Permit •
1111 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00270
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/11/2007
PARCEL: 2 S 103 B B -06500
SITE ADDRESS: 12195 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: KEERINS
Project Description: Installation of a/c heat pump.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 0
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
KEERINS, HERMAN 0 + PATRICIA E Description Date Amount
12195 SW 121ST AVE
TIGARD, OR 97223 [MECH] Permit Fee 5/11/200 $72.50
[TAX] 8% State Surcha 5/11/200i $5.80
Total $78.30
Phone:
Contractor:
AAA HEATING & COOLING
2915 NE MLK JR BLVD
PORTLAND, OR 97212 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 284 -2173
FAX 503- 284 -1552
Reg #: LIC 222
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
/ \ p / fc Issued By: i I I �l Permittee Signature: a( t o
Call 503.639.4175 by 7:00 a.m. for inspections that business d
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From: 05/11/2007 12:31 11250 P.002/003
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Mechanical Permit Application l.(►ii iirrici (i: (.')l;l`
City of Tigard *, Received r >l l 1 6�' All Hall Blvd., Tigard, OR , , c
13125 SW
DateBy: / Penult No.: H LL 0 _ oo2.70
Ph 503.639.4171 Fax: 503.598.19 1 1 200 Plan Revi
" Inspection Line: 503.639.4175
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Date/By: Ready/By: Other Permit:
t :) , Internet: www.tigard- or.gov � i .
.. ► R ® Date G � fited/Mhetod: S Se for
�',� of . � `r ®�v t1 Noti a l Suppi emeata lnformadon
Y:=ri;^.:f -:i Y:;x•:J:.u{ :it.`i.X `�1�=',°.i;`vrb� "rim Rt.. .uarrwt�a�.,wa A - '�$ .2y M, r t c - 4,, +. . . ti �''''''''rnss� , ni ; w�v. �+M*+e
sac - z:,n .avx?c`;Ly,. .: ems;' :'i� =Q=' ,y'^..S}�'•;: i ti ° .1 .: a ��t . .d ; ,fie r � ti, .t...: a �a,a xe:;a:� •s`��..:; • `r » .� . = :w
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❑ New construction Addition /alteration/replacement Mechanical permit fees'" are based on the value of the work
❑ Demolition ❑ Other performed. Indicate the value (rounded to the nearest dollar) of all
"'' Demolition
-r' � =t , * _: TM...� , , ,,� _ mechanical materials, equipment, labor, overhead, and profit
J;�(? t � „B�x}1yt r.t�:, x rs °�' t ' i ',,� ; �" y,.y+. o.+�^�.��- .,.<:�3'r�x
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-'v::•..'..:x`-:x3. ktY:•.r.`- :. :. n;t.:22T:i2s�.'� '.c ee 1 n O'�4]0 �K1 ' c r Y'^- 3�ti" J.� •.1.1..1: Value' $
X an 2 - f am il y dwelling ❑ Commercial /industrial �a }- ry ��;.� � a` >f
/ ❑ Accessory buil ding - -,: , s ;Z-t �
For special information use checklist.
❑ Multi- family 0 Master builder
❑ Other:
tfil �:� �xx. z �:, ; x Description
�ii'' ` �'Gi:� J> ,:.?:?�� .t{� ° �` ) A 'd. 510:24711,---,0f I P Y�^ , �=i h, �' {'� �a (�.•, ' r•` � �' I Ea. I Total
aBx 3 tar's 3b-i.,:�V ,1#2 4 • ;;L .t v,: " ie saki ,�'`: lad �,,5i' Heating,/cooling 1
Job site address Z' 415 L ' l Z i I_ g Air conditioning or heat pump )
T (requires site plan showing placement)
� 14.00 (�-�•
City/State/ZIP: " -(' ( \ a tc� Q( " - -2 .... z .Z Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldgJapt. no.: � I Project name: l
) �
X \_ Furnace 100,000+ BTU (ducts/vent) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
bydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot Flue/vent for any of above : 10.00
Tax map /parcel no.:
Oth
et _ 10.00
Other fuel appliances
3 f , U .ftaa - 01 ' r„ '-o,. '.-_ µ � t t --- 2.11 3 . , tY.A, 1 ,jy Igk +'Li Water heater
.._2?� > 111.00
S� [�_.4_� t t \ & 1 '� �t Flue fireplace 10.00 _
� L�.l l� ,i ' Flue Yent for water beater or gas
"L V L I �atA.l t fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fueplace/msat 10.00
3 ': " ` ' R r �Y s yr r - c - :
Chimney/liner/flue/vent /liner /flue/vent
t 1 tj " ,. .+,, �ii a lie'. , ey 10.00
.
