Permit CITY TIG AR MECHANICAL PERMIT
DEV ELOPMENT SERVICES PERMIT #: MEC2005 -00364
DATE ISSUED: 6/21 /2005
-- ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103AD -05800
SITE ADDRESS: 12680 SW 111TH PL ZONING: R -4.5
SUBDIVISION: WILDERNESS LOT: 004 JURISDICTION: TIG
Project Description: Extend gas piping, install gas fireplace.
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: 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: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
CRANDALL, CLIFFORD E AND Description Date Amount
LINDA S
12680 SW 111TH PLACE [MECH] Permit Fee 6/21/200` $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/21/200E $5.80
Total $78.30
Phone: 503- 620 -2193
Contractor:
G P & W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED ITEMS AND REPORTS
Phone: 360 - 835 -3516
Reg #: LIC 108176
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: : i 71 2', Permittee Signature:
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.
Jun 20 05 03:38p GP &W Systems, Inc. 360 - 835 -5716 p.1
r'
:', , FOR OF FI CE I USEON LY'i` , ,. } +° -
NYeclnanitrai Permit li � � ® ,- .:.. .,,
City of Tigard Da . - Permit No. � 0036-v
.Z c
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -
Phone: 503.639.4171 Fax:503598.1960IIKI r[ Date/By: Other Permit
Inspection Line: 503.639.4175 �" ° 1 0 o J / L� �' II I • Date Ready/By: Ilial El See rage 2 for
Internet www.ci.tigatd.or.us Notificdafethod: Supplemental Information
CITY OF TIGARD
l bt6V ION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical ❑ New constriction ( �Additiontalteration/replacement Pmt fees* are based on the vahte of the work
performed. Indicate the value (rounded to the neatest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value. $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
BI- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checkltrr.
I
❑ Multi- family ❑ Master builder 0 Other Description 1 Qty. 1 Ea Total
JOB' SITE INFORMATION AND LOCATION Heat[ng/cooling
to Su , 1 i ( Q Air conditioning or heat pump
1 2
Job site address: ; la � t L (requires site plan showing placement) 14.00
City /StatefZlP: aA G , a `/'72.2.3 Furnace 100,000 BTU (ductslvenls) 14.00
Furnace 100,0001- BTU (ducts/vents) 17.90
Suitelbldgiapt_ no.: Project name: Gas heat pump I4.00
- Cross street/directions to job site: - Ductwork.. 14.00. .
Hydmnic 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
Flue/vent for any of above 10.00
Subdivision: l Lot no.: Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 .
Gas fireplace ( 10.00 /6
rt'�K'leriet e r TT "" n r lts4L CJ
(l as A Flue vent for ureter heater or gas
�p ) fireplace i 10.00 , /Q
he -kin i...rl (era_ / s tGcnd. L u .r L r'19 Log lighter (r s) 10.00 ,, LIE D a� ../ Wood/pellet stove 10.00
Wood fireplace/insert 10.00
�/ Chimney/lines/flue/vent 10.00 i
I$ PROPER7lC OWNER ❑ TENANT Other 10.00
Name: C (i “CYCt Cet1-01r %44 CO i ' Environmental exhaust and ventilation
Range hood/other kitchen
Address 12. 6 rcs .'(y.1 (1 I (P144.-e_. equipment 10.00
City/State/ZIP: EV61/4 et 7 2.Z3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
P hone: �t 9 Pal: ( ) toilet compartments, utility rooms) 6.80
IPIT �) �
APPLICANT D CONTACT PERSON Attie/craw]space fans 10.00 .
1 _Otter: 10.00
Business Hama P 4' 5-kg-iv -kg-iv ins �F"`- t/ Fuel piping
Contact name: L4091j4/e- /�7 SSA0 for first four; SLOO for each additional
Address: 73 2. �, f & L ee etc.
/V �� f � 1T �� ��,,//�� G,p/� Gas beat pump 1
G
City/State/ZIP: wi&b 4-L aik 7 ,7/ Wall/suspended/unitbeater
Phoae: ( 366 cc./.1- cello 1 Fax: : ( ) g, -$7/41 Water heater
Fireplace 1 `7. S ISI
E -mail: R�Be 1
CONTRACTOR Barbecue
`7 1O i-1� -i _ S y S Clothes d (as)
Business nam / e: � e ins , jet L _
Other:
Address: '73- ;47k ittsesd MECHANICAL PERMIT FEES*
City/statrJZIP: W v 6 44._ & H- 5 t.7) Subtotal L ST
Minimum permit fee (572.50) 1 2_. 1"7
Phone: ?rge6 036# g5 /47. 1 P83(: /e g3' 574 Plan review (25% ofpennit fee)
CCB lie: AVM Ale-4 F951- State surcharge (8% of permit fee) 5.
TOTAL PERMIT FEE 7$"e 3
�.., This penult application expires if a permit b not obtained within 180
Authorized 51 da after it pas hem ateepted as complete
L i/ ' Da te: 6/246 5.
e : ! ' F eatna th u dobgysetbyTriCoantyBuiIdingfndoatrySesvio Board
i Print nun
•
CITY .OF 'WARD ,;t.
