Permit CITY TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2001 -00085
c 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/8/01
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PARCEL: 2S112CA -13000
S ITE ADDRESS: 15566 SW 76TH AVE
SUBDIVISION: RENAISSANCE WOODS NO. 2 ZONING: R -7
BLOCK: LOT: 054 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:
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:
Remarks: Installation of exterior A/C unit. Unit cannot be placed within the required setbacks.
Owner: FEES
HUTTON, BRIAN D + DEBORAH A Type By Date Amount Receipt
15566 SW 76TH AVE PRMT CTR 3/8/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 3/8/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 624 -2704 Final Inspection
Reg #: LIC 76359
PLM 34 -175
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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 -0080.
You may obtain co ies of these rules or direct questions to OUNC by calling (50' )246
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Issue By: Permittee Sign - .r e■'^'� LL '
Call (503) 639 -4175 by 7:00 P.M. for insp- tions need - the next business day MP
Mechanical Permit Application
Datereceived: 3 f d/ Permitno.: ergo o'/-6 g,
^ City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 l/ Y �� p
Fax: (503) 598 - 1960 (/ Case file no.: Payment type:
Land use approval: Building permit no.:
- • .TYPE OF. PERMIT .. • • . : • i .
A 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION • • COMMERCIAL VALUA'T'ION SCIIF DULE
. Job address: 155 Op W to 7 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanicaLmaterials_ equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ _ _ •
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county:'' ZIP: 4 , - 1`& 2 FANMI.LY •DWELT ING�PCRIVIIT I f E SCIiEDUL1 ''
Description and 1 ation of work on premises; • _' Gamic G� ANI) COMMFRICALIINDUSTRTAL EQUIPMENTS(; DULL
1 . .
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
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Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Is existing space insulated? 0 ❑ No
Air conditioning (site plan required) 1 id ,00 ID An
g p ace Alteration of existing HV AC system
MEC HANICAL CONTRACTOR Boiler compressors
Business name: a V b1 4 J74 ' 4, State boiler permit no.:
HP Tons BTU /H
Address: • .C, x a X9'1 smoke dampers /ductsmokedetectors
City: IStateO ZIP:97aa2 Heatpump(siteplanrequired)
Phon ' •a`l04 Fax: 548- E - mail: Insta replacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: '1(0,� 59 InstalUrepla /relocate heaters- suspended,
City /metro lic. no.: 1 2 - '7 `a.. wall, or floor mounted
Name (please print): �' ' , a __ Vent for appliance other than furnace
. CONTACT PERSON Refrigeration:
• Absorption units BTU /H
Name: ,1 f' ` a l ' "Z Chillers HP
Address: S?'b 12)p� cy,'2)C1, 1 Compressors HP
Environmental exhaust and ventilation:
City.: '�Ig__() State:De_ I ZIP: C 1 a Appliance vent
Phone: ,,.:• - a Fax:S98.OD7o E - mail: Dryer exhaust
OWNER Hoods, Type 1/ II /res. kitchen/hazmat
• "' } hood fire suppression system
Name: - \/: r 3 . n Exhaust fan with single duct (bath fans)
Mailing address: 155 S(...t s '1(l 1 Avie__, Exhaust system apart from heating or AC
City 1 'a (Z{� • • State: ZIPQ� as Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil ,
Phone: - Fax: E - mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appllance or equipment:
Address: • D ecorative fireplace •
• City: I State: I ZIP: Insert - type
Phone: Fax: - mail:
Woodstove/pellet stove •
iu -
.sit y i ^ �t� ��`� ate., O ther:
Applicant's
_ _� D � , j tether: ,
Name (print): 'Tr k' C i a .c . \ 'Mk.
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ -
0 Visa 0 MasterCard Notice; This permit application Minimum fee $
Credit card number: expires if a permit is not obtained
/ / Plan review (at _ %) $
• Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 1
Cardholder signature Amount
440-4617 (6 /00 /COM)
6
HEATING & COOLING, INC.
P.O. Box 230397 Tigard, OR 97281 -0397
(503) 624 -2704
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