p � - � ._ t�f .,. , 10.00 ,
Name: C--' 4" V\ `\ eX \{ n'e t ' Environmental exhaust and ventilation
Address: \ Z ∎ el s S,,..7 L -t--- r /L. , e _ Range hood/other kitchen
L •�'�
equipment 10.00
'T1 �Z� Clothes dryer exhaust . _
Phone: ( C% �&, -1 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
' 1 W'''' - k .. y , d, 7. r : `.' P" 1 0 „..; 51 4 t . 7 1 t - :TEI lAtT ; Attic /crawispace fans _ 1
0.00
Business name: Other: 10.00
Contact name:
Fuel piping
$5.40 for first four, $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
E -mail: Fireplace
� r.': >1a' , ' }':i> >'1t r %H"��� . u ui:j 1;�j� i K ��r , :t -• }, w;fj;, . 5 � y ..�"�a�.„..:",51.0�.: >}•:i+.sr:. W% Range
=. t;_,.C;•6:^ r v�� �'r.:2C j� _ ��' .,.•* .1"55� V.`c y `Mu'' 'Nti+ , + ` S.1
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< ,,, .• _ -.,:. •;,.,, ..,. a�rr. �� cw ..,; �.a •. - .:�.r,..= 't:�,f�cr �.m �,�vxa?�:r. t'rYti'S�x�.-a:��; Barbec
Business name: fl fr� ik n \ � 4 > ` 1 Clothes dryer (gas)
Address: Zee (� �' `„ �J �j�vK J Other:
��': fy t��y�. *,�.�i � dt� +^ "��Fr.;`r.'�'sr'`
City /State/ZIP: P��1 &_A (N2 ''I1 Zl � Subtotal '}
Phone: () r D . 2,14 irk I Fax: 0/73)2.g..1, Minimum permit fee ($72.50) '" .�
Plan review (25% of permit fee)
CCB lic.: j.,a�
State sutc e 8%of
( permit fee) 5, Sr)
I � 9 TOTAL PERMIT FEE "'7 ; p
Authorized signature: V V _ Thh permit appl cation expires Ira per.•mit is not obtained within 180
F �, days after It has been accepted as compkte.
V
Print name: t C L, ■‘` k_. e I Date: 6 \ -D-• = Fee methodology set by Tri-County Building Industry Service Board
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CONTRACTOR • ArCellEAT PUMP -- UNIT SITE PLAN •
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= :AAA HEATING & COMING, INC, • I • . •
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, .. 2915 NE MLK JR BLVD,
PORTLAND OR 97212 • -
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GUSTOlgiR INFORMATION • ,
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CITY OF TIGARD -.
BUILDING DIVISION PERMIT #: MEC2007- 0027t)
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1 007
Phone: (503) 639 -4171 *Ago( it, J 2 f'
Inspection Requests (24 Hrs.): (503) 639 -4175 4 AL
INSPECTION WORKSHEET FOR DATE: 6/26/2007. TIME: 7 :00AM i //
PAGE: 65
SITE ADDRESS: 12195 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: KEERINS
DESCRIPTION: Installation of a/c heat pump.
OWNER: KEERINS, HERMAN 0 + PATRICIA E, PHONE #:
CONTRACTOR: AAA HEATING & COOLING PHONE #: 503 -204 -2173
Inspection Request Scheduled For: Date: 6/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 050915.01 503 - 204.2173 N
Corrections /C mments /Instructions:
VA a k ke ‘ \<- ,
V . 1) N ft ( 0 - 1 T e C It • ( - 4AAA OA( 34 -3 L e — 3)
/ hr
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ASS n PARTIAL APPROVAL Ti CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
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Inspector: '14,-(A-- Date: LA / 1 / / #: (503) 718- 24