Permit C TY TIGARD MECHANICAL PERMIT
)* DEVELOPMENT SERVICES PERMIT #: MEC2004 -00067
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/04
PARCEL: 2S1 11 CC -22700
SITE ADDRESS: 10390 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R -12
BLOCK: LOT: 285 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace gas furnace and vent.
Owner: FEES
DARBY, EVERETT J AND NANCY A Description Date Amount
10390 SW GREENLEAF TERRACE [MECH] Permit Fee 2/18/04 $72.50
TIGARD, OR 97224 [TAX] 8% State 2/18/04 $5.80
Total $78.30
Phone:
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 284 - 2173 Final Inspection
Reg #: LIC 222
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. 7 rn
• Issued By: 2 i� , ' / Permittee Signature: "A/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received / � ,,{yam Mechanical
V ED
Date/By: 01/7/09 yE ' . Permit No.+�EC Z 007 U X000 6 7
City of Tigard RE CEI Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 11 CC 2004 Date./By: Permit No.:
Phone: 503- 639 -4171 Fax: 5 (A 8 -T960 Post - Review Land Use
%O Date/By: Case No.:
Internet: www.ci.tigard.or.us Y of T% P ( A - 1I
: r i , � - 6 1 Contact .110s.: ® See Page 2 for
24 - hour Inspection Request: >gl)i Name/Method: / /(S Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
0 New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
I J Addition/alteration/replacement 0 Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
1i & 2- Family dwelling 0 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
0 Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description 1 Qty 1 Fee(ea.) 1 Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** - 1 , 14.00 j L ob
Job site address: / n"3‘-) 0 5/4) C- Jf J,Y1LLfA.F reete4 . Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
Project Name: J iDC�,t21;�c�1 Hydronic hot water system 14.00
J Residential boiler
Cross street/Directions to job site. (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 1 10.00 1 o . 4/7
Subdivision: 1 Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
___I')5 f - l_ I I (5 / F Flue vent (water heater /gas fireplace) 10.00
tLSJ I I plc 71 Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
•PROPERTY OWNER • 1 0 TENANT Other: _ 10.00
Environmental Exhaust & Ventilation
Name: ;TCE-DCA.4abLi Range hood/other kitchen equipment 10.00
Address: 1 C? ' (J , 5 1N C9. 0442_0_6_F T�(c
J Clothes dryer exhaust 10.00
City /State /Zip: T/ G( d I) (Z- �I 7 Z Z
Single duct exhaust
Phone: (00,0 - 3() 1t2 / 6 Fax: (bathrooms, toilet compartments,
❑ APPLICANT 0 CONTACT PERSON utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: 1 Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTOR Water heater **
Business Name: 4AA y—( a-{ i rig i (/ C) / (-7,f G Fireplace **
Address: ;? J Range **
/,' /1 /E I' **
City /State /Zip: PQ�e t 1 a�rr j tt) . ` Z Clothes dryer (gas) **
Phone: .._S;c-J —2173 Fax: -2/ -1551 Other: **
CCB Lic. #: 2;77 Total:
Authorized Mechanical s*
/> "fr / 4 D ate: a / / 2 J Subtotal Fee $ �, (/D
Signature;, g4/1/1 (� ���Q/j/L( Minimum Permit Fee $72.50 $ -7, , 5 0
i
S in Via_ W {C) Plan Review Fee (25% of Permit Fee) $
(Please print na State Surcharge (8% of Permit Fee) $ 5, $ 0
TOTAL PERMIT FEE $ -7 ' ', 30
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received /426 14 Date Requested 3 - Z3 -0541 PM BUP
Location /D3 99 % Suite
Contact Person ,Z1 i ' . 40 6 ) -2—/ 21 ?3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access•,.
Ftg Drain f- ELR
Crawl Drain ��/ 7::;)
Slab Inspe 10'n Note : SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final , /
PASS PART FAIL
PLUMBING / f /
Post & Beam 0f <
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 Line
S • .. - Dampers
Fi ,
- M: PART FAIL
CTRICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach /Sidewalk Date v v ( Inspector � Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL