Permit -r` r
CITY TIGARD MECHANICAL PERMIT
I�� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00112
�' DATE ISSUED: 3/11/04
�` -�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 115AA -02400
SITE ADDRESS: 10582 SW KENT ST
SUBDIVISION: DOVER LANDING NO.2 ZONING: R -4.5
BLOCK: LOT: 063 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace furnace
Owner: FEES
COOK, GARY R /SUSAN E Description Date Amount
10582 SW KENT ST [MECH] Permit Fee 3/11/04 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharf 3/11/04 $5.80
Phone: 503 639 - 1284 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 453 - 4822 Final Inspection
Reg #: LIC 62196
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 ~
Issued By: / _z;
- Permittee Signature: /r/ / .. / c..--ax
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the n -xt . usiness day
, Mar 11 04 12:O1p climate control 503 968 7224 p.1
• Me 1 . ', , !t A pp li ca ti on �. � OTFICL � USL +, O'�Tl:� , -
r 2004 Date received Permit no.,81,(l,( �Y / 1 oZ-
., illy O g
:_ * City Project/apph no.: Expire date:
Address: 1G1 SYSW1-1Ttl bilPli?ard OR 97223
City of Tigard Phone: 1DLt7IDIVISION Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: y6 Building permit no.:
t t '
�«.2e t' : tiles - i e � 12� ' 4'�V t , a _ '. t ' = # "
(,. i,. 3f { t... >, .UI'�:` tit � fi,
1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
D New construction 0 Addition /alteration /replacement ❑ Other:
r," �' A W1OB SITE w $ COMMERCIAL VAI UATI J
Job address: 106 ga 5tv I 4-_.t` indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: Block: Subdivision: *S. :e checklist for important application information and
Project name: `80y - per{ 5 - Ccx)1L jurisdiction's fee schedule for residential permit fec.
'- & T'AMffY DVIr� .LLI1�16
City /county: j �qcz �C� 1 ZIP: C(7 a��- 2
JJ AA COA714ERICALIINDUSTRIAL ,QUIPMENTSCHERULE
Description and location of work on premises: �
1 /1Siz - « Pt kt/ v\�- Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: H 'dAC:
Ai handling unit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No Ai- conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
' ' M CT
TRAOR Wit`' Bciler /compressors
�'` State boiler permit no.:
HP Tons BTU /H
—
Fire /smoke dampers /duct smoke detectors
c:17Da. Ile at pump (site plan required)
Install/replace furnace /burner ism BTU /H C `
Including ductwork/vent liner'�Yes CI No 1 I.`.•� ' T
CCB ' InstalUreplace /relocate heaters — suspended,
Ci • lic. no.: • wc.11, or floor mounted
Name (please print): • tu_.
Vent for appliance other than furnace
,.`' ` ' COP aA CI ; P ERSO N Refrigeration:
Absorption units BTU /H
Name: Chillers HP
-- Compressors HP
Address:
Environmental exhaust and ventilation:
City: 1 State: 'ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
s err , t, r nfi r , % = 1 r:. Hoods, Type I/ II /res. kitchen /hazmat -
°' - hood fire suppression system
Name: ( t • Exhaust fan with single duct (bath fans)
Mailing address: U IU55...2-- - '").) Exhaust system apart from heating or AC
Fuel piping and distribution (tip to 4 outlets)
City:11' ` • ca I State: OR I ZIP: 9 4
'Type: LPG NG Oil
Phone:r --o _ '_.,`, I Fax: E -mail: Fuel piping each additional over 4 outlets
't" " * gs `. c LNGI R ? ` ' rocess piping (schematic required)
Number of outlets
Name:
Ocher listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert — type
Phone: I Fax: I E -mail: WDodstove /pellet stove 1
Other, 1
Applicant's signature: L l U� Date: 03 — ri{'� Other: _ - 1
Name (print): Avyi..3 t't t --fr I l .
JJ Permit fee $ 1-4' C_
Not all jurisdictions accept credit cards. please call jurisdiction for more infortnatinn.
Notice: This permit application Minimum fee $ — 0..50
D Visa ❑ MasterCard
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 day> after it has been
State surcharge (8 %) .... $ •''
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 715.0
I
Cardholder signature Amount 440 -4617 (6 /(10 /COM)
CITY OF TIGA RD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION . - Business Line: (503) 639 -4171 MST
2 /I / BUP A.
Received` / 11 ` Date Requested .3//6/ AM PM B
Location _40 57 2 - / t Suite MEC � �--- `` _
Contact Person Ph (S03) z n L -- PLM
Contractor Ph ( ) SWR
BUILDING Tena Owne ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam PM
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ( ;) %C ,. ,3
Framing : ( !✓t2 r.tc� /�.a.
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post•& Beam
Rough-In
Gas a Line
�� r �Da mpers
4 PART FAIL
E CTR ICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE -% 0 Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk ®at® Inspector - Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL