Permit C ITY O F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00511
AO-
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/21/03
PARCEL: 2S103CC -06400
SITE ADDRESS: 13795 SW 124TH AVE
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install exterior A/C unit. Do not place within the required setbacks
Owner: FEES
TODD ERICKSON Description Date Amount
13795 SW 124TH AVE [MECH] Permit Fee 8/21/03 $72.50
[TAX] 8% StateTax 8/21/03 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223
Phone: 503 624 - 2704 Final Inspection
Reg #: LIC 76359
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: T Permittee Signature:
Call (503) 39 -4175 by 7:00 P.M. for inspections needed the next business d
Mechanical'Permit Application
Date received:42, 1 3 9 no.t(p4A pp 3 _ov S /
.1,L''MI.1 City of Tigard Project/appl.no.: Expire date:
CiryojTigard Addre§s: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory U Commercial/industrial U Multi- family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement U Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIEDULE
Job address: / 3 - y 3 5 J /, a
.,......e___. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: I & 2 FAMILY DWELLING PERMIT F11 SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPM ENTSCIIEDULE
. L� {= r - Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? U Yes 0 No Air handling unit CFM /
space insulated? 0 Yes ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
Boiler /compressors
Business name: 6 // l�' 4/,� Cie i, G State boiler permit no.:
H �i HP Tons BTU /H
Address: p 0 13 ox .7 3 0 3 7 Fire/smoke dampers/duct smoke detectors
City: State: a , , ZIP: - Heat pump (site plan required)
Phone: (. 24,1- 2 7 0 L Fax591 QL7,, E -mail: Instal replacefurnac Burner BTU /H
CCB no.: 94 3 +f Including ductwork/vent liner ❑ Yes ❑ No
Install/replace /relocate heaters-suspended,
City /metro lic. no.: /a 7 4 wall, or floor mounted
Name (please print): m, '4A a / p /..4d- f Vent for ap Hance other than furnace
e era on:
PAM Absorption units BTU/H
Name: I� Any QA lip y DAN ala A f Chillers HP
Address: 4 y Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 0 Fax: E -mail: Dryer exhaust
Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: be/K G / r it j,-- 7 Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: I State: I ZIP: Type: LPG NG Oil
Phone: Fax: E -mail: Fuel i ing each additional over 4 outlets
P rocess p p g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
_City: I State: I ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove
Other:
Applicant's signature:O_� I Date:c4' //3 Other:
Name (print): ,6',9--/2.46),
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
eoz
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE El 10
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
/ ,
/ / O1
JOB ADDRESS:
SITE PLAN FOR AC OUTDOOR UNIT LOCATION