Permit CITY TIGARD MECHANICAL PERMIT
�� DEVELOPMENT SERVICES PERMIT #: MEC2005 -00097
� I ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/10/2005
PARCEL: 1S134BD-07900
SITE ADDRESS: 11676 SW PENN CT
SUBDIVISION: PENN LAWN ESTATES ZONING: R -4.5
BLOCK: LOT: 007 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:
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: Installation of a/c unit.
Owner: FEES
KRISTINA COFFIN Description Date Amount
11676 SW PENN CT [MECH] Permit Fee 3/10/200: $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 3/10/200° $5.80
Phone: 503 - 524 - 7590 Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397 REQUIRED ITEMS AND REPORTS
DUNDEE, OR 97115
Phone: 538 - 2953
Reg #: LIC 125815
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 obtai ies of these rules or direct questions to OUNC by calling (503)246 -6699.
Issued y: Permittee Signaturt ( ) 639 -4175 b 503 _e
Call 7:00 P.M. for inspections needed the next business day.
by
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.
Mar (19 05 Ol:Olp 503 - 537 -2172 p.2
Mechanical Permit Ap l pt' D FOR OFFICE USE ONLY
City of Tigard � V ��-- Da , �� rearm No. Ha 22,5 i
1 3125 SW Hall Blvd_, LL//
Phone: .6 513163 Fax: 503.598.1960 3.598.1960 a 10 05 Fn,.� '�I,i Date/By: Other Permit
inspection IA A r, L s ■•,�� Date Ready /By: , H See Page 2 for
Internet: www.ci.tigard.or.us CST OF T,GARO .s Notified/Method: Supplemental Information
uu r O �S
' _ : S W ORK • . - • COMMERCIAL FEE* SCHEDULE - CHECKLIST
❑ New construction Addition /alteration/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: mechanical materials, i ment, labor, overhead, p ead, and profit.
. . . • • : CATEGORY . OF 'CONSTRUCTION' ....
..... :: .
.Valu
S
l and2 - famil dwelling RESIDENTIAL :EQUIPMENT *.
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. i Total
' . JOB SITE INFO TION AND LOCATION
Job site address: ( (/�� A nditionurg or eat pump , I
1‘..t1 ll� �/�}� requires s lowing placement) l 14.00 I
City/ State/ZIP: /Jl / ,t� 0)2. 811223 Furnace 100,000 BTU(ducts/vents) 14.00
% V W "` i Furnace 100,000+ BTU (ducts'vents) 17.90
Suite/bldg. /apt no.: Project name: 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
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended. etc. 10.00
Subdivision I Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map /parcel no.: Other fuel appliances
DE SCRIPTION . OF WORK: r l0 0
Water !!ca
,CA t1 u 1 n '� Gas fireplace 10.00
Cwt Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) • 10.00
' Wood/pellet stove 10.00
Wood fireplacc/insett 10.00
P PROPERTY OWNER ...• _ I •.: . 0, TEbAN►T : :
un iner /Iluelvent
ney.
Other 10.00
Name: , A, ` _ .( fi r ' Environmental exhaust and ventilation
I i bit I Range hood/other kitchen
Address: r
/ equipment 10.00
City/ State/ZIP: ` L a • Z Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phon: SgrAWM. Fax: ( ) toilet compartments, utility rooms) 6.80
. 1 : APPLICANT . : ' . ❑ CONTACT ' ERSON . Attic/crawlspace fans 10.00
Business name: t Other. 10.00
4 ► . s . ��.� A
..4 /i A Fuel piping
Contact name: 4 g $5.40 for first four; S1.00 for each additional
Address: / / I J n Furnace, etc.
Gas heat pump
(�
City /State/ZIP: � l) Wall/suspended /unit heater
Phon 2 3R 6053 I'SST ) 5 —1 -3-2----- Water heater
�` c Fireplace
E -mail: Range
. ONTRACTOR • ' - Barbecue
Business name: `/ /AAA ../ . , I / 1 � 1 J► Al A � .
Cl othes dryer (gas)
Other 0 Ir 41 a MECHANICAL PERMIT FEES* -
City/ State/ZIP: /� Q 0 _ ' a ll Subtotal
y'-"`� � 2„�
Phone; 655;4603 P• I ) 3 1 21 �'� Minimum permit fee ($72.SU) e it ee
t� 3 � Plan review (25 /• of perm fee) �
CCB lie.: 96 `( State surcharge (8% of permit fee) ) Ov
N. TOTAL PERMIT FEE „te,
Authorized - atu • / This permit application expires if a permit is not obtained within 180
(i 0 days after it has been accepted as complete.
Print name atilt) \ ► , AP L' DateTkS • Fee methodology set by Tn - County Building Industry Service Board
i:\ Building tPennitAMEC- PenniWpp.doc 1 440 4617T(II/02/COM'WEB)
Mar 09 05 01:01p 503 -537 -2172 p.3
Site plan for : coffin 11676 SW
Penn Ct
I
r' i2Gn;
SVV Penn Ct.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -00097
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/10/2005
Phone: (503) 639- 4171 '` �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/30/2005 TIME: 7:11AM PAGE: 66
SITE ADDRESS: 11676 SW PENN CT CLASS OF WORK:
SUBDIVISION: PENN LAWN ESTATES LOT #: 007 TYPE OF USE:
PROJECT NAME: COFFIN
DESCRIPTION: Installation of a/c unit.
OWNER: COFFIN, KRISTINA PHONE #: 503 5247590
CONTRACTOR: OREGON HEATING + A/C INC PHONE #: 538-2953
Inspection Request Scheduled For: Date: 3/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 003148-02 503 - 538-2953 Y
Corrections /Comments/ Instructions:
[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Y Date: ` Phone #: (503) 718-