Permit •
CITY TIGARD MECHANICAL PERMIT
I'" D EVELOPMENT SERVICES PERMIT #: MEC2005-00483
' DATE ISSUED: 8/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S111CD-03300
SITE ADDRESS: 09625 SW BRENTWOOD PL ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.9 LOT: 522 JURISDICTION: TIG
Project Description: Install a/c unit
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
ROBERT BLUMENFELD Description Date Amount
9625 SW BRENTWOOD PL [MECH] Permit Fee 8/4/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 8/4/2005 $5.80
Phone: 503- 620 -5651 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 - 557 - 2220
Reg #: LIC 72623
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 -3
Issued :y: Permittee Signaturs►'s• _ �, _„;
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.
Aug 02 05 04:53p Tri County Temp 5035570919 p.1
•
Mechanical a e r;nxtt 00.1 u ® - _,,> typv vs> owl -
City of Tigard R ece i ved _
DateBy: Permit No. v ,,,, f
13125 SW Hall Blvd., Tigard, OR 97223 if ,
: ./ 1 ' � !I
Phone: 503.639.4171 Fax: 503.598, P960,y 4 2005 i Pian Revrew
DzteBy: Other Permit:
_ Inspection Line: 503.639.41.75 P Date Read /8
n�' Ready /By: furls' El See Page 2 for
Internet: www.ci.tagard.or.us
Notified/Method: ' /P . Supplemental Information
CITY OF TIGARD t�Jv
DI fit r !Plr` r,,, r,r.. ....
t , '. .' - F . 1:LEDITL:E - ' i3SE'CHECIQ.ZST
I ❑ New construction KAdditionialteration /replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
l lY T 'mechanical materials, equipment, labor, overhead, and profit.
,. ' : d .w ,. - - ..1.• . VP. - - Value: S.
1 - and 2 - family dwelling 0 CommerciaUindustrial k? SIDENTIAT ■ E QUIPM ENT SYST EMS :FEES*
❑ Acc ess ory building
❑ Multi- family For special information use check list.
esc
:... on Qty i Ea. I Total
master builder ❑ Other: npd
❑ Ma st b
. OB„SIT:EiWOR AT1 -9. :: : D L OCAT.10.r r.: :_ " : :• •; ' -:
Q `A' , . ...: Hea[in Jcnoling
Job site address: " 1 26 g� b F a:1 4t� Air conditioning or heat pump
"` """"'���+++ i (requires site plan showing placement) I 14.00
City/State/ZIP: T a-rd (,11�� .' Furnace 100,000 BTU (ducts/vents) ::•:.) 1 • i4 - I
C1122-4 I Furnace 100,000+ BTU (ducts /vents) 17 90
Suiteibldg. /apt. no.: Project name: i
Gas heat pump 1 1 4.00
Cross street/directions to job site: Duct work I 14.00
I
Hydrenie 'not wa :cr sys_era 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10 __ - - "
- _ .... .. _
Subdivision: Y y of above 10.00
Other: 1 10.00
Tax map /parcel no.: Other fuel appliances
.. ? ; DESCRIPTION , QF . .toi v :: e '' R ;`: Water heater I 10.00 •
1 Tr IL I Gas fireplace 10.00
�'� Flue vent for water heater or gas
fireplace 10.00 _
I Log lighter (gas) 10.00
I Wood/pellet stove 10.00
Wood fireplace/insert 10.00 i
I'RUPRR `,,., ... :_ . , Chimney /liner /flue /vent 10.00 •
.. _ . : Ar..t.r Other: 10.00
Name: Environmental exhaust and ventilation
Address: — Range hood /other kitchen
"- - — equipment I • 10.00
City /State /ZIP: i Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone:) W��{ / Fax: ( ) , toilet compartments, utility rooms) I 6.80 •:,D,;`2nP$Lr4:1:. E . :;c; :� t^ , .GON'TA: •T,= Attic /crawls ace tans 10.00
Business name: Tr! C LrrI Tanp COE'R 1 Other: 10,00
Fuel piping
Contact name:
S5.40 for first four; 51.00 for each additional
Address: 0 i aD e. C (QCkfm@S RJ v f I UC) Furnace, etc.
�I Gas heat pump
City/State/ZIP: Cregen C4 704- Wall/suspended/unit heater
Phone: (5c?3) 5 720 F ax:: (�ifl�) f 5 57_M 1 () Water heater
J J f C / (L ( Fireplace
E -mail:
Range
s _ -•x� : . 1; �1 „' • :z ,.;� ^ _.� 'E.N - _i5•— _ _ 'ilir- S{: _' ' - i: +
. ._ : - :".ud ` :_ �i<;�:ki.:,; S; w.COL�L FCTopy t ,9;a o :,7,. - Barbecue
Business name: - Fri COL -Temp f � ! ` Clothes dryer (gas)
� rn r 4 / C/Tl I Other:
Address: i }' )0 �• t il <(. t ' L03 �R v hn \� I 60A-A- -A- PERIVI :FEES '' •
CityiState/ZIP: Dye( F!I L 0 \ I C � Subtotal
Minimum permit fee (572.50)
Phone: (5., 55-7--2--12--r;' 111 Fax: (tJC:: l ( - L, 161
P;an review (2 5% of permit fee)
CCB lic.: -7 State surcharge (8% of permit fee) (`��
j -
-y-�/1 TOTAL PERMIT FEl
Authorized signature: s C,C� 2 I - e � ` This permit spplicatian expires if a permit is not o etL
'I) days offer it has been accepted as complete bta
Print name: bean< iii(U.S0 Date: 104, . Fee methodology set by Tri - County Building Industry Service Board
: :'.Buildint\ r its\NLEC- PcrmitApp.doc 12.03 at0 4 7T 11 I/0?ICOM'wEB)
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CITY OF TIGAK)
BUILDING DIVISION PERMIT #: MEC200S-00483
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/4/2005
Phone: (503) 639-4171 Al
ft'iP111109
Inspection Requests (24 Hrs.): (503) 639-4175
•
INSPECTION WORKSHEET FOR DATE: 8/29/2005 TIME: 7:13AM PAGE: 85
SITE ADDRESS: 09625 SW BRENTWOOD PL CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.9 LOT #: 522 TYPE OF USE:
PROJECT NAME: BLUMENFELD
DESCRIPTION: Install a/c unit
OWNER: BLUMENFELD, ROBERT PHONE #: 503-620-5661
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503-557-2220
Inspection Request Scheduled For: Date: 8/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 014446-01 503-667-2220
Corrections/Comments/Instructions:
4
• •
PAS'S I I PARTIAL APPROVAL CANCEL fl NO ACCESS
FAIL r7 ALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: F Phone #: (503) 718-