Permit CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00090
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/3/04
PARCEL: 1 S•136CB -01800
SITE ADDRESS: 11215 SW 82ND AVE
SUBDIVISION: RANCH VALLEY ZONING: R -4.5
BLOCK: LOT: 014 JURISDICTION: • TIG
CLASS OF WORK: ALT FLOOR FURN: • EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: • VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
• 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: Replace gas furnace
Owner: FEES -
DAVIS, DWIGHT J DONIS L Description Date Amount
11215 SW 82ND AVE
TIGARD, OR 97223 - [MECH] Permit Fee 3/3/04 $72.50
[TAX] 8% State Surchaq 3/3/04 . $5.80
Phone: 503 - 639 - 5896
Total $78.30
Contractor: .
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR .
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 557 - 2220 Final Inspection
Reg #: LIC 72623
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: Permittee Signature: A
Call (503 639 -4175 by 7:00 P.M. for inspections needed the next b siness day
•
Mar 02 04 01:46p • p.
Mechanical Permit Allttnn FOR OFFICE USE ONLY
City of Tigard EIVEDA Datc/B�iiL Pembt jaO - OD o'
13125 SW Hall Blvd., Tigard, OR 97223 pl .. ,
Phone: 503.639.4171 Fax: 503.598.1960 ) ) O l ,Gnn'i� t4 :. Dazc/By: Other Permit:
Inspection Line: 503.639.4175 MAR G (- �1 -•� . Daze Ready/By: 1 MZ , ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY O�
T I WO(�RK V I S I O N COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction II Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '
[3] 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist. .
❑ Multi- family - ❑ Master builder ❑ Other: - Description I .Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
• Z, ' S t; v i d A A. . Air conditioning
fires s a ping or heat late
Job site address:
`5 (requites site plan showing placement) 14.00 ,
City/State/ZIP: Tj n,_ 7 .2-2:3 Furnace 100,000 BTU (duets/vents) / 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldgJapt. no.: Project name: Gas s heat pump • 14.00 •
Cross street/directions to job site: Ductwork 14.00 .
. Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
•
Unit heaters (fuel type, not electric), .
■
' in -wall, in -duct, suspended, etc. 10.00 -
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other. 10.00
Tax map/parcel no.: Other feel appliances
• DESCRIPTION OF WORK Water heater 10.00
— Gas fireplace 10.00
t S fr." � C� e S 1��41 cM .- . d ent for water heater or gas •
10.00
•
Log lighter (gas) 10.00
' Wood/pellet stove 10.00
•
Wood fireplace/insert 10.00
Chimney/liner/flue/vent f 10.00
❑ PROPERTY OWNER ❑TENANT
Other: 10.00 -
Name:
0,•,„
v, 5 4 , f - L ira a r 3 Environmental exhaust and ventilation
Address: Range hood/other kitchen
<
. ti ;^ .. equipment 1000
.
City /State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5 ) 631f - SAS 9 G Fax ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four, $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: • Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E- mail:, Range
CONTRACTOR Barbecue
1 . Clothes dryer (gas)
Business name: ( --� of .
Ti .- r . �: a......., / Z r + / CJ 1 Grill -� Other:
Address: / 3/ 5 s [ r /Gtd r. i Net s /C • i/ [ /t/ >/ - MECHANICAL PERMIT FEES"
City / State/ZIP: e, 1 Cs q 7P ' j i S Subtotal
_ _ Minimum permit fee ($72.50) / a ,,,so
Phone: ( ) 5 - 2o F (c,-0.3) 55 7 - 07 , 'f Plan review (25 %ofpermitfee)
CCB lie.: 9.2.-d 2, Z State surcharge (8% of permit fee) , �
y T OTAL PERMIT FEE - - I 3D
'/ This permit application expires Ira permit is not obtained within 180
Authorized signature:, ��•'� lL y - days after it bake been accepted as complete.
1 r . / 4, f �l�t 1 j /,' /G ' j I s e.....ww .�.,i........ s.... 7 r.: �......... n..:i,t:....1...t...�... c....:.. n ..a .
ev I S r
CITY OF TIGARD. 24 -Hour • _ •
BUILDING ' Inspection Line: (503) 39 -4175 P
INSPECTION DIVISION Business Line: (503) 639 -4171 MST •
22 BUP
Received3 /P 3 : S Z D ate Requested , 4/ 0 ? /O AM PM BUP
Location 2 -f Z � Suite MEC tD Q�
Contact Person 44.4.t-_c44A t ' Ph ( 5 5 � 2 2 ZONLM
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 e t- 4 6-Z, a !L . - a — 1'12
Insulation
Drywall Nailing 41110 Oz-/e4 C./ r 7/�'✓ A- '
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceili • g
Roof
Other:
Fin
f -- PART FAIL
• LUMBING
Post & Beam
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 .gampers
Final
S8 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: fl Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 3 9 _UC- Inspector Ext
Other:
Final DO NOT REMOVE this inspection. record from the Job site. .
PASS PART FAIL