Permit _ —:
C ITY OF TIGARD MECHANICAL PERMIT
�1 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00604
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
PARCEL: 1 S125DB -01100
SITE ADDRESS: 09115 SW 70TH AVE
SUBDIVISION: SHADY DELL ZONING: R -4.5
BLOCK: LOT: 011 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:
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.
Owner: FEES
KEENEY, FRANCES G Description Date Amount
9115 SW 70TH [MECH] Permit Fee 10/16/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 10/16/03 $5.80
Phone: Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
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 -00
`v7 /' /6G
Issued By: / C�/ Permittee Signature: U 1 4 C�
all (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• FOR OFFICE USE ONLY
1Vlechanica�ermrt Application Received Mechanical
• Date/By: /0//q/C2.3 Permit No.NQ 2003 `4
Planning Aproval Building
City of Tigard G�1��D Date/By:
Permit No.:
13125 SW Hall Blvd. RE Plan Review Other
Tigard, Oregon 97223 Permit No.:
Phone: 503 -639 -4171 Fax: 503 MA-146u.- 2O� Post-Review Land Use
/h; � ; A,� ;F i , � Date/By: C No.:
w
Internet: ww.ci.tigard.or.us r •� � L Contact .: El See Page 2 for
24 -hour Inspection Request: 503- 6aj1ef T " S` i� ' "
Name/Method: / Supplemental Information.
TYPE OF WORK - .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 CONSTRUCTION materials, equipment, labor, overhead and profit.
• 1 & 2- Family dwelling 1:1 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
O Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE* SCHEDULE •
Description 1 Qty 1 Fee(ea.) 1 Total
❑ Master Builder 0 Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add - on air conditioning** ■ 14.00 (t-} .00
Job site address: °l l 15 S 1. 7 ^ i l Gas heat pump 14.00
1
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name:4_tn(`�zj.{?i¢�Y'� t -o- Hydronic hot water system 14.00
■ 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 ID • o O
Subdivision: I Lot #: Repair units 12.15 _
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
\ V\S *Li. GI (t. S C ��X� A Flue vent (water heater /gas fireplace) 10.00
�rJ�LS h I v �� Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
ROPERTY.OWNER • 1 0 TENANT Other: 10.00
Name: '��Cu.4�� iii Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: at \ S l.J - 1 bl'V1 `-e Clothes dryer exhaust 10.00
City /State /Zip: „ Act 15__ on 21- Single duct exhaust
Phone: a 44 -7i'. Fax: (bathrooms, toilet compartments,
0 APPLICANT. 0 CONTACT PERSON ' ` utility rooms) 6.80
Name: Attic/crawl space fans _ 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, 51.00 each additional)
F etc. ••
Phone: Fax:
Gas heat pump •*
E -mail: Wall/suspended/unit heater ••
CONTRACTOR Water heater •*
Business Name: i( - \-l-e ( c j `4 - l r Fireplace ••
Address: oZ ° \,l5 V "*LAC-- J Range ••
BBQ ••
City /State /Zip: (o-x--ti 0..1-.01 ITQ- Ck`l 2.,1 Z Clothes dryer (gas) •*
Phone :x5173 - a$1-1- ?Al 3 I Fax: -2 LA • 1V, 2 Other: *0
CCB Lic. #: 'L'LZ Total:
Mechanical Permit Fees*
Authorized $ Z+-1. i�17
Signature: 1 . &R. Date: t - D -0 ; Minimum Permit Fee $72.50 $ - 11 -c p
\ 1 ` C. \� � ( Plan Review Fee (25% of Permit Fee) $
V (Please print name) State Surcharge (8% of Permit Fee) $ - gO
TOTAL PERMIT FEE $ g .
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 :'DsislPermit 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 5 //6 r• Date Requested 3 1 ! S AM PM P 11/ BUP
Location 9//5 7' v - k4o Suite co 3 6 cL
Contact Person Ph ( 57 3) 2_,5 ?-3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - ELC
Footing d ELC
Foundation Access:
Ftg Drain • ELR
Crawl Drain
Slab Inspection Notes: / SIT
Post & Beam l72 ('».PSI
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
Post & Beam
Under Slab
Water Service
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
SS� s .'ampers
PART FAIL
CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 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 Da Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL