Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00261
Al. I 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/11/2004
PARCEL: 2511 1 AC -00900
SITE ADDRESS: 14655 SW 91ST AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT: 050 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install
Owner: FEES
AMOS, PAUL Description Date Amount
14655 SW 91ST. AVE [MECH] Permit Fee 5/11/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 5/11/200 $5.80
Phone: 503 627 - 5895 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 66578
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.
Issued By: � - Permittee Signature: , T7-1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application' :, FOR OFFICE USE ONLY
Received Mechanical I
t f , ' Date/B iJ f( y e Permit No.: �G.A Ey' 0 r _
Y Planning put'. at auilding
City of l'i gard V 5 ® Date/13 : Permit No,:
13125 S W 1 11 Blvd. Plan Review Other
Tigard, Oregc n 97223 Da Permit No.: .
i
Phone: 503 -E39-4171 Fax: S• v Q3p5;98119 1 004 ,+ Post - Review Land Use Date/13 : Case No.:
- _ it, l
Internet: www.ci.tigard.or.us r1 T g .
24 -hour Inspection Request: sgiT6YP,Ft"BGA -w >a See ee Page a for
In(nrmnfinn_
BUILDING DIVISION
_
TYPE OF WORD COMMERCIAL FEE* SCEIEDULE - USE CHECKLIST • .
n New construction _[] Demolition Mechanical permit ices" are based on'the total value of the work
❑ Adc .ition'alteration/replacement ❑ Other: performed, Indicate the value (rounded to the nearest dollar) of all
-- CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwellin 11 Commercial/Industrial value: S See Page 2 for Fee Schedule
r Accessol Builclin_ in Multi Family _ RPSIDENTIAL.EQU1PNIENT/SYSTEMS FEE* ScII.EDULE ••-
Description i Qty FeeCea.) I Total
❑ Master E uilder . ❑ Other: - - _.._. ---- _ -fie Cooling
JOE SITE INFORMATION and LOCATION • •:. .• Furnace - dd - air conditioning** J 14.00
-- y
Job site add;'css: Ll t' S (Li ( I �~ v ? Gas � . heat o to % " 14.00 I
..
Suite 7_ I BIdQ. /Apt. #:
Duct work —� 14,00
Pro'ect Nan e: Hvdronic hot water system 14.00
Residential boiler
Cross street, Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in - duct, sus•ended, etc,) 14.00
Flue /vent for any of above) 10.00
Subdivision: Lot #: Subdivision: units I 12.15
_ Other Fuel Ap liances
Tax m ap /pa reel #; water heater I 10.00
nESCRIPTCON OF WORK Gas tire•lace 10.00
Flue vent (water heater /+,as Or lace) 10.00
— `� Lot lighter (gas) 10.00
_ _ - Wood/Pellet stove 10.00
_ Wood fire.lace /insert 10.00
Chirone /liner /tlueivent ' 10.00
IN PROPER: CY OWNER 1 ( TENANT • . Other: 10.00_,
l Environmental Exhaust & Vrntilation
Name: l� 1 Jy� `"� Range hood/other kitchen equipment 10.00
Address: C ^ Y- . _ Clothes dryer exhaust 10.00
City /State, Zip: Single duct exhaust
Phone :: 4 z -1 S i' ' Fax: (bathrooms, toilet compartments,
• API'LIC/,NT • .. • , Q CONTACT'PRRSON'' ^`■ utili rooms) _ 6,80
Attic /crawl space fans 10,00
Name: ' -•-, Other 10.00 .
Address: _ Fuel Piping
Cit /State. Zip: J55.40 for first 4, SI -00 cad, ndditionsl)
Furnace, etc. "•
Phont:: Fax: Gas heat .um• M .*
E -ma :1: wall/sus ended /unit heater
_ . .CONTRACTOR ' Water heater ■ °MINIM
Busin.ess )Jame: S t oy G (C--(, ' 1- 1-<C"� rAs- Fire•lacc -�
Addzhss: (c C' �L i v t� e f , Ra "-
L CBQ
Cit /; >tate / Zip: 1TI G!S(� � F,- Z "` -.
� . �1 ;Vr l elonc�sd. erfgas) ■ `
Phon H'o - v C` . )- Fax: ,;' O �i 3 Other. IIIIIMMOMM
Total: l
CCB Lit. #: L, ( y C - Mechanical Permit Fees`
Authorized .
uthorized � _ Subtotal: 1 s
Sign
-- 1i �
atimre: // �''` E /
t G�c �C `"-- Date: 1 0t i Minimum Permit Fcc 572.50 $ e. < 0
— ._\,.�'� =_�,` 0 a ce— Plan Review Fee (25% of Permit Fee) $
State Surcharge (8% of Permit Fee)
(Please print name)
TOTAL PERMIT FEE EIMMENIENI
Notices This ?ermir application expires if a permit Is not obtained within `Fee methodology set by Tri -County Building industry Scrvier Board.
ISO days aftc - it has been accepted as complete. "Site plan required for exterior A/C units.
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TREET
Specialty Heating & Cooling, Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793
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