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Permit p C ITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005-00376 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/22/2005 PARCEL: 2S111AA -09900 SITE ADDRESS: 09021 SW BLACKOAKS LN ZONING: R -4.5 SUBDIVISION: GREENSWARD PARK NO. 3 LOT: 083 JURISDICTION: TIG Project Description: Installation of A/C unit. 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: 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: GAS OUTLETS: > 10000 cfm: Owner: FEES KOLDSBAEK, CARYN Description Date Amount 9021 SW BLACKOAKS LN TIGARD, OR 97224 [MECH] Permit Fee 6/22/200f. $72.50 [TAX] 8% State Surcha 6/22/200f $5.80 Total $78.30 Phone: 503- 684 -8212 Contractor: SPECIALTY HEATING & COOLING 7500 SW TECH CENTER DR #120 TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS Phone: 503- 640 -3607 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 or 1- 800 - 332 -2344. Issued By: , j Permittee Signature: , SC) Call 503- 639 -4175 by 7:00 a.m. for inspections 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. 06/22/2005 08:48 FAX a002/003 i Mecha Per . t,App Fog OFFICE USE ONLY City of Tigard tti kot U L�IU na` ° f� — Permit No.. • r- 2/ - Ic 13125 SW Hall Blvd., Tigard, OR 97223 ?hone: 503.639.4171 Fax: 503,596,1'960 PlanAeview t vr il Yr •i DomB Ogler Permit: Inspection Line: 503,639.4175 , I � 2U�5 µ, hJrJ +'r Date Ready/By: Cr7 See Pace 2 ter Internet: www.ci.tigard.or.us Notified/Method. Supplemental Information CITY OF TIGARD • i ,;y.. ")V.lrn,�gN, ".„l' t• q � t i iB .�,I ,t., a. 'i' -';" e .;�� �}.r''.i ,r ` "„ ,',I,' II• �y,� I i a • ''" -4 ..: I Ii'a, •, � ,. l `LrrKyt. �;lt; ,; : c: ,ro , u I h. I h '91'I' rill LL , .I I l „ 'C�1 AS C�'• 'Fill ` SC9 U•i.E USE' CI )iCIQ. ❑ New construction ❑ 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 ....n Dctnolttion ❑ Other: . F mechanical materials_ equipment, labor, overhead, and profit. ; {�I 17.','∎.1 "yl ;P '; i l ;.0#0,1' i,?Op` " r,, I'. it „ , ,' ;r ,. V al . - - add,;,, pi �,1:,� 5•' �L1CC.>;ON'';�u:,�;;}1 � I , �'. .,,,�” V al": S r t'-' " "' Q.U]3xMENT / SYSTEMS, FEES* 1- and 2-family dwelling Cotrtrnercial /industrial 'S # TriAL')e3 Y 3 ❑ ❑ Acce55ory building Fer,lpeciai information we checklist, DI Multi-family ❑ Master builder 11 Other: Description Qty. I Ea, I Total 'h..I' # :I � •';:�" rii I it , , w "ai;it%,I w,1,3',c.v[ IO e;'Sit ITV ; .` `` .M - TV§ -.0.'0: Lo ixllON. =' .-,u, ., ,, I "'t(� Heattn /eooll p 7 © Air condition; or heat um Job site address: ' c 7 , � _ e L ,t, M n8 pump S t � �� ( f , �'� .4'� ( ro q ulr es sit p la n ,showing p 1 14,00 City/State/ZIP: - v ' )C'.-4'4 , q Z _ y - Furnace 100,000 BTU (duets/vents) 14,00 Furnace 1.00,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14,00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14,00 Residential boiler (radiator or h dronis) 14.00 Unit heatorS (tLel -type, not electric). in -wall, in -duct, suspended, etc. 10,00 Subdivision: Lot no.: Flue /vent far any of above 10.00 Other: J 10.00 Tax map /parcel no.: Other fuel appliances •1..P„` ; .:, 1 ' ,2,. ;',' - 1r1 / ' ' ` :, ' �_ ],D! `�'S iii �JFikI : ' eiiP =: r a � � el� ��i1'i ' 6;J : '`' i i l ' '.'� ;;;i• I'' Water heater 10.00 , ,a I , N . %., a •hio r /,' „,, F • '190.1•. Gas fire•lace 10.00 Flue vent for water heater or gas � k - fireplace 10.00 'T - Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 �� a� ww1r .+ I'. Chimney /liner /flue /vent 10.00 �:'..t'm + J : ' OPIr.B'FYi;:(3.* kE it;.�y�lir'; :i,l ° � ' L ____'_? I 'u ' r F,' ..,h Cl Other; l 0,00 Name: (, t — I. _, )i_� I 1 c ek., Environmental exhaust and vendlat Address: Range hood /other kitchen equipment 10,00 City /State/ZIP: Clothes dryer exhaust 10,00 Phone: Single -duct exhaust (bathrooms, ) 7t .f _ 6 Z' A Z F ax ( ) toilet compartments, utilia rooms) 6.80 '!qi ' Alt•' ;;i1 B 'I�CAN1` r i I' , i' r w fans 1 0.00 !+i, d�' 1 to vl,. h • r- A[[ic /ern Ispace aria ••:,,. ^ ;;a' , .!�� � i . � _ >ar�� ���'.''_;,r '., I ;; ' � �,�.� % ,,.. [�;;IO{�t;r�'I'11v.. , . ' I,� ; - ) / Other: 10.00 Business name. -, t. C C`,( T- f-T (; C'' / e Fuel piping Contact name: t — I i r^ E e4 01 c.c.:-, $5.40 for first four; $1.00 for each additiona C c S /„......,) Furnace, etc. Address: " �c C .- r c k � Qt (Z u= Gas heat pump City /State/ZIP: 7 J / 1 CL ■ C- r c ie G , } Z Z 3 Wail /suspended /unit heater Phone: (Sbs ) 6 (..I � - ? ( 7_ Fax: : (N 1, Z) {' ( — 0 4 `j ? Water heater 1=ireplace E -mail: Range Z T 4 : L' •- -V - "l I I ,•� I' ,IF '41411 �� ,n.. `4 Barbecue — ,:y ' { ; `'�f°. irl � t',� "�t'+ "t`h >r"��I}`,�,�`r y V, 1 Ql','d1h111 �; °' ,.f 1@�Y i:, - � `�1�'' y ,t''''>- rti1 1' i, t ,�' ' -.� l 1.,(`. -. }.A�F. J.hl°r " "w :'" rli -1, ,,y /'1, " ��,. I Business name: J n t � G c, - i"t f .^ d . ` Lv C Clothes dryer (gas) • �' . 0e'..—e''" 1' ` \ Other: "� J ij1 ='" �';; ,�',r,: ';, ;','; 1illOI.>.,�liCA ith iE)SS Address: ' City /State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit foe ($72.50) Plan review (25% of permit fee) CCB lie., (� _ L S "9. State surcharge (8% or permit fee) _ TOTAL PERMI FE ? :D. Authorized Signature: C� 4 �L ` Thb permit application expire. If a permit I. not obeelned within WO _ days a fter it has been accepted as complete. Print name: G" k �L�.• ` � -� I S L, Date: �a ' V , Pee methodology sot by Tri County Budding Industry Service Board 06/22/2005 08:48 FAX Z003/003 SITE PLAN PL 0 PL <D‘' PL PL STREET 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 CITY OF TIGARD - Y B ILDINq DIVISION SION PERMIT #: fvfEG2005 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: &22/2005 Phone: (503) 639 -4171 iA,n ryp41+��'� I l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/20/2005 TIME: 7 :11AM PAGE: 64 SITE ADDRESS: 09021 SW BLACKOAKS LN CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 083 TYPE OF USE: PROJECT NAME: KOLDSBAEK DESCRIPTION:. Installation of NC unit. OWNER: KOLDSBAEK, CARYN, PHONE #: 503 -684 -8212 CONTRACTOR: SPECIALTY HEATING & COOLING PHONE #: 503 -640 -3607 Inspection Request Scheduled For: Date: 7/20/2005 Pour Time: Code # Inspection Description Confirm # Contact #. Message 699 Mechanical final 011699 -01 503-640-3607 Y Corrections /Comments /Instructions: / / f i1--id k-7uL. 5 ,�4 706 4- 7,cici✓ • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date7� �"d5 Phone #: (503) 718-