Permit CITY TIGARD MECHANICAL PERMIT
I , DEVELOPMENT SERVICES PERMIT #: MEC2004 -00384
G � JI ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/18/2004
PARCEL: 2S111 DD -09000
SITE ADDRESS: 15877 SW 87TH AVE
SUBDIVISION: CHESSMAN DOWNS ZONING: R -7
BLOCK: LOT: 016 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: 1 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: Install furnace and a/c
Owner: FEES
MICHAEL COUGHELL Description Date Amount
15877 SW 87TH AVE [TAX] 8% State Surcharl 6/18/200 $5.80
TIGARD, OR 97224 [MECH] Permit Fee 6/18/200 $72.50
Phone: 503 684 - 3954 Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 1441 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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -
Issue By: )\-_,.A... :to Permittee Signature , j�!>/I� �'i,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next • u iness day
FR O: M :JacobsHe ating . FAX N0. Jun. 16 2004 07 :52AM P2
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C "` ° : gi b ' j ga d' RECEIVED i1,w1y_ Permit _ _ - -
131 Or Hall Blvd. Plan Review Other
Tiger' Oregon 97223 11 I ' 1 1 200 - Y: , Penult No.:
Phone: 503 -639 -4171 Fax 503-598-1960 Post Land Use
Case No.:
Interact t+ww.ci.tigsrd.or.ua
10 ,,i q Cdiitact � " ' =' See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 ` s 1� - Name/Mathod: _ /G Supplemental Information.
•
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Ea � n i construction ± " /'�! Demolition ° 1k l Machatti �+ ! . -
,Ir. ?t YF'; 61 I. +:.9.. rt�)A'L G >�„ liff'; .•C� �1ri- '!' K.�K vtl 1 .1,... r H... eiI,.1... Zi,_.ii. 1i:L wia„�.. �., ,i R+ tr' 1
,■ New const� per mit fees arc based on the total value of the work
Addition/alter'ation/re.lacement I. Other: performed. Indicate the value (rounded to the nearest dollar) of all
P■ � • 4 t,; 1l L r �i I alr, trl �l!� q.f1'
i o + , mechanical materials, equipment, labor, overhead and profit.
n 2-Famil dwellin: 11 CommclallI � ;n ndustrial
r to • dusVi I Value: $ Sec Page 2 for Fee Schedule
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er
�. p�li`+ilpl "'� t� 0° 17� inii 1i * t 1v0E1 , r 1 II , { r l° iIr�U �1. 1
I■ Access° Buildin I■ Multi - Family i >.,..� i .,.., ,.._ . l.. r.... � _ f�..1�� 4 ..,- i...:a..
I. Desert tiers t
r l U ;i'4 1 n' C6'oi tl +j�
■ Master Builder ,} O �, am
N +. j r, .i ;` o t.'•i 'A: ,14 �.3+ -1 '�, ;�Ia 163 ..}.ai !'1 � n Furnace - add -on air conditio s• �� 14.00
Job site address: . 'L1 Gas heat pump 14
J
Suite #: : + 1 g. /Apt. #: Duct work 14 -00
H dronic hot waters Item O 14.00
Pro'ect Name: !_a. Residential boiler
Cross street/Directions t,. job site; for radiator or h ironic s tern 14.00
Unit heaters (fuel, not electric)
in wall in -duct sus .ended etc. 14.00
above Flue/vent for an of 10.00
Subdivision: ` � L ol # 0 heri, ueli `� , j I!�
Tax ma. /. arcel # Water heater 10.00 N
1' r.' t i0l "/ 1, :i i . +,u. gihri.�l azi. °jai., is l! lillMiaaBIE Gas fire. lace ME1111:
Flue vent water heater /;as fi . r lace I
Lo. li 1 ter .as 10.00
IIIIIIiik .1 , P � - Wood/Pellet stove 10.00 WM
Wood fireplacchnsen 11°0:00 11
Chimne /liner /flue/vent
g r
[i5+ ;I 4 '.:ii ". ',..bl.il,'! .' ^ " 1:L,!11: Y 1,I'Z'jrC,f l :1 + ,. 0,Kiiiiiil 'IRA Other: i0.00
Name: W�� r. if ' ' "i d i .. i.:s t' ' i'i7" �1 t
• ' ,� + +. Ran hood /other kitchen equipment _ 10.00
Address: �r4b► ll Clothes d ryer ex 10.00
ENEriE 1 r Single duct exhaust
Ps. e: , • -- ! ' 11 (bathrooms, toilet compartments,
ii:; x!1'11 .,:,t t . iLifi t rrllii I E1t, I 1 .h(i1),! .!>h,l!illIl',I' d io >li's II P. r; Willa utilit rooms 6.80
rName: , L y / Qc' Attic/crawl s.ace fans 10.00 -
Other: ■ 10.00
Address: 1 4 •
c 1 for first 4 $1.00 each additions!
Phone: F Gas � �
E-mail: . Wall/sus • ended/unit heatc
ffil
g > J ii ! 21 , . ,, . +n, i ?...l a + L 1 • i +.rf ai i4 4+ 41!, 5,1 c I rl " tl i�lllilift
I�b .c # > i.J��k�i } �! , �: fi ar >� .,, ' � �d / � � q _ v�� Water heater
Business Name: C• /, O r MMIM1.11 Fireplace
Address: ` -I 5`r vim' `0 K. e BB ° E **
Cit /State /Zi • : } l iZ.® .: _ Clothes d r • as
Phone:' Fax: i 4 1 z : Other: _ MINIM
CCB Lie. #: L. ∎-• M Mcclip
� --Total:
Authorized r .' - Subtotal: ..
Signature;
. a e: Minimum Permit Fee $72.50
I I 1 Plan Review Fee 25% of Permit Fee ■ MP
Via, • � 1 ' - 1 " ^ State Surcharge (8% of Permit Fee
(Please print name) _ TOTAL PERMIT FEE ingerinliti
Notice; This permit application expires if a permit is not obtained within *Pee methodology set by Tri- County Building Industry : e cm c • ard.
180 days after It has been accepted as complete. "Site plan required for exterior A/C units.
i:\Dsts\Pennit Porms\MocPormitApp.doc 01/03 cs
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FROM :JacobsHeating FAX N0. Jun. 16 2004 07:53AM P3
RECEIVE.,.
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IGARD
BUILDIP DIVISION
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503 - 23d - 733/
MX 503- 23'/ 6652_
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503)..639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested — f ( e AM PM BUP
Location /5 d-v\- I` Suite MEC g()U 1- { - On3g`f
Contact Person =P Ph ( ) 6 8 4 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Fog Drain Access: ac,e2N,+•�'1 a'')
ELR
Crawl Drain
Slab Inspection Notes: : SIT
1/44 Post & Beam lQ Y
Shear Anchors
2C a. Q 6 5 r
Ext Sheath/Shear v1 �2
Int Sheath/Shear
Framing
Insulation
Drywall Nailing /
Firewall l\1 Ac
Fire Sprinkler I
Fire Alarm ,4'2 V/'
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 PART FAIL
MECHANICAL
Post & Beam t ZZp/
Rough -In
Gas Line
Smoke Dampers
PART FAIL
- 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 J Please call for reinspection RE: r Unable to inspect — no access
Fire Supply Line
ADA '
Approach/Sidewalk Date r7 Inspector , Ext
Other:
Final DO NOT REMOVE this inspection record fr the job site.
PASS PART FAIL