Permit C ITY OF T MECHANICAL PERMIT
i ' DEVELOPMENT SERVICES PERMIT #: MEC2002 -00496
i! DATE ISSUED: 11/7/02
^ -s- 13125 SW H all Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S125DA -01000
SITE ADDRESS: 09115 SW 66TH AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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: DOMES. INCIN:
LPG 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: Installation of fireplace insert.
Owner: FEES
HEPLER, JUDY Description Date Amount
9115 SW 66TH AVE [MECH] Permit Fee 11/7/02 $72.50
TIGARD, OR 97223 [MECH] Permit Fee 11/7/02 $0.00
[TAX] 8% StateTax 11/7/02 $5.80
Phone: [TAX] 8% StateTax 11/7/02 $0.00
Contractor: Total $78.30
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 620
Mechanical Insp
Reg #: 66578 Final Inspection
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 �j � /y
Issued By: 4 fedGc.�� A
Permittee Signature: 17 4416 0;61 ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Nov 05 02 08:44a Specialty Heating 503 598 0718 p.2
'
Mechanical Permit Application
�,-, City it t e ivexi: per no -:
, I City of Tigard 7 � � � �
Project/appl.no.: Expire date;
City of Tigard Address: 13125 SW Hall Blvd, Tiga„0IR 0 97223 ---•
Phone: (503) 639 -4171 iV(J v Date issued: 134 0 1 Receipt no.:
Fax: (503) 598 -1960 rice file no.: Payment type:
Land use approval: , Building permit no.:
TYPE OF PERMIT
X 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improl emend
0 New construction p 2 Additioalalteration/replacement 0 Other.
—
JOB SITE INFORMATION CONI NE' CIAL VALUATION SCHE
Job address: t' // S ,_- r) e„, (, 64 i 4 ✓ Indicate equipment quantities in boxes below. India to the dollar
Bldg. no.: 1 Suite no.: value of all mechanical materials, cquipmtent, labor, overhead,
Tax map/tax lot/account no_: profit. Value $ .
Lot: Block: I Subdivision: - *See checklist for important application information and
- Jurisdiction's fee schedule for residential permit fee. _
City/county: a c/ ZIP: 0 2_ y.3 1 & 2 FAMILY AWELLING PERMIT FEE S t IIEDULE
Descripdon and location of work on premises: AYE Ari4 b AND CONIMERIC$L /INDCiSTRIAL LQUIPti1EN SCHEI)LZ
..: . I.-:4 F ee ; Total
Est. datc of completion/inspection: / / / / //B y Description . Oty. Res. only Res.uniy
t A :
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned Yes 0 No
Air conditioning (site plan required)
Is existing space insulated? % Yes 0 No Alteration of existing HV system MO
11ECUANIC:AL CONTRACTOR Boiler /compressors
Business natn• • 1 e. 4/..- . f ' :a• oi , AIZ 11! State boilerpramitno.:
Addi ecs: • 4 60-.) f / • al . 0.- ed Tons ETU/H
erelsmoKa 'duct smoke detectors
City: T a4 4 State :4 ZIP: 97a v. ,a • cat puinp (site p an requited) E •
Phone. ,3(P(9p6[g FaxS'9FS1:77 E-mail: Install/replace ,urner BTti H
CC13 no.: 444-, 7 Including ductworlt /vent liner 0 Yes 0 No
„` Install/replace/relocate heaters-suspended,
City /metro lic_ I no.: I I) ta . i wali,.or floor mounted
Name (please point): . a p A A l 21,5 Vent for appliance other than furnace
CONTACT PERSON Rcfi3geratlom
Absorption units _ _ ETU/H • _
Name: ^; R � 4 es /1/ .�� Q l� Chillers HP - _
Address: c9S.2. 8 :S f S 7 Co.. H o
' .. q 7c 7 — .'.. . 3 - .7 Applian vent
Cery: �• ail � � , _... ..... I S : � 23P41 ce and yen n. El
Phone* - 3 0 -S6 C' ax:59g0?I S' %.: . - Dryer exhau t 11 • •
O wNER ' cods, Type 1/Wz s.kitchen/hex:nat
-.,,.. .., hood fire suppression system
Name: '.=,. p � .�: 8 ' s ,i,..._ .: Exhaust fan with single duct ( bath fans) IIII
Mailing address: '' //5 $V :' ..A.... ' • Exhaust system • • art from • • : ring or AC
City f�:'.;M i q' • .. . S ZIP: 9 7 ,, rr„t t*^i on up to 4 outlets ■
Type: • ! L PG NG _ Oil
Phone:,' • . ^ :r /... • .Fax: ..... ,.... E- mail .. .. ..... • . Fuel . i • ing each additional over 4 outlets
ENGINEER . , essp mg (schematic required) OM
Niiiam'''' `.. :`,," . . , ; .., • ° x ; ''• • Nutnberofouticts ., •
Ad. ,...ss ' o re ent.
di'.e:, , �. • �e; Tiste�spp ' ' or
...
. ... - Dxotativefie+e plane ,
City:' , 'T , ' . . : • • , . • . • 1 State :.. J ZIP . . .. Inset - typo r _C
Phone:: • rFnx: ' 1 E-mail: : 1 " — '�•oodstove/pe ctstove
Applicant's signature: aG , 2�t/I Date: // /S5 GZ�
Na (print): Art- 6K/ivy[ - "_.
Nam -
Not an jurisdictions accept edit cards, please =II jurisdiction for maim Worm/Won, Permit fee $ VZ - C
0 visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number. expiics if Zt p ermit is not o b ta ined
l / Plan review (at ` 4b) $
Expires within 180 days after it has been State surcharge ($%) $
Name of carthaIter as shown on emit` accepted as complete.
$ TOTAL $
Cs aigmwro Amount
44C -0617 (CrVNCOM)