Permit 4 C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00280
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/30/03
PARCEL: 1 S134AD -03000
SITE ADDRESS: 10875 SW 108TH AVE
SUBDIVISION: BLACK BULL PARK ZONING: R -4.5
BLOCK: LOT: 016 JURISDICTION: TIG
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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install exterior AC unit. AC cannot be placed in the required setbacks.
Owner: FEES
SONDRA GUIZAR Description Date Amount
10875 SW 108TH
TIGARD, OR R 97223 [MECH] Permit Fee 5/30/03 $72.50
[TAX] 8% StateTax 5/30/03 $5.80
Phone: 503 670 - 0295 Total $78.30
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 71878
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. Yo may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: 17_ ' ( Permittee Signature: , ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
MAY -28 -2003 11 55 A TEMP HEATING 5035572990 P. 02/03
` Mechanical Permit Application O1 F1( 1-: t ' S I: ( } N I . 't
Date received: / `!' -7 ". Permit no.: �tJ.�vvz — " r�� 1
' i {, City of Tigard EVE Project/appi. no.: Expire date:
of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223
City
f Phone: (503) 639 - 4171 Date issued: By :e_e Receipt no.:
Fax: (503) 598 -1960 MAY 2 8 2003 Case file no.: Payment typo:
Land use approval: CITY OF TIGARD Building permit no,:
1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition /alteration /replacement LI Other:
.JOB 5111: INFORM 11 ION (O111NIERCI:1L 1,11.1 11 10N tit 1il•
Job address: Oh di 5-- IA..) OE' I _ 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: T (Block: I Subdivision: _ "See checklist for important application information and
Project name: (' k1- Z9.,}L, jurisdiction's fcc schedule for residential permit fee_
City /count _ I ZIP: C�'� 2.2 5 1 .,%: 2 IAMB .1 1)1! FLUNG 1 I 11.1. 4(111.1)1 I I.
Descn iQ�t andlocato , kon�nre tats:
AND (' Q111I1: RI(': V. IINDtSilt1 11 ,Itll.il1�111:.vfsriii:)lil.i
_ -b,.� - 'L1� / • Fee (ea.) Total
- Est. date of completion /inspection: Descri . tion Qt . Res.onl Rea. onl
''A :
Tenant improvement or change of use: Air handling unit UM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? C i Yes 0 No Alteration of existing 11VAC system
Boiler /compressors
yv`.Iv 44- State boiler permit no.:
Business name :4
Tons B
Address:1 _ y • DU(� S E. * j' 1. - detectors 1
�! Fire/smoke dampers /duct smoke detectors
Cit► rf ��� / F.?.i�it 6 Heat pump (site plan required)
Phone: LGbQ Fa 5rta99 E-mail: 0 nsta /replace fnrnace/bumer BTU/1
Including ductwork/vent Iiner Cl Yes Cl No
CCB no.: ri L t ^( S Install/replace /relocate heaters - suspended, 1 I
City/metro lie_ no.: I /IL/ ( wall, or floor mounted
Name (please print)D Q.(1L. Vent for a liance other than furnace
e ngeratton:
Absorption units BTU/II
Name: Chillers HP I
A d d ress:
- • w - - Compressors FIP
1./ —. Environmental exhaust and ventilation:
City: - • : • t I Zlt „ Appliance vent
Phone: Fax: E -mail: Dryer exhaust
Hoods, Type I/ It/res. kitchen/hazmat
hood fire suppression system
Name: CSIck(N _. GU t - Z.-(, K. Exhaust fan with single duct (bath fans)
Mailing address: f to ) 0 Exhaust stem a art from heatin or AC
City: Scat ZIP Fuel piping and distribution (up to 4 outlets)
ty T ype: LPG NG Oil
Phoneip $ Fax: E -mail: I ue pipet$ eat a rho over out eta
Process piping (schematic required) ,
Name: Number of outlets
*tiler listed appliance or equipment:
Address: Decorative fir place
•
City: State: ZIP: Insert - type _.
Phone: Fax: E-mail: Woodstove/pcllct stove
Applicant's s',na [ +15021 Da EL25 0 Other:
Name (print): Q Q . , C`- - 4-e,+
' Not all jurisdictions accept credit cards, please call Jurisdiction for Mort information. Permit fee $ _ C6
Notice: This permit application Minimum fee $
❑ Vitt 0 MasterCard exp ires if a permit is not o b t ained %) $
/ / Plan review (at _ /o
credit card number; within 180 days after it has been
} "r"TO� y State surcharge (8 %) .... $ 0
Name of Cardholder ox Fhown on credit card accepted as complete. TOTAL $ _ if • - */) Ti
Cardholder eta nature Amount (6/00/C01.4)
MAY -28 -2003 11:56 A TEMP HEATING 5035572990 P.03iO3
A -Temp Heating and Cooling
Site Plan
Prepared by: Air/ asr I v� Dato:
Customer Name: ndre .. cup z4tr Address; J0r'7.S AI
7 7 1/4 "r r . 97aaa
Customer Plhon So3 67o —aaq6" •
C5253 403 a s
1
. I'i iperly I3ouruiary Line
is '--�
•
House
s
t
Street ' • ry 10
TOTAL P.03