Permit 1
A e ,'CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00016
�+L .- — 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04
PARCEL: 2S101 AA- 09100C
SITE ADDRESS: 12447 SW 69TH AVE
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT: OOC JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Mechanical TI, install (2) new VAV's, low pressure & relocate diffusers.
Project Value: $5,500
Owner: FEES
HOULSEHOLD CREDIT SERVICE Description Date Amount
12447 SW 69TH AVE. [MECH] Permit Fee 1/15/04 $150.50
TIGARD, OR 97223 [MECPLN] Plan Rev 1/15/04 $37.63
[TAX] 8% State Surcharl 1/15/04 $12.04
Phone: 503 686 - 2048 Total $200.17
Contractor:
ALLIANT SYSTEMS LLC
1600 NW 167TH PL, STE 330
BEAVERTON, OR 97006 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 153420
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 By: � "` a,r� ; Uffai Permittee Signature: A., ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
2+DO 6
Mechanical Permit A h lit ` "fir:
— _ _ - Date received:
- , y :�'� � � City of Tigard a Permit no.: N -- ,. � -.Was
='U- g Project/appl. no.. Ex . ire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti R1942 014 Date iss l /. � Receiptno.:
• Phone: (503) 639 -4171 �J1tl`I
Fax: (503) 598 -1960 1/Pit Case file no.: ' . ment
GITY OF TIGAA� y type.
Land use approval: BUfn1NG DIV1S1O Building permit no.:
"I' I'F OF rl•:RA1I I
U 1 & 2 family dwelling or accessory Commercial/industrial O Multi- family 0 Tenant improvement q-J\
Cl New construction Addition/alteration/replacement 0 Other.
JOB SI I F INFORMAT (0i\1MI:11(I; 1. V ALUATION SCIIFI)Li1 I
Job address: 4 : � A ■ A. A i t� Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: e2. Suite no.: IIS r ' value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ I D0.00
Lot: (Block: I Subdivision: 'See checklist for important application information and
Project name: ft-oi p ci. je*Mp jurisdiction's fee schedule for residential permit fee.
City /county: C1( Qp IZIP: al'1/j.1 I & 2I. AiMII% I)WFI"LING PERMIT FEE SCIII UULE
Descri tion and 1 tion of work on premises: t
AND CON1N11:RIC:AL /INUITS "I RI: Al. I:QU11' ;\1 EN (•SCI IEDlil"E
VkI( 1 Fee(ea.) Total
Est. date of completion/inspection: Desaiption Qty. Res.only Res.only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned ?rnes 0 No
Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? XYes 0 No Alteration of existing HVAC system
MECIIANICAL CON "I "R:A('IOR Boiler /compressors
usiness name:
mit 4( its State boiler permit no.:
� �J ./� HP Tons BTU/H
4 Address: up0 04w (� 1 IZ O gim n . • . n .' 7 w
V City: ly te4 M : t�� ZIP: 11 D()& Heat pump site p an required)
Phone: , ' " a Fax: jr E - mail: Install/replace furnacedbumer BTU /H
Including ductwork/vent liner O Yes 0 No
CCB no.: r nstal rep a re ocate . eaters- suspen. ed,
City/metro lic. no.: 7 " - wall, or floor mounted
Name (please print): . - • / P all Vent for • .. fiance other than furnace
(' (IN "1 " A(`I" 1'I:I1SON Absorption units BTU/H
Name: Oa- 4 o1 t -- (A -vi,o NT Chillers HP
Address: Con�►►ppressors HP
S � Ewironmental exhaust and ventilation:
City: !State: 1 ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OIINI:It `•,.., ype - f fres.kitc e azmat
� hood fire suppression system
Name: � *.C 1 + P " *,4421 II 4NT Exhaust fan with single duct (bath fans)
Mailing address: • D LA 4 Exhaust s stem • • art from heatin: or AC
�' .: f < , Cr:i�.� o• ! ZIP: .. . 'a P P i _ I t' 7 on up to • ou e(s
Type: LPG NG Oil
Phone: a , G r , �f i .� Fue .1. in : eac itional over • ou ets
I:N :I:It . pI sc emaucrequired)
Name: "-4- Number of outlets
r • 4, J G t'I 1 : app l : or i pment:
Address: Decorative corative fireplace
City: Gf� 1 State: (ZIP: - nsert -type
Phone: I Fax: 1 E-mail: Woodstove/pelletstove
Applicant's signature: , I • d i r C p ' Date: - Other.
� t,.±II► 'P Tim
Name (print): • / „
Na all jurisdictions ia accept c edlt cards, please call jorisdation for more information. Permit fee $
o Visa O MasteiCard Notice: This permit application Minimum fee $
expires if a permit is not obtained
Credit card number: / / Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardbolda as shown on credit cad accepted as complete.
S TOTAL $
catdbolda sips= Amount 4444617 (6100/COM)