Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit #: MEC2009 -00429
a�3,ma14f 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
TIGARD 9 Parcel: 1 S133DD10800
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Jurisdiction: Tigard
Site address: 11958 SW 125TH CT
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 145
Project: Pederson
Project Description: Install A/C Must maintain 3' rear and side yard setback
Owner: FEES
PEDERSON, LANCE Description Date Amount
11958 SW 125TH CT Air Conditioning or Heat Pump 08/18/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 08/18/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 08/18/2009 $58.50
Contractor:
SPECIALTY HEATING & COOLING INC
7500 SW TECH CENTER DR STE 120
TIGARD, OR 97223
PHONE: 503 - 620 -5643
FAX: 503 - 681 -0793
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: `/ Jittaf Permittee Signature: 6-14 /; ptte_ r
Call 503.639.4175 by 7:00 a.m. for an inspection 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.
AUG,14 /2009/FRI 03 :57 PM FAX No, P. 001
o r i ) E D
Mechanical Permif App l>i ca ti o .\I a , - } 1 llr v 0.; .a. r,Ji1:; % ,. m u„uwrr ,,, 1,,. ,, ,. • . r;'W ,.rl��.lyr .>^ ru,u- ' ll f' - : .1, � Ci of Tigard Received Permit No.: Mg� 1 - UU2q
� w . °r " 13125 SW Hall Blvd., Tigard, OR 97223 1 II G 1 4 2009
Date/13y:
Review
Phone: 503.639.4171 Fax: 503.598.19 D Re Ocher Permit
rI CTA Inspection Line: 503.639,4175 CITY p ady/gy curia: Sep Page z for
:.a 4 - " '% Internet: www.tigard- or.gov CI i o '- {O ^' `�" NotiYeNMetlwd: Supplemental Information
BUILDING DIVISION
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❑ New construction r 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.
HEMP �: r r ,tie m - ir.>:kI .. ,4 n=014- - 7r. + .0 y. #? ti g.,. k 1,, 1 "t -7, ` 1" V a lue $
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n 1 • and 2- family dwelling ❑ Commercial /industrial 0 Accessory building "rt" { -3.. •., L u
For special information use checklist.
❑ Multi -family ❑ Master builder ❑ Other
Description [Qty. r 13a. I Total
IMP , t i U]t � ut r� m�i.0 -,.3 '7.tk u- } �'rl`'f,� z , a i i. ra 1 1 r 7 �
4 ' ?`I 3, d��11 33.7 {� .1 tkG,cl,' r (® , ^s ui 1 Wi A bpi` OYy '{ M t }1 r r - i -r(, , Heating,/cooling
rwJ1# � 1,.4. -r. ( d1 b;rY,aini l_I As iss , ✓ia:C 4 '4 , 41,, ; 1 r .0 .111 . -„11, 7,n,1„af .1?l
7 �1 Air conditioning or heat pump
Job site address
1 1 a 5 $ 3t) j i 0 _4, (requites site plan showing Placement) 14.00 1
City/State/ZIP: 1! 3 af c 6 g 1 "� a Furnace 100,000 BTU (ducts/vents) { 14.00
Suite/bldg./apt. no.. Project name: r°` Furnace 100 :00D BTU (ducts /vents) 17.90
Gas heat pump 14,00
Cross street/directions to job site: Duct work 10.00
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. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
_ Other; 10.00
Tax map /parcel no.: Other fuel appliances -
t {'+ , r l�± 'r('Jk'� L1 p r t ' '. J..�. L }?r a 9` j l yj 7 ",yy 3 Want t ya '1,1 '3 ft ptf
{ { , :. ' ' - - i _,.11 d 1t , 4.. ( -ll .} uli i i ° j ii_Lt Water heater 10.00
7:L•:'� rr k' tk. t , :,v.:.:�1 - 'tic .,
S -& a_-Lj, A Gas fireplace vent 10.00
t - Flue vent foor water heater or gas
fireplace 10.00
- Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
�� 1 r 7 P41: s 1 r r tr .1sltt. i p i 4 ` f7,{} +�,k }, + { Chimney /liner /flue /vent 10.00
� t ' P1h 1 B t ' it -�l �r G j ; c is 1l a ) { t t ,f l 7 !
:. ai.. r.,, llt� ,, d.l_'- - c11.1vii:t .r Ll t i Vi,. M.- - -#J x +, .4 ru:It'.,. It Other' 10.00
Narne: ,/ ✓1 Environmental exhaust and ventilation
Address ry � - q Range hood /other kitchen
4 equipment 10.00
City /State /ZIP: 1 7 , cud_ 6 . q 7a- Clothes dryer exhaust _ - 10.00
t Single -duct exhaust (bathrooms,
Phone: r 6 ! • _ Fax: ( ) toilet compartments, utility rooms) 6.80
f.a } N }'� 1't r r r. - +Lf } .:1 Y urn. , Lr i F > 7 41iPJ , �.yE7 l t f r f l�, it I l ?.:' Apr *' Atticicrawlspace fans 10.00
''�1 fl�, r .i 3 s ea atlas ?� ° � i !a q ht # ]1 10.00 1 tlilliii 9 f ao• C t i. r ,fa a �.
Business name: // , Other
� Z v Fuel p iping
Contact name: $5.40 for first four; $1.00 for each additional
-
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Ran. e
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1 j I 11 . #{ 1 1 i { irRI P;..:{ 1 I tart ,r} t " +JI r 1 1t'I { C F ;}{�pl# F�# '1 }1 } Barbecue
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Business name: Specialty Heating & Cooling, Inc. Clothes dryer (gas)
Other:
Address: 7500 SW Tech Center Drive #130 l ilt�l`71 ! a� L, ` } r ' tj �I' t_ ;d I �!4 ,r `y`� i j ��r 1 (}! vr ,u •{ k + + r , j '1
.. .. ..� ' 3 f7:1. �.". igogi: r Ii sib iStib Ctlt •aid'' 1 %:i 3, • I.I;i ,∎l,l.':a ' ill?
City /State /ZIP: Tigard, Or. 97223 Subtotal
Phone: (503) 620 -5643 Fax; (503) 681 -0793 Minimum permit fee ($72.50) a JQ
Plan review (25 %ofpermit fee)
CCB lie.: 66578 State surcharge (12% of permit fee) S ,/0
�, TOTAL PERMIT FEE (, 2, D
�'""/
Authorized signature: Y Y, This per mit application expires if a permit is not obtained within L80
J / • days after it has been accepted as complete.
Print name: Andrea Dripps Date: I t L� / b9 • Fee methodology set by Tri- County Building Industry Service Board
t :1 Ben !dine�ermittaLEC- PermitApp.doe 01/19/07 440 -4617T (1 /02/COMfW5B)
.• AUG;!14 /2009 /FRI 03.57 PM FAX No, P, 002
8 ITE PLAN
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Il9sF s /2,- --11- 'T aro( OA 99
STREET
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NOTE — Please show the following on the site plan: ;;
•:• Location of Indoor Unit and Outdoor Unit
• Indicate how the flue will be run (thru the roof — out the sidewall — etc)
• Indicate with dotted line how the lineset will be run and approx. dis,E'ance
Indicate how the c ondensate will be run
SIJ 7500 SW Tech Center Drive
SPECIALTY Suite ># 130
HEATING Tigard, OR. 97223
COOL 1 N G (503) 620 -5643 Fax (503) 681 -0793
N c www.sneciatitvheating.com