Permit A t, '7'. CIT Y OF TIGARD MECHANICAL PERMIT
, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00650
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/2004
PARCEL: 1S136CB-08800
SITE ADDRESS: 11084 SW 81ST AVE
SUBDIVISION: HERB + PEGGY'S PLACE ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: OTR 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: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas insert and gas line.
Owner: FEES
DEES, DANIEL L SHIRLEY M Description Date Amount
11084 SW 81ST [MECH] Permit Fee 9/29/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 9/29/200 $5.80
Phone: Total $78.30
Contractor:
T & K MECHANICAL
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 121165 Final Inspection
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 -0 : - : h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) -6699.
Is ued By: ` � �`� // Permittee Sign. � � + -
Cali 51 . • 39 -4175 by 7:00 P.M. for inspections needed the next business day
FROM : HOTSPOT FIREPLACE PHONE NO. : 15036269138 Sep. 28 2004 12:13PM P1
Mechanical Permit Application
Date 9 R� Permit I
y � ' - City g FIVE ��._ dy ��� —��
City of
.
' �'E City of Tigard and R 9 I • ojecUappl,no.: Expire date:
Tigard Address: 13125 SW Hall Blvd, Tigard, (�R X37223 -
-- Phone: (503) 639 -4171 Date issued: dew Receipt no.:
Fax: (503) 598 -1960 SEP 28 2004 Case file no.:
Payment type;
Land use approval: CITY OF TIGARD Building permit no.:
- ...... 11G r -- 0
TYPE OF PERMIT
X I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction Addition/alteration/replacement 0 Other:
4.
.1OII SITE INFORMATION, COMMERCIAL VALUATION SCHEDULE
Job address: / JOIN < ( ) gl_, 4 indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $
Lot: !Block: I Subdivision: *Sec checklist for important application information and
Project nUM: _ -- jurisdiction's fcc schedule for residential permit fee.
City /county: C« . ZIP; a, , .. 1 & 2 FAi' LILY DWELLING PERMIT .FEE SCHEDULE
Dc. ri • - •p and location of work on promis AND C'OMNIE:RICA Lit NI) CS* i ui.X1.1 ? ENT NTSCI1LDITT,E
Alit . • ' • • t i .Pi,-- Fee(ea.) Total
;.t. date of completion/inspection: Deseri , ' on Qty. Res. only Res.only
Tenant improvement or change of use:
Air unit _ CFM
. Is existing space heated or conditioned? 0 Yes U No handling
II
tr V011 mooing site an requi
•
Is existing space insulated? O Yes U No `
MECHANICAL CONTRACTOR :01 er/compressors
Business name: 1,j M ■ Hp Tons BTU/H
. Address: I I 5d,. . ,SC.J (6t `4 n v\ FireIstnoice damper duct smoke detectors mummegiim
City: ' : se P V , 0 St :Q,i ZIP: • • eat pump site p an rcqul + =MIN
�/ E -mail: nets rep ace urnac •urner ■ --
Phone: �� fp ��! i. i including ductwork/vent liner LI Yes 0 No
CCB no.: ,.
City /metro lie. no.: walla 1 rep no re grate aters— suspcn• ■ --
i - — wall, or floor mounted
Name(piease,print): j. = NM'
Absorption units BTU/H .
Name: t l
Q —INOMii
Address: .v.,., " ! , l - .: � ��
�
�•
Cit ! �Q i1�'t� Statc:(� ZIP: � 7c�C�` � •
Phone: ,,,. , — , _ Fax: ,.. , '" 2• E -mail: I
OWNER Hoods, Type U 11/res. kitchc hazmat k. hood fire suppression system
�M 4 Exhaust fan with single duct (bath fans)
Mailing address: . N • s . 1 1 1 * aust system a . art from e l fi n , or • C
13=21 ZIP: � T p p ■ g an Lam nb on to out �
Plone:
eil.VIV E - mail: uc r t . in • car a. ditlonal over 4 outlets ..........
ENGINEER ' eocessp p 1, g(schematic required) (♦■111.11Min.
Number of outlets
Other listed appliance or equipment:
Address:
t' Decorativefireplace
EZIIIMIgIVA State: f IP: ■____ , . et !e ,ll' •_�'�i►f/ ,I,
Phone: -- r�?'L / —C3�" "00 ■ III
• Applicant's signs A 21/I a,M mil L'] —�
Name (print). i .� . V/ J EN
' Not al ittfiedktioaa accept credit c • , please call jurisdiction for mote information Permit fee • $ T
❑Visa OMastetCarti Notice: This perm • 'J�J 'Cg)
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%) ..:. $ 0
None of cardholder as shown on credit card accepted as complete.
TOTAL r $ -4
$
cardholder signature Amount -, 44/14611(6A00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -41
INSPECTION DIVISION Business Line: 4503) �7 MST
` BUP
Received Date Requested /°' J // AM PM BUP
Location / / () g ! g/ 4,t Suite 410 ,, O, y - '9c6 ,
Contact Person Ph ( ) PLM
Contractor Ph ( ) 3 S 7 - 1 -7 / � / V SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation -
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: , _ SIT
Post & Beam p 4 ; : : x 4 _c .e. — ��9—e
Shear Anchors , _a -
Ext Sheath/Shear 6.,—...,,.._ 444 �,' ! Int Sheath/Shear d� t�•Framing
Insulation TP s ? 2-3 1 7 2
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
I ( Final '
a
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
rf
Water Service
Sanitary Sewer
Rain. Drains I
Catch Basin / Manhole .
Storm Drain -
Shower Pan
Other:
Final
PASS 1:1,98T FAIL
MCH,4L
Post & Beam
'.a •.:
Smoke tampers
m : !i
PART FAIL
Air TR 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: 0 Unable to inspect — no access
Fire Supply Line �/ ,
ADA Date 1 O A ` a Inspector \�' V U
Approach /Sidewalk
P Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL