Permit CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: MEC2009-00431
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S104AA00300
Jurisdiction: Tigard
Site address: 12665 SW 127TH AVE
Subdivision: BELLWOOD Lot: 52
Project: Cromwell
Project Description: Install A/C Must maintain 3' rear and side yard setback
Owner: FEES
CROMWELL, JO Description Date Amount
12665 SW 127TH Air Conditioning or Heat Pump 08/18/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 08/18/2009 $8.70
PHONE: 503 - 228 -6122 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.
Issued By: i&A,6,(1 Permittee Signature: "r /1 a ,n
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.
An/ 18/2009/TUE 09:02 AM FAX No, P. 002/003
Mechanical Permit App lic a tio n , „ .., FOR OFFICE USE ON ix
City of Tigard 8 2009 Permit No.: ' a. _ 0.0 4+31
Ili 13125 SW Hall Blvd., Tigard, OR 97223 i ' 1 1 8 200 g Review
C Phone: 503.639.4171 fax: 503.598.1960 bate/9y; Other Permit:
l -1 RA) laspee.tion line: 503.639.4175 crry OF TIGARD Date Ready/By: lutist El See Page 2 for
Internet: www,tigard- or.gov B DIVISION Notified/Method: Supplemental Infpm
rsnen
CI New construction Addition/alteration/replacement Mechanical permit M e are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
1 ❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit.
ly {{ 4 1 j1;1L { +tl +If11 {I`Ll +kl it „ r h a t . .r 1 +{ f '1!I', Value S • I d r.(. W-1- . ' , :,,i,.., , + 11:.'eLf� .._ t -E ; j, ,,,' ; { 1.1-Lin l I L,,.u;+ .n.,,. ' f f., , il .;r1„; f l ■
pi_ and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
Master builder For special Oformatfon use checklist.
0 Multi-family ❑ ❑ Other. Description j Qty. I Ea. 1 Total
to 111 rl ;y s1 Il, , i ' 1 �, , t l ( a a ,, d �;� 1 : :h +fi l {
{ 1 h l? It�l i i i ,ol u�l �. + rig It 11' u 'a � {" �!" �a i a �e li:� r_ «�' tr � I r ti f 't� ¢J . p .! _, { a � , Heabny/cooling
Job site address. 1_ x'" � - y � ' Air conditioning or heat pump
'�� ro S ,. c f ) 12_"1 Y (requires site plan slowing placement) 1 14.00
City/State/ZIP: t Furnace 100,000 BTU (duets/vents) 14.00
Suite/bldg./apt. no.: Project name: Furnace 100,000+ BTU (duets/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 (fbel -type, not electric),
in -wall, in -duet, suspended, etc. 14.00
Subdivision: Flue/vent for any of above 6.80
Lot no.:
._ Other. , 10.00 J
Tax map /parcel n0.: Other fuel appliances
t. 1 'illf ln i + ). ,61) v'ati i �`a'{�l'11$1ry7j(m +11)111 +11 f1+ 1 {1 i ' ,1 1` Wafer heater 10.00
1,m�.1. €,f11o1: ,, ,. l..tn t „l.l a a _ I u.,.:,; t .,,.,,.,, n.l,n„ ,,., tjgs flr 10.00
Flue vent for water heater or gas
e 1 , aa fireplace 10,00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fire +lace /inscn 10.00
?' �'�, R , lG1 tt�tt , +{ipi1 „ JfIS' ,r 1r p'h ;;Pit 7 ','fl f ^m ,q; m rw 'ean , ?' m ”: Chimney/liner/flue/vent 10.00
7 1 i 1 /r �� � F 1 N J � f ' ' Oth 10.00
Name: Cromwell, Jo R0924 Environmental exhaust and ventilation
12665 SW 127 th Place Ragehhno�otherkitchen lo.00
Address. Tigard, Or. 97223 —
Clothes dr exhaust
City /StatelZIP; (503)228 -6X22 S ngle duct exhaust (bathrooms, 10.00 µ
Phone: ( ) toilet compartments, utility' rooms) 6.80
l,l f tern �t brv, ,, y Q r w i .E f� r Attic/erawiS aCe 10.00
g pr7�f,, y� y ��Ppyy ,;._
{ w , f' , � � � f Ji l t i , l l- 1 i tl,, . G ilfl t t) t p "R�,fP i4 w7 . , ! IfR • :731 i � �rr .4.„, , c n ., 6Si. �' '''P ,,G,, . •, :', Z �L : im ., p _
"" . Other: 10,00
Business name:
Fuel piping
Contact name. $5.40 for first four; $1.00 for each additional
Furnace, etc. _ _
Address: w_ Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater -
Fireplace
E -mail: Range
1 '.i ! 7., .. / '(t' till , f +I ft:f+Q`k`F tlr+''! lilt' <lflt 111�I l�E�`lftr3 t 1j 11 t t+f , Barbecue
Business r , 1 ' I .:
mess name; Specialty Inc
P ry Heating „ g & Cooling, ..... _ � g, .,..,.._. - , ,. Clothes dryer (�) _
Other:
Address: 7500 SW Tech Center Drive #130 I I; I ' `{, !'1 ' ' f` Lt l i + ari d •t ' ..
1't ,t111,il'` 5 l f' 1 :.,.fr.,1, t � t L ° 1 1 i ' z '1 ,:
.. 1 ,-,. t f � 1 . , .: L' 4' df ,, , ,
�k iii Ir' ;[ f
City/State/ZIP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 620 -5643 Fax: (503) 681 -0793 w
Plan review (25% of permit fee)
CCB lie.: 66578 State surcharge (12% of permit fee)
CA \` TOTAL PERMIT FEE X l , . D Authorized signature: `/ `r' This vomit y after It h been a as complete. ed within 1 e0
Print name: Andrea Dripps I Date: R / 18/0/ * Pee methodology id by Tri- Coenty Building Industry Service Board
I: 1BuildiosTennite \h15C- Pennlm0.pp.doc 01/19/07 140-4617r (11 /09/COM//22)
4G /18/2009/TUE 09:03 ANI FAX No, P. 003/003
SITE PLANT
PL
PL /44 PI.
PL
STREET
•
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. disrance
• Indicate .how the condensate will be run
SRC 7500 SW Tech Center Drive
SPECIALTY Suite #130
P TY Tigard, OR, 97223
HEATING ECIAL
(503) 620 -5643 Fax: {503) 681 -0793
C O O L I.N G
N , c www,specialitvheating.com