Permit CITY TIGARD MECHANICAL PERMIT
, DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00118
,_f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/04
PARCEL: 2S111 DD -08700
SITE ADDRESS: 15815 SW 87TH AVE
SUBDIVISION: CHESSMAN DOWNS ZONING: R -
BLOCK: LOT: 013 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: Installation of new furnace
Owner: FEES
BROWN, DALE E + DENISE A Description Date Amount
15815 SW 87TH AVE [MECH] Permit Fee 3/16/04 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchaq 3/16/04 $5.80
Phone: Total $78.30
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503-234-7331 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
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 Not ratio. Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952-I: -0100. Yo may obtain copies of these rules or direct questions to OUNC by calling
(51. )246 -6699. .
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Iss ed By: ` Permittee Signature: J
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mar -15 -04 10:31A P.02
a , FOR OFFICE
US • O NL) '
l i ch ni a1 Permit A tion - Received Mechanical
G D a t e / B y : /S O 7 Permit No. :M 84.0./664 OD 11 g
Planning Art. vat Building
City of Tigard R� P Yernur No.:
13125 SW hall Blvd. Plan Review Other
Datc/��: Permit No.;
• Tigard, Oregon 97223 MA ^R 1 ` 004 AR °
Post-Review Land Usc ca
Phone: 503 -639 -4171 Fax: 5q �I � g� , , Datc/B Case No.:
Internet: www_ci.ti aTd.or -
g Ci VIS ,. v . 1 1 � � Y u : g Sce Pa e 2 for
� 1 ' Contact J r
24 - hour Inspection Request: S�fr0 - 4
t 175 W NarncJMethod: I I , Supplemental Information.
—
:; OF WORK ..
. TYPE :: '; •irPiCOMMFRCIAL FE�. tiSC1IEDUI F. �' /SE rilECKLIST
Q New construction Demolition Mechanical permit tees* arc based on the total value of the work
Q Addition /aiteratioti/rcpitteement ❑ Other: performer]. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead and profit.
'CAT EC0ItY OF CONSTRUCTION See Page 2 for Fee Schedule
V a l ue: U T
4 1 2-Family dwelling _[] -
' Commercial/industrial -- - -
:..RES 1sNT1AL EQUIPMENT /SYSTJ MS sE" SCHEDULE Accessory Building I . 1 Multi-Family •., ue?rrlptinn j Qty I F e(eaa Total
•e Tot
El Master 13ui ltner r] Other: - Hcatin Ceoli ..
....
JOIE SITE INFORMATION and LOCATION Furnace -add on air condition un�;•• — 14.00
Job site address: t ` ' CU e.- _ Gas heat pump 14.00
1 3id /A t # D uct work 14.00
Suite #: S . . P 14.00
LO ]hydronic hot water system _
Project Nam_ 6 c - Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system)_ -- 14.00 _.
Unit heaters (fuel, not electric)
on wall, in- duct, suspended, etc.) — 14.00
Flue/ven1for any of above) 10.00
Repair units 12,15
Subdivision: Lot Other Fuel Air liaeces• ;
Tax ma /.arccl #: Water heater 10.00
ra 4 .: ::lit : .�Y:" to. `SCRIPTiIONDF.WORI(C" ru'+4}1f1 " ' ?' ' Gas fireplace _ 10.00
Flue vent (water hcatcr /gas fireplace) mod
Log lighter (gas) 10,00
__.,..i �.. �' Wood/Pellet stove 10.00
_ , Wood fireplace/insert - 10.00
Chimney /liner /flue /vent _ _ 10.00
. _ 10.00
I►''!f nI'E `� ' 'C ElY 3 - r l • .. i, ^ >,r, ;� ; Other Environmental Eahaust &Ventilation' . ,
Name: l 4. • .. . Range hood /other kitchen equipment _ 10.00
Address: ��� ( ► _. Clothes dryer exhaust 10.00
City /State /Zip: '� ' . ; 0. - 1 ,2z .. .._ Single duct exhaust
P1 a e: o il O. 7 Fax: (bathrooms, toilet compartments,
utility room~ G.RU
V. PPI IC T • .: •' CONTACT PERