Permit •
C ITY OF TIGARD MECHANICAL PERMIT
r t e DEVELOPMENT SERVICES PERMIT #: MEC2005 -00286
" I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/31/2005
PARCEL: 2S112DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: I -P
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 040 JURISDICTION: TIG
Project Description: Replace all A/C grilles & thermostat. Valuation: $1100.
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:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 5/31/200f. $72.50
PORTLAND, OR 97224 [TAX] 8% State SurcharE 5/31/200f. $5.80
Phone: 503- 624 -6300 Total $78.30
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 copies of these rules or direct questions to OUNC by calling 503 -246 -6699
or 1- 800 - 332 -2344.
Issued By: ,L Permittee Signature:
Call 503 - 6394175 by 7:00 a.m. for inspections 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 Iltictor ED FOR OFFICE USE ONLY
City of Tigard Date/I3 3 -ii-05- - Permit No.!' �� 0 II
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 n :) All° Date/By: Other Permit:
Inspection Line: 503.639.4175 MAY 3 1 2005 i �- �.f I Date Ready /By: 2I See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR i ^^ J Notified/Method: Supplemental Information
BUILDING DIVISION
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: $//00• , 0
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. I Ea. I Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: iS((� S .7 7241
�
Air conditioning or heat pump
VV (requires site plan showing placement) 14.00
City/State /ZIP: f .� e 9/7 2,Ly - Furnace 100,000 BTU (ducts/vents) 14.00
/ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: / D 0 Project name: r� mob, Lt.._ Gas heat pump 14.00
Cross street/directions to job ste: 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 : 1 '
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 • ' ---
n A Gas fireplace 10.00 --
/? p si 4a.. 119 /C Gus peek ,,t,w o,s a 1T Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑' TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: pie_ �huJ r Environmental exhaust and ventilation
Range hood/other kitchen
3
Address: / SC) stJ �vJ See 0014 ! Xkly equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
S�^v emir_ Single -duct exhaust (bathrooms, -
Phone: (4 310-- g'60 / Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT $' CONTACT PERSON Attic /crawlspace fans 10.00 -- --
Other: 10.00
Business name: Q
/ /�vr1B,.'!/ d l:t O/' *PZr Fuel piping
Contact name: g_ kP �� �./1/4, $5.40 for first four; $1.00 for each additional
Address: 7, g g S � / 7 n, Av Furnace, etc.
Gas heat pump
City/State /ZIP: A D 7 7 Z Z L Wall /suspended /unit heater
Phone: (r6 t 23 3 •. 4 9 /1 Fax:: ($ 3) 22 8=9 7,,[? Water heater
Fireplace •
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
s�4 Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone �A3 — . / 7-.4 ) q Fax: Minimum permit fee ($72.50) jl,,Z_ ��
Plan review (25% of permit fee)
CCB lic.:a r L 8r e,> e s —' 7 0 1 State surcharge (8% of permit fee) 5
Authorized signature:
TOTAL PERMIT FEE 7 .3 0 '
This permit a ex if a permit is not obtained within 180 - i
_ -
days after it has been accepted as complete.
Print name: C - JL • _ Date: 6 — - * Fee methodology set by Tri- County Building Industry Service Board _ - .f
i
i:\ Building \Permits \MEC- PermitApp.doc 12/03 440- 4617T(11/02/COM/WEB)
w - -
CITY OF TIGARD
BUILDING- DIVISION PERMIT #: 0,4 ' ZC .7-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: CO284,
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ( j - 63��Stc) S 7 2 ` CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: GCS
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
C,cfci w
Corrections /Comments /Instructions: CC' 89, I C? ) `
....-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
. ❑ FAIL \ CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
�,/`
Inspector: � Date: v Phone #: (503) 718 -