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Permit j . CITY OF TIGARD MECHANICAL PERMIT I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00424 eh( 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004 PARCEL: 1 S133AC -08800 SITE ADDRESS: 10915 SW 130TH AVE SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R -25 BLOCK: LOT: 006 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SFA 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: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Installation of a/c unit. Owner: FEES AUTUMN PARK TOWNHOMES, LLC Description Date Amount 9500 SW BARBUR BLVD., STE 220 [MECH] Permit Fee 6/29/200 $72.50 PORTLAND, OR 97219 [TAX] 8% State Surchari 6/29/200 $5.80 Phone: 503 892 - 8758 Total $78.30 Contractor: FORECAST HEATING & AC 17135 NE GLISAN ST. PORTLAND, OR 97230 REQUIRED INSPECTIONS Phone: 503 253 - 7020 Final Inspection Reg #: LIC 152194 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- -:••. . i / / I 1 -41 / 4 ssued By: 0_ ;" � i�..:; Permittee Signature; all (503) .39 -4175 by 7:00 P.M. for inspections needed the next business day • / • ; . FOR OFFICE USE ONLY - . Mechanical Permit Application Received Mechanical Date/By /9 o4 Permit No.: , (w Planning App .val Building ' City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960 , . I, r � Post - Review Land Use Date/By: Case No.: Internet: www.ci.tigard.or.us . L Contact J,44e: ® See Page 2 for •- a (J ' 24 -hour Inspection Request: 503- 639 -4175 -" �.. Name/Method: '' f iT Supplemental Information. TYPE OF WORK 7 . - .. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST . ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION - •° mechanical materials, equipment, labor, overhead and profit. ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE *SCHEDULE. • Description 1 Qty I Fee(ea.) l Total ❑ Master Builder ❑ Other: Heating/Cooling JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning** / 14.00 Job site address: /©91.5 .S h) /30*- nA LP Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: (44k/IC 13 � Hydronic hot water system 14.00 7 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 13 0 k Wig p R(D6[ - Unit heaters (fuel, not electric) 7' (in wall, in -duct, suspended, etc.) 14.00 Flue/vent (for any of above) 10.00 Subdivision: [- -Ap1 KS S Re units 12.15 EA ?P Lot #: (p Other Fuel Appliances Tax map /parcel #: Water heater 10.00 - • DESCRIPTION OF WORK Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 AM... - Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 Chimney/liner /flue/vent 10.00 R — u OPERTY OWNER I 0 TENANT - • Other: 10.00 ✓ L n �C$4910.1 � ct A igOC. Environmental Exhaust & Ventilation am F Range hood/other kitchen equipment 10.00 Address: 1-141 j(i) SEA DD9J$ R D. Clothes dryer exhaust 10.00 City /State /Zip: 0 OSa/EG'O OQ .c/705 Single duct exhaust Phone:c/7 /_ 237..0 o 7 r Fax: 77/•2$3 (bathrooms, toilet compartments, 0 APPLICANT .ONTACT PERSON utility rooms) 6.80 Name: B A J NI E Attic/crawl space fans 10.00 Other: Address: 4' 4a) S) NICADa&, �- s1j %TE400 Fuel Piping City /State /Zip: LAKE 0 5 W E Co , E,12 E,12 • R) 0 3J * *($5.40 for first 4. S1.00 each additional) F urnace, etc. ** Phone:s03 -8/0 - Q Fax: s03'!Z1-4 bs Gas heat pump ** E -mail: Wall /suspended/unit heater ** . CONTRACTOR Water heater ** Business Name: F'Ag'E6A51 -J 4-rioG Fireplace ** Address: '7 i 3 S N E G 1 /AN STi Range ** C BBQ City /State /Zip: QBgTu41, p a1'7Z30 Clothes dryer (gas) ** Phone:505- 251 -702o Fax:503 -Z52 -4593 Other: ** t S a 1 4 4 Total: CCB L,1C. #: Me chanical Permit Fees Authorized /q o � • Subtotal: $ Signature: ��' Date: U! Minimum Permit Fee $72.50 $ 7 `a, 50 j ep. VCE CO t•9'5 Plan Review Fee (25% of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ 5s IS 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 • • (sp'(C • A/C ( • I W ■A � 5' CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTIO 4 DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location / O /5 / . 3 Suite p MEC e; `f 7 c Contact Person V d `Ae� Ph ( ) O 4 o 7 PLM Contractor Ph( 7 // SWR BUILDING Tenant/Owner /TG-4/ kf (7 ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing j Firewall air �� Fire Sprinkler — _ Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING 4111" Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain -. Shower Pan OW . r Othe Final A � 1 MarirSign" PASS PART FAIL `y ' - MECHANICAL Pos & 13 am ou as ine Smoke Dampers PART FAIL " 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 E Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL