Permit is
I. CITY OF TIGARD
MECHANICAL PERMIT
r6, DEVELOPMENT SERVICES PERMIT #: MEC2002 -00447
`" 4 !I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/11/02
PARCEL: 1 S 125DA -07501
SITE ADDRESS: 09335 SW 69TH AVE
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT: 062 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install furnace and duct work.
Owner: FEES
PACHECO, LINDA M Description Date Amount
9335 SW 69TH AVE [TAX] 8% StateTax 10/11/02 $5.80
PORTLAND, OR 97223 [TAX] 8% StateTax 10/11/02 $0.00
[MECH] Permit Fee 10/11/02 $72.50
Phone: [MECH] Permit Fee 10/11/02 $0.00
Contractor: Total $78.30
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 234 - 7331 Heating Unt Insp
Final Inspection
Reg #: 1441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: _&41 Permittee Signature: ( )-) a 03.
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busine day
Oct -07 -02 04 :07P P.02
;,l
• wet.' _ - �. -.
Mechanical Per Appl
A Date received: l 0 I I Z Pcnnit no, , % ) -OD 1 / 7
,41h City of Tigard Project/appl.no.: Expire date:
Ci ofTi and Address: 13125 SW Hall Blvd, Tigard,_ OR_ 97223 , �
h' [` Y l Date i ssued: By ;`$f) Receipt nn.;
Phone: (503) 639 -4171 •) ,�,
Fax: (503) 598 - 1960 � Case filc no.; Payment type:
Land use approval: T - 7 2002 Building pennit nu.:
2 family dwelling or accessory 0 tryetWftgtriali� 0 Multi - family U Tenant improvement
0 New construction 0 ►c dit ✓a Iteration /replacement U Other.
JOB SITE INFORMATION COMNIEJ1CIAI. VALUATION SCHEDULE
Job address: q ,53c- , ' k,„Q \'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 loI /account net.: profit Value $ ,
Lot: Block: Subd m
tviSion: *See checklist for important application in and
Project name: (1CO jurisdiction's fee schedule for residential ' e it fee.
pent'
City /county: • • CJ _ I ZIP: -C1 j ^ 1 S - 2 fAhI1LV DWELLING PERM FEE 'SCHEDULE • --
Descript and location of work on premises: AND COMM ERICAUIN01ISTRIAL EQL'IPM ENT SCIIEUL1,E
"n Fee (ea.) Total
Est. date Of completion/inspection: Description Qty. Res.only Res.only
'Tenant improvement or change of use:
Air handling Air ha unit C.hM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVA system
ME('l IAN l('A1 ('ONTRArl Olt Boiler /compressors
Business name: Cie S }�Q Q4 ,,. State boiler permit no.:
HP Tons BTU/II
Address: " " ) " L . V ' . \ �L v Fire /smokedampers/duet smoke detectors '
City: 'f+ � S • 63. 12IP01 1 ea�1 t pump One plan required) _
Phone: - , Fax: i ! 1 E -mail: Install/replaceftunacc/burner . BTU/11 l
Includingductwurk/vent lineres 0 No
:�
CCB no.: Install/replace/relocate heaters - sus pended,
City /metro lie. no.: . �( wall, or floor mounted
Name (please print). J • .. A CC • ■ dry, Vent for appliance other than furnace
CC/NI 1'LltSON $efrrgex roe: • -
Absorption units li'l't /H
Name: Chillers HP `
Compressors HP
Address: IEnvironmeutal exhaust and ventilation:
City: T State: 1 -LIP: Appliance vent _
Phone: Fax: E -mail: rycrex aunt
Hoods, Type U IUt s. kitchen/haztnat
hood fire suppression system
Name: . 0 C.) Exhaust fan with single duct (bath fans)
Mailing address' f, ti .. 1 4 t Exhaust stem span from heating oT AC:
Cit ZIP: 2 " Fuel piptag and distribution (up to 4 outlet,)'
Y `� I C� Emig: 1 �o � Type: LPG NO oil
Phone 0 If 1 L Fax: E -mail: I •ucl piping each additional over 4 outlets
ENGINEER Process piping (schematic require <t)
Name: Number of outlets -
Other listed appliance or equipment:
Address: Decorative fireplace
_('!tyT _ State: ZIP: _ lnscrt -type --
Phone: • Fax: E -mail: _, Woodstove/pelletstove
�r r.
• Applicant's si: nn: r. A i a ► • Other: '
Name (print): . 1�jtivAiti�i�•sr
NN dl jurisdictions atop credit cards, pease Call jutietSetiOn for mom loofa m�aiva Permit fee $ J � #2A.' 50
ovsa t7 MasterCard Not This permit application Minimum fee $
Credit card number: expires if a permit is not obtained Plan review (at _ %) $
expires within 180 days after it has been State surcharge (8%) ,.,• $
Name of eardaotdec as Moan on clam cad accepted as complete.
S TOTAL $
' ._._ `a`.,.pi,:.r.<ar sip7tvme " Amount , t
oS C) L° ° 440-46l7 (6410X:0114
CITY Of TIGARD 24 -Hour ,
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2 / AM PM BUP
Location d / 3 3,C 4-u-41-- Suite MEC ' 447
Contact Person Ph ( ) 't 0f PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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 l�Y /�/c= r C L � c�2[ ('A Grit z A.40 , C_
Insulation ,
Drywall Nailing - G, 7 c)/ NC=
Firewall C A.X)7) G g 6�
Fire Sprinkler
Fire Alarm \ 4 �--
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
Pecs PART - AIL
�- I�IIF HANIC3
Post & Beam
Rough -In
Gas Line
Smoke Da • ers
•
*ASS PART FAIL
ELECTRICAL
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 .2 - L / D 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL