Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00221
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/23/2006
PARCEL: 1S125DA
SITE ADDRESS: 09955 SW 65TH AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Install heat pump, air handler & duct work.
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
JAMIE MIKAMI Description Date Amount
9955 SW 65TH AVE
PORTLAND, OR 97219 [MECH] Permit Fee 5/23/200E $72.50
[TAX] 8% State Surcha 5/23/200€ $5.80
Total $78.30
Phone: 503- 452 -0312
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 -598 -0718
PRI 503- 620 -5643
Reg #: LIC 66578
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.
Issued By: -� C u Qa . Permittee Signature: ��t1 h n •
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.
05/22/2006 12:29 FAX el001/003
Mechanical Permit A i 1). hiriz OFFICE USE: o`'r.N
City of Tigard 1 - Received
13125 SW Hall Blvd„ Tigard, OR 97223 Daze/By. =- • / - -- �/ 1 //� -.n.
Phone. 503,639,4171 Fax: 503.598.1960 p� / `±, ,,
Pl
on Review
Inspection 503.639,4175 � {y l L U !_ j : i D
Line: 9,41 ll i
ate/By Other Permic
Internet: ne:.tigar9,41s Date Reedy /ey: El Sae Paee 2 for
CITY O Notified/Method; Supplemental information
,2F; 4 i h' OM S ,. r, J. L i ;. (•,. r ,' l.. .'f " I ( N /;;1' L,{It {; F; .r'la'•'r O Y
New construction i'i Addition/alteration/replacement Mechanical permit fees' are based � an the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
CI Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit
o� ^;' :y < }t : p r v . - t c6:2 ir*.t1i:" 4, ,QB,' 'OO S LZIUCLIUIY' e ^. ii ' .; ,, i CC'a. ; k ; „' „ a , . Value: $
1:!(l mm
l- and 2- family dwelling ❑ Coercial/industrial ❑ Accessory building i' i' 91D1! TLFA [:$IQL�I)1VTS7l9'E�1�S;F�>�5!'
❑ Multi - family CI Master builder ❑ Other:
For special information use ckeck/Isr,
'. � 1 � Ocscription I Q. I Ea. Total
. ''I. � j+,1f1,. .r „iT,�'. 1L'�
ID �f�l4Ii��� 110 ', � 'h� '�
r , • , . ,.1 LOCA'T)kdl1);. Y � . '' ''" ` , /�6a 4 • Heatinf,/coolLnR _
Job site address: IA 955 S i 4,S Aye Air conditioning or heat pump '
j (requires site plan showing placement) 14.00
City / State/ZIP: / i n q 7 t <<C � Furnace Yefiducts/venre) 1 14.00
J a • Furnace 100,000+ BTU (ducts/yenta) 17.90
Suitc/bldgJapt. no.: Project name:
Gas heu�ump 14.00
Cross street/directions to job site: Ductwork 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14,00
Unit heaters (fuel- type - not electric),
_ in - wall. in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue /vent for any of above 10.00
Other, 10,00
Tax map /parcel no.: Other fuel appliances
�I ,W I1 ' '
1 I, w� I p 1 �� ,,y W 5 ,,J, f „ ii earer l
� "V^��f•h, Si�ll� �'F4.'�o +�: �,"4Y.,...., � ,NEyV•�'•,:, � O IRK i�I:� 7r. '�'I!;' „i��1; ": � ' . „. Water h - 0. 00
Gas fireplace 10.00
hi ski /, head pub 9 air i4M i 1 woad, Flue vent for water heater or gay
I fireplace 10.00
- Log lighter (gas) 10.00 .
Wood/pellet stove 10.00
Wood fireplace/inscrt 10.00
fA 1Q R i ,r,, ;• Chimney/liner/flue/vent
10,00
. ;. ^ , R'1L'Y .�, :; ; ;�� !0}116 ,:1 � , ia,;1'${NA4 . .,i ;. Other; y 10.00
Name: ♦ r te rn , 1�!u.p ti Environmental exhaust and ventilation
Q _l Ave, ange hood/other kitchen
Address: L qg5 S�) 6,5i�l. n equipment 10.00
City /State/ZIP; L 6 and O O. q 72x..3 Clothes dryer exhaust 10.00 _
Single -duct exhaust (bathrooms,
Phone: 6.03) 4 _31 Fax: ( ) toilet com.ertments. mill rooms 6,80
I,', ,: LI.; *.' 4 1 °/ J'b; i,,� , �' , y ( j' i$ a , ,' '! .,:' :i Atti c/crawls' ace fans 10.00
�.,;:,.�•, �� '1 �Jtr ..ti �;ct��i• • :�v4,i�ri„ ''� CONTAC'>�'r•,lE' i�SON;ia�,', ,,,,: 10.00
Business name: �) Other;
SPe ce��4 fi'L Fuel pipL�
Contact name: S he r • t S5.40 for first four: $1.00 for each additiona
Address: Sa rri e Gas heat etc,
- - Gas heat t pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water hearer
I Fireplace
E - mail:
� ; , , y ,�. 4 / r � ' ' ��.. •IF!L J i C:a_ .1 : " ,• { Range
ii ti ^a I:i w�'�: �, �:r 'F/� ;'cd� ? ^' Q 04 m kIM' ;i''' ;:h' „ i ., 'Sf 9 .,t.M „,: p'i
� 1 % ; �i: �t.') ISl' .',:n'.M;I�rw'� r-•i /x•I;y� , ti''. e,{ Mii, � y� IiP Y °:wr' Barbecue
Clothes dryer (gas)
Business name: Per s f- µ 4„� 44” 4 l�bl,L” re_
r/� ` � /� p //•�� y� -V '�J� Other;
Address: ,,�,�
?J Yo V K/ -r`.-•1 ► Vim+ u4C.r . 1 VU .Ill;,,.i; �,''id': r'f"1.1l '1)C",C rIZY.[il_'Jl 5t' IC,.'� ).i . ''
1;,r � . . : %ice 1d'.
Cit /Stat/ZU': --
0#2 q 7a Subtotal
Phone: 663) t C & 43 F ; C5 03) S R - C) i p Minimum 25% fee r mit fee . ?�_S A 7 l Plan review (25% of permit fee)
CCB lie.: I ` 5 Z $ S tate surchar (2% of per mit fee) 3 frO
TOTAL PERMIT FEE 72
Authorized signature: This permit application expires if a permit is not obtained within 180
drys after it Sae Seen accepted as complete.
Print name: 5(, p/ j m Date:Sy e • Fee methodology set by Tri -County Building lndusay Service Board
I.\ Guild .na.Perrnit3WlEC•PermirAppdoe 12/D] 440-4017( /02/CO %UWEa)
05/22/2006 12:29 FAX LJ002/003
SITE PLAIN
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Ar 6 777 five
STREET
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Specialty Heating, & Cooling, I nc.
1 SW G6 NT e1 2 - pie 1���
Tigard_ OR 97223
Phone 503.620.56 43 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793