Permit CITY Ti GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00356
�, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/17/2005
PARCEL: 2S111 BA -09800
SITE ADDRESS: 09519 SW BROOKLYN LN ZONING: R -4.5
SUBDIVISION: SHANNON MEADOWS LOT: 003 JURISDICTION: TIG
Project Description: AC install.
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:
Owner: FEES
CHEN, PAN Description Date Amount
9519 SW BROOKLYN LN. [MECH] Permit Fee 6/17/200; $72.50
TIGARD, OR 97223 [TAX] 8% State Surchaq 6/17/200E $5.80
Phone: 503 639 - 1706 Total $78.30
Contractor:
KIRK HEATING & COOLING
2092 NW ALOCLEK DR. #512 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone: 503 349 - 3406
Reg #: LIC 158366
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: /i�/Ir�i1/� Permittee Signature: 8`>t_
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.
Jun 17 05 10:43a p.l
A
`7 1Vleclanical Permit Application FOR OFFICE USE. O\r.1
Received 6; Permit No..
City of Tigard g'� n p Pan Review 0 .j bC 5 6 o364
13125 SW Hall Blvd., Tigard, OR 97 11l1� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 .; Date/Ely: Date/Ely: Other P rmit:
y: 1
Inspection Line: 503.639.4175 ` 1 Date Ready /By: j % See Page 2 for
Internet: www.ci.tigard.or.us JUN 1 7 2005 R Notified/Method: . 1 G / � Supplemental Information
fair'
E * b> li t-iu COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
ti;Li:A N ly� � Mechanical permit fees" are based on the value of the work
❑ New construction ) A (a LD ddition /alteratlori/rep`lacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description f Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION • Heating/cooling
Air conditioning or heat pump
Job site address: 9 c' G I S L.) gasx ; CL 1 ✓v (requires site plan showing placement) 1 4 . 00 I v
City /State/ZIP: 7% C, ,/�JZ r, 9 ,D.2 `/ Furnace 100,000 BTU (ducts/vents) _ 14.00
J Furnace 100,000+ 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
hydronic) 14.00
Unit heaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 10.00
Flue/vent for any of above 10.00 ,
Subdivision: Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
N S ( ( i Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
, Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
yt PROPERTY OWNER ❑ TENANT Other: 10.00
Name: (' [ < P ` � N Environmental exhaust and ventilation
/ C S Range hood /other kitchen
Address: C S I' S C l l..,-) (S CI ! f•J equipment 10.00
City / State/ZIP: j 9 / 2 ,. ( L ( arz -7 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (SG 63 9 _ 1 v Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT A Attic/crawlspace fans 10.00
CONTACT PERSON 10.00
Other:
Business name: 1; V S / C +- COO (; •- Fuel piping
-
Contact name: 1` (.. { (•---1—
t j l $5.40 for first four; $1.00 for each additional
f-1 70 I C c ID 2 . S ( `Z Furnace, etc.
Address: a �� L1/4.; Gas heat pump _
City /State /ZIP: J-) , , /g b C2 C q - 7/9 L Wall/suspended/unit heater
! r heater Fax: : (5O ) S+" / Water
`
-/ 333 Fireplace
E -mail: Range
CONTRACTOR AL ,( . K Barbecue •
/ Clothes dryer (gas)
K Business name: n t/ S /-4 _ / n J / e, `b`i--- (C;U I ^ 5 Other: _
Address: U S D ... _ . A'(,_ � ,2 • 3 1 1 MECHANICAL PERMIT FEES*
City /State /ZIP: /-/ ; i i 5 I c,---c) c 7 7 /i2 (-, Subtotal
Minimum permit fee ($72.50) 7 2 S�
Phone: (Si 3 ) <- 3 / y () 6 Fax: ( Sc-�) `7' G 0 s" 3 Plan review (25% of permit fee)
CCB lie.: / S S'S 6 6 / 7._d O ( State surcharge (8% of permit fee) ._ . ,
TOTAL PERMIT FEE ? g 3 c
This permit application expires if a permit is not obtained within 1811
Authorized signature: days after It has been accepted as complete.
Print name: ,,' /� _ Dart 4, / • Fee methodology set by Tri•County Building Industry Service Board
P• 3
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FRONT
K IRK 'S
HEATING & COOLIti
CC8 11 6
CITY OFARD
BUILDINu 5f/ISION PERMIT #: MFC2006 -00366
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/17/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR 4 ., DATE: 6/28/2005 TIME: 7:09AM PAGE: 2
r
SITE ADDRESS: 08518 SW BROOKLYN LN CLASS OF WORK:
SUBDIVISION: SHANNON MEADOWS LOT #: 003 TYPE OF USE:
PROJECT NAME: CHEN
DESCRIPTION: AC install.
OWNER: CHEN, PAN, PHONE #: 503-639-1706
CONTRACTOR: KIRK HEATING & COOLING PHONE #: 503-349-3406
Inspection Request Scheduled For: Date: 6/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 010336 -01 503348 -3403 Y
(5637403- za Gc:)
Corrections/Comments/Instructions:
(� PASS ARTIAL APPROVAL ❑ CANCEL E NO ACCESS
n FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: j Date: 27---7A Phone #: (503) 718-