Permit CITY TIGARD MECHANICAL PERMIT
oS DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00180
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/8/04
PARCEL: 2S 103C D -06900
SITE ADDRESS: 11635 SW FAIRVIEW LN
SUBDIVISION: TERRACE TRAILS ZONING: R -4.5
BLOCK: LOT: 029 JURISDICTION: TIG
CLASS OF WORK: ALT 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of furnace and A/C unit. A/C unit cannot be placed within required setbacks.
Owner: FEES
EMILY SMITH Description Date Amount
11635 SW FAIRVIEW LN
TIGARD, OR 97223 [MECH] Permit Fee 4/8/04 $72.50
[TAX] 8% State Surchari 4/8/04 $5.80
Phone: 503 - 624 - 5617 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 453 - 4822 Final Inspection
Reg #: LIC 62196
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 B; �� " i /
Permittee Signature: / / / -7 /O^/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Apr 08 04 12 :O80 climate control 503 968 7224 p.l
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') Mechanical Permit Ap jccation o F F .1 E. U SE ONLY
' � � i E G E D ate received: D Y �
,4„I. 4i1 City of Tigard / Dy Permit no ��e 2.00 - 0:
City of Tigard 7�2t? 2004 PiOlect/apph no.: Expire date:
Address: 13125 S W Hall Blvd, Tigard, ORR9
Phone: (503) 639 -4171 Date issued:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: By Receipt no
Payment type:
BUILDING DIVISION
Land use approval: Building pernut no.:
TYPE OF PE MINIIIIIIIIIMINIMINEE
1 & 2 family dwelling or accessory ❑Commercial /industrial
0 New construction ❑ Multi-family D Tenant improvement
0
t 0 Other:
JOB SITE INFORMATION
COMMERCIAL VALUATION SCHEDULE
Job address: (l (d35 5( c=t -ci2T
Indicate equipment quantities in boxes below, indicate the dollar
Bldg. no.: Suite no.:
value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.:
profit. Value $
Lot: Block: Subdivision: * '
Project name: See checklist for important application information and
0 L ect - rn - f j "] jurisdiction's fee schedule for residential permit fee.
City /county: • , rA ZIP:
9 & 2 FAIMILY DWELLING PERNIIl' FEE SCHEDULE
Description and to ation of work op prom •ses: A I COMMERICALIINIDUSTTtIAL EQUIPMENT SCHEDULE!
t 113 • _,I 1 vvxatiL W A tL
Est. date of completion /inspection: Li -q -U Fee (ea.) Total
-0-1
Tenant improvement or change of use: Description Qty. Res, only Res. only
is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
Air conditioning existing (site plan required) p
Is existing space insulated? 0 Yes ❑ No
• ��C CO Alteration of existing HVAC system
CONTRACTOR Boiler /compressors
Business name:
IA _ ` 1 I Stale boiler permit no.:
Ad. ress: I (r5 S(v ")._r1 HP Tons BTU /H
City: �)�k\� State: Fire /smoke dampers /duct smoke detectors
Q� ZIP g - 7 D_L{ Heat pump (site plan required)
Phone: �fJ3 U V£3� Fax 1,8 -mail: install /replace furnace/burner BTU /H
CCB no.: 'C (� Including ductwork/vent liner, Yes 0 No li
City /metro lic. no.: f (9 Install /replace /relocate heaters - suspended,
Name (please print) :�fyy/ 6(n wall, or floor mounted
Vent for appliance other than furnace
CONTACT PERSON
Refrigeration:
Name: Absorption units BTU /H
Chillers HP
Address: Compressors HP
City: State: ZIP Environmental exhaust and ventilation:
Phone: Fax: Appliance vent
E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen /hazmat
Name: EYE L LA -
3 0x�� hood fire suppression system
Mailing address: v Exhaust fan with single duct (bath fans)
(l (D • 3� 50 V IJ(V_L) e Q Exha.lst system apart from heating or AC
-a rax: ZIP: City: Mr Cx�� State: Q(f� C...? 223
Fuel piping and distribution (up to 4 outlets)
Phone: v * D.C-1 Type. LPG NG
E -mail: Oil
ENGINEER Fuel piping each additional over 4 outlets
Name: Process piping (schematic required)
Number of outlets
Address: Other listed appliance or equipment:
City: Decorative fireplace
• State: ZIP: Insert - type
Phone: Fax: E -mail: Woodstove /pcllct stove
Applicant's signature: 7 Date: 4- 5/•._ C) L( O ther:
Name (print): ,Q-1, / .�- , �"' Other:
,� 1 I i
Not all jurisdictions accept credit cards. please call jurisdiction for more information.
Visa 0 MasterCard fee $
Notice: This permit application
Credit card number: _ Mlnllilllm fee $ ]a. c...-) / / expires if a permit is not obtained
Expires within 180 days aC�•er it has been Plan review (at •_ %) $ c
_
Name of cardholder as shown on credit card State surcharge (8%) $ J ?(b
accepted as complete.
Cardholder signature - $ TOTAL $ -- , _3d
nature Amount
440-4517 16RX 7COM)
Apr 08 04 12:08p climate control 503 968 7224 p.2
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