BUILDING DIVI PERMIT #: MEC2005 -00364
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21/2006
Phone: (503) 639 -4171 41111 nlp 1 �yi
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 23
SITE ADDRESS: 12680 SW 111TH PL CLASS OF WORK:
SUBDIVISION: WILDERNESS LOT #: 004 TYPE OF USE:
PROJECT NAME: CRANDALL
DESCRIPTION: Extend gas piping, install gas fireplace.
OWNER: CRANDALL, CLIFFORD E AND, PHONE #: 5503-620 -2193
CONTRACTOR: G P & W SYSTEMS INC PHONE #: 360.835 -3516
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009988 -02 360-772-6328 N
Corrections /Comments/ Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D ate: C2 Phone #: (503) 718-
CITY OF T,.IQARD ,"
BUILDING DIVISION PERMIT #: MEC2006.00364
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21/2005
Phone: (503) 639 -4171 �'� %�4M�yp� flliO
Inspection Requests (24 Hrs.): (503) 639 -4175 �� z�
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 24
SITE ADDRESS: 12680 SW 111TH PL CLASS OF WORK:
SUBDIVISION: WILDERNESS LOT #: 004 TYPE OF USE:
PROJECT NAME: CRANDALL
DESCRIPTION: Extend gas piping, install gas fireplace. •
OWNER: CRANDALL, CLIFFORD E AND, PHONE #: 503- 620 -2193
CONTRACTOR: 0 P & W SYSTEMS INC PHONE #: 3648353516
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 009988 -01 360.772 -6328 N
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: G- 2-J Phone #: (503) 718-
Inspections Required for: MEC2005 -00364
✓ Code j Inspection Description I PASS Date [ By j I ✓ Code Inspection Description T PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation _ 105 Underground/slab cover I .
410 Fill — _ 110 Temporary electrical service
415 Grading 115 Electrical service /reconnect
205 Footing _ 120 Electrical rough -in
805 MFG-Structure gading/footing - -_ 125 _Wall cover
210 Foundation walls -- _ - 130 Ceiling cover
215 ! Footing drain 135 Low voltage
j 220 Slab _ 140 Sign installation
r 310 Crawl drain ■ 145 A/C or heating unit circuit _
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection: �
235 Shear walls /anchors - 199 Electrical final - I
240 Exterior sheathing
r 245 1_ Firewall
I _ 250 Roof nailing _ NI ELR - Restricted Energy Permit
255 1 Wtr proofing basement walls 135 Low voltage
260 _ Tilt -up panel 195 Misc. inspection: _-
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 ' MFG- Structure set -up __ MEC - Mechanical Permit
_ 280 Insulation
— 605 Post/beam mechanical
285 Drywall nailing X 610 Gas line
287 Suspended ceiling X 615 Mechanical rough -in — 2 z j C A '
295 Misc. inspection: 620 Hydronic piping
. 899 I MFG - Structure final 625 Duct work ___
498 1 Grading final 630 Fire damper _ _
1 635 Smoke detector sh �
299 i Final inspection �- - utdown
640 Exhaust hood
695 Misc. inspection:
X 699 Mechanical final _ 1(E_ Z3 /44
• BUP - Fire Protection System Permit
905 1 Sprinkler underfloor /slab PLM - Plumbing Permit
=
910 Sprinkler rough -in _ 305 Plumbing underslab —__
915 Fire alarm rou•h -in 310 Crawl drain
920 Su session tri• test 315 Post/beam plumbing
995 Misc. ins ection: 320 Plumbing rough -in — ___ __
998 Alarm final 325 RP/backflow preventer
999 Sprinkler final
- 330 Water service
335 Rain drain
_ 340 Storm drain __ -____--I.
SIT - Site Work Permit _ 505 Sanitar sewer _1
405 I Excavation -_ I - 1 I 345 Culvert /catch basin
k _ 410 Fill 350 Se•tic tank
415 Grading _ �— 395 Misc. inspection:
205 Footing l 1399 Plumbing final I
210 Foundation walls I
215 Footing drain
420 Sprinkler supply lines _ _ SWR - Sewer Permit _
- 495 Misc. inspection: - -- _ 505 Sanitary sewer - - -- _
' 498 Grading final _595_ Misc. inspection: L
499 Final inspection �_ I 599 I Final inspection L __
1: \Building \IVR \InspCard- AOP.doc 02/02/2005
C ITY OF TIGARD MECHANICAL PERMIT
t4.1 lk DEVELOPMENT SERVI DATE
PERMIT #: : 6/21/2005 0036a
13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171
PARCEL: 2S 103AD -05800
SITE ADDRESS: 12680 SW 111TH PL ZONING: R -4.5
SUBDIVISION: WILDERNESS LOT: 004 JURISDICTION: TIG
Project Description: Extend gas piping, install gas fireplace.
CLASS OF WORK: O T R 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: 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:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: • FEES
CRANDALL, CLIFFORD E AND Description Date Amount
LINDA S
12680 SW 111TH PLACE [MECH] Permit Fee 6/21/200; $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 6/21/200` $5.80
Total $78.30
Phone: 503 -620 -2193
Contractor:
G P & W SYSTEMS INC rn
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED ITEMS AND REPORTS
0
Phone: 360- 835 -3516 ;1
0
Reg #: LIC 108176 W
'"F
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. A!I 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 'DJ 6'1 „® — Permittee Signature: ''
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.