Permit ..;.
A ;. CITY OF TIGARD MECHANICAL PERMIT
v l j DEVELOPMENT SERVICES PERMIT #: MEC2003 -00484
,- I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/18/03
PARCEL: 2S 101 AD -02800
SITE ADDRESS: 12665 SW 69TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 031 JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 4
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 4 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 400,000 BTU 15 - 30 HP:
FIRE DAMPERS ?: Y 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 4 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 4
Remarks: Mechanical system for new office building.
Owner: FEES
CEDAR ENTERPRISES Description Date Amount
MARTY GOLDSMITH & RON ENYEART
4004 KRUSE PLACE [MECH] Permit Fee 9/18/03 $159.30
LAKE OSWEGO, OR 97035 [MECPLN] Plan Rev 9/18/03 $39.83
[TAX] 8% StateTax 9/18/03 $12.74
Phone: Total $211.87
Contractor:
COMFORT AIR INC
3634 SE POWELL BLVD
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 236 -6829 Gas Line Insp
Heating Unt Insp
Reg #: LIC 00004307 Cooling Unt Insp
Duct Inspection
Fire Damper Insp
Misc. Inspection
Final Inspection
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 -001-00
Issued By: Ake, � - .�, Permittee Signature: ,t
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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Mechanical Permit Ap licW'on OFFICE USE ONLY
E L, Date received: 3, it) 3 Permit no.: ELl, • 3'" 8 4
Cit of Tigard n
AA ^'J I!
City Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, TTardgOl 9
Phone: (503) 639 -4171 Ath 1 1 C Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: �TMING flGA ID °4 Building permit no.: A r� 1p9� 4037
BUILD
Tvi't OF PER NOT
❑ 1 & 2 family dwelling or accessory Commercial/industrial O Multi - family 0 Tenant improvement
XrNew construction 0 Addition /alteration/replacement 0 Other:
Job address: /, 65 S I*/ 6 f1 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot /account no.: profit. Value $ a 5 000 .
Lot: (Block: 1 Subdivision: *See checklist for important application information and
Project name: L ' A i v / e / d v / 7,1 , te , //' /?/i ;,iy ju fee schedule for residential permit fee.
City /county: C�� /e (ZIP: 97, 3 1 & 2 FANI1I.l DWELLING PEIt 111' FEE SCIIEAl11.I
Description and location of work on premises: ,�.is a //4ff/ifC • NI) CONINIERICAL/INDUSTRIAL EQUI PlIENT SCHEDULE
S i,4.s — Fee (ea.) Total
Est. date of completion /inspection: / t/tj, Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
Boiler /compressors
Business name: l� State boiler permit no.:
`�� TOS f �/ 1��' HP Tons BTU /H
Address: 3� 3 L/ „. E. � � 4 /vpA Fire /smoke dampers/duct smoke detectors
City: ga/e, + I State:0,, I ZIP: 97 p ' Heat pump (site plan required)
Phone:2364g2 I Fax: _236-/3431 E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: LA 30 7 Install /replace /relocate heaters - suspended,
City/metro lic. no.: 1 /$3,3 _ wall, or floor mounted
Name (please print): G ..„,c./ , Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 57,4r ; �� G j Chillers HP
Address: 363 L/ 5 4 if/,,,,1 Compressors HP
� Environmental exhaust and ventilation:
City: /UX / 1 State' A I ZIP: 97�Qa Appliance vent
Phone: • 6- f ,?9j Fax: ',36- „xL3 E -mail: Dryer exhaust
Hoods, Type I/ II /res. kitchen/hazmat
/ hood fire suppression system
Name: : #As Z;e7r 6/e Exhaust fan with single duct (bath fans)
Mailing address: 4/e)0 S r✓w2Cw A Exhaust system apart from heating or AC
City: l ' �,.q/ I State 'IZIP: 92 ,, Fuel piping and distribution (up to 4 outlets)
7 Type: LPG NG Oil
Phone: 6 6 — 45 Fax:64' - , j E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fa,: , / , E ail: Woodstove /pellet stove
Other:
Applicant's signature: ���Ar' � Date:9�O3 Other:
Name (print): r je. V - C &Alb Ag-- L ;,,7;
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Permit fee $ /5
❑ Visa 1:1 MasterCard Notice: This permit application Minimum fee $
Credit card number:
/ i expires if a permit is not obtained Pla review (at %) $ 3 9 B 3
� �
Expires within 180 days after it has been State surcharge (8 %) .... $ Z 4- '1
Name of cardholder as shown on credit card accepted as complete. TOTAL $ i? f /
s Cardholder signature Amount 440-4617 (6 /00 /COM)