Permit - CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00636
T 'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 150
Project: Harrison CPA Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Relocate duct for new floor plan.
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
9788 SE 17TH AVE ATTN: N PIVEN
PORTLAND, OR 97222 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 233 -6911 PHONE: 503 - 624 -6300
FAX: 503 - 238 -9767
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/05/2012 $84.41
Class of Work: ALT Type of Const: Plan Review 12/05/2012 $21.10
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 12/05/2012 $10.13
Stories:
Project Valuation: $1,000.00
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 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 $115.64
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
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 que ' o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 7L Permittee Signature: /� �✓ `.. .`
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 . Fol2 onrid : USE O
•
City of Tigard Received
`J Date/By:
/ _di% Permit No.: G -
q 13125 SW Hall Blvd., Tigard, 0' P'
�'
C ` Phone: 503.718.2439 Fax: 503. '':.`�'�:': +-�j � -+ � D gay ew Other Permit: x )
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: See Page 2 for
Internet: www.tigard - or.gov DEC 0 5 2012 Notified/Method: Supplemental Information
TYPE k l kTIGARD • . COMMERCIAL FEE* SCHEDULE -:- USE CHECKLIST
.. WAIN D VISI0 1 Mechanical permit fees* are based on the value of the work
❑ New construction ®Addit a rep acemen performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ $1,000.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- 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:
Air conditioning
Job site address: 15350 SW Sequoia Pkwy (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: Tigard Oregon 97224 Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: 150 Project name: Harrison CPA Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF .WORK Water heater 23.32
Relocate duct for new floor plan Gas fireplace insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑., PROPERTY OWNER '. ❑ TENANT .
Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT ' PERSON Attic /crawlspace fans 23.32
Business name: Protemp Associates Other: 23.32
Fuel piping:
Contact name: Bruce Butner $14.15 for first four, $4.03 for each additional
Address: 9788 SE 17 Ave Furnace, etc.
Gas heat pump
City /State /ZIP: Milwaukie Or 97222 Wall/suspended/unit heater
Phone: (503) 519 -6199 Fax: : (503) 238 -9767 Water heater
E -mail: bruce @protmp.com Fireplace •
Range .
CONTRACTOR Barbecue
Business name: Same as above Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal y/
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee) ( 9// . /D
CCB lic.: 38868 State surcharge (12% of permit fee) /D, /3
TOTAL PERMIT FEE , , 4 1
Authorized signature: /U�` t7�rs, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Bruce Butner Date: 12/5/12 * Fee methodology set by Tri -County Building Industry Service Board
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