200.00 11x17)
Fuel Air Handlers
Fuel Types: Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Fumaces: 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 $332.07
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Grills
Bast Worts
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 952-001-0090. You may obtain a copy of the rules
or direct questions to O by callin 503. 1987 or .:00.33 344.
Issued By: _10Permittee Signature: „3/�,G4,c/0C.}c
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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 OFFICE I SE oyl,v
City of Tigard -a 4, , P , Received �.
Date/By: ��� t� /j S_� I
4 13125 SW Hall Blvd.,Tigard,OR 97223 '
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 A I I; 1 Li / i DateBy:
TIG.ARD Date Ready/By: Juris: Ei See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
A .$1/'A-1ri1 ii-OI a'I
;" "�" " ","�" Mechanical pennit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$6,200.00
GATE , - ROIDENT1A '. sT,SYNT MSF S� `= ,
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
300,SITE INFORMATION'ANTI LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:12084 sw Main St Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard Oregon Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name:Kimberly Berg's rebel fit i Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: 1 Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
OF wW m Gas fireplace/insert 33.39
�" ' Flue vent for water heater or gas
Vent two exhaust fans,Tranfer grills and move duct to new floor plan fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
# Chimney/liner/flue/vent 23.32
13 P"�E TYaoW 11t 1 ►+ Ate' Other: 23.32
- Environmental exhaust and ventilation:
Name:Kimberly Bergs Rebel fit club Range hood/other kitchen
equipment 33.39
Address:12084 SW Main St. Clothes dryer exhaust 33.39
City/State/ZIP:Tigard Oregon 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
23 32
❑;.aPPLIcIVT r: _. �A �� Other: -
Fuel piping:
III Business name: $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
fitetv/ZIPr- s Water
cater- _ — _
Phone:( ) I Fax::( ) Fireplace
Range
E-mail: Barbecue
CONT114,OM ; Clothes dryer(gas)
Business name:Protemp Associates Other:
M :llt4,>! lt000PEw ,,
Address:9788 SE 17th Ave Subtotal
City/State/ZIP:Milwaukie Oregon 97222 Minimum permit fee($90.00)
Plan review(25%
of permit fee)
Phone:(503)519-6199 Fax:(503)238-9767
State surcharge(12%of permit fee)
CCB lic.:38868 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
15, days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Bruce Butner Date:8/15/196
L\Building\Permits\MEC PemvtApp_040113.doc 440-4617T(11/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12084 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2019-00604
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor