Permit A,,1 `CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00573
R � II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/24/2004
PARCEL: 1S135AA-02500
SITE ADDRESS: 10440 SW 87TH AVE
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT: 038 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:
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
LYON, DONALD J HAZEL J Description Date Amount
10440 SW 87TH AVE [MECH] Permit Fee 8/24/200 $72.50
PORTLAND, OR 97223 [TAX] 8% State Surcharl 8/24/200 $5.80
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503-624-2704 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
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: .,21 x�j J i P Permittee Signature: ,P Q _.
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Aug 23 04 01:09p PRM DRLBY 503 - 598 -0270 p.
RE C 'cation Mechanicti PLr mit 'App a FOR OFFICE USE ONLY
City of Tigard AUG 2 3 2004 Re _ Li ilig Permit No.\ �� _05,
ce ive.
1312 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 50 Other Permit:
6 " � Date/By: OF TIGARD .j I� ` D/B: feria: 1 GI See Page 2 for lrspcction Line: 503.639.4175 s " I Date ReaZyBy: 11 Supplemental Information Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method:
7iYP Q,>F WOR;)C - EE * ":SC — 'USE'.CHE'CKL[ST I
E ,.... .. . . " ; :.COMIVIERC� "'I+ I3EAUL• E
Mechanical permit fees" are based on the value of the work
❑ New construction Additiordalteration /replacement performed. Indicate the value (rounded to the nearest dollar) of alt
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,. _ Value S
i • OATEGORIi •OF,
RE%DEftIaL EQUIPViEE3T I SYSTEMS FEES* •
.
[}- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Ivlulti-family ❑ Master builder ❑ Other .
Description 1 Qty. I Ea I Total
7OB rSITE .INF'Ol 'Y - OhON 4D LOCATIO Heating/cooling
1
// 7 Air conditioning or heat pump
Job site address: /0 0 S L g 7 h' (requires site plan showing placement) 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) / f 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90 1
Suite/bldg./apt. no.: I Project name: ,
Gas heat pump 1 14A0
f Cross street/directions work 1 14 OC directions to job site: j 1
Hydronic hot water system 1 '' Ou {
Residential boiler (radiator or
1 hydronic) I4.00
Unit heaters (fuel -type, riot electric), I
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.: Other: 10.00 ,
Tax map /parcel no.: Other fuel appliances I
,ta.. t. , N r F heater i 1000
Water heate
•x z t, . < : . , pg PT OE .'Y 0° Y .. x.. :...�_ 2i: x
Gas fireplace
n /b L � efS ` � 4 � � Flue vent for water heater or gas 10.00
f G I 2/ fireplace
Log lighter (gas) 10.00 1
Wood /pellet stove 10.00 I
Wood fireplace /insert I I 10.00 1
i Chimney /linerifluelvent j 10.00 l
O PEN O t r •.. r ' N ..- iiI. T .... : 10.00
. , Y **k
K . } a r .,. 1 ` ! T t ` . Other
Name: "7119 — 2 / / vo"j Environmental exhaust and ventilation 1
Range hood /other kitchen
Address: / 19401t3 S4) 7 equipment 1 10.00
Clothes dryer exhaust 10.00 I
City/State/ZIP: i I) �t� Single -duct exhaust (bathrooms, I
6.80
/ Fa toilet compartments, utility rooms) j
Phone :<( ) 47 2 V(.../ 6 ( ) 10.00 1
cr , ` Attic /crawlspace fans J
:' # Q i tgo`I� 2: _ ` 1} ;�_.f . > y . .•.,nr 4�xC °P 40-i1..... `• �; i I. 10 I I
Other:
Business name: Fuel piping i
Contact name: ,• /O 1-f ■ O/)• /fj �/ $5.40 for first four; 51.00 for each additional
f Furnace, etc.
Address: I Gas heat pump 1 I
City/ State /ZIP: Wall /suspended /unit heater
Phone: ( ) 1 Fax: : (�p3) S ys , � 0 Water heater {
�� � (p a �/ fj , 7 Fireplace ` I • E-mail Range I .1 r +: ' . F CONTRACTOR a t?• '- ' .. "' • Barbecue
Clothes dryer (gas)
Business name: Gp 7 M b /q, GA - T7r M CP ` a /, — , Other
p 6 o) 3°.-Y ' :re MECHANICAL PERIVIIT.F,EES
Address:
Subtotal I I
City/State/ZIP: T R-4-1V Q/ --" 9 .,.1
Minimum permit fee ($72.50) 1.7.—,.3
Phone: 1) G a of �1O l Fax: (- .. S9 o a ?o Plan review (25% of permit fee)
CCB lie.: ✓ S { 9 i I State surcharge (8% of permit fee) l
I TOTAL PERMIT FEE I? 3' f;<
Authorized signature: Ge...••7'7'1/ This permit application expires if a permit is not obtaine within ISO
days after it has been accepted as complete.
I
Pr name: :41 /f4 C A ,4 I /6 f7 I Date: Si 4:310 c/ • Fee methodology set by Tri- County B uiloing :ndustry Service Board
4
:'•. vildingtP :rnvistMaC- PermaApp.dcc 122/03 440.4617T II 1 /02'COMVwEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line' (503) 639 -4175
4
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / , F AM PM BUP
Location / C7 Y4 --/o Suite / / ;?,00 573
T
Contact Person P �YVL - Ph ( ) a -a 7o y PLM
Contractor Ph ( ) SWR h p
BUILDING Tenant/Owner ELC 1 "r
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear "1,1?
Framing
Insulation M is C /S0 ; P•N 1 C,
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
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
PASS - •' FAIL
,�. t os :Beam R
Rough -In
Gas Line
Smoke Dampers
�• SS PART FAIL
EL TRICAL
Service
Rough -In
UG /Slab \ /
Low Voltage '.(�
Fire Alarm 1
40210
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE [I Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector _1 4/---(—.1 " - e
ct
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
/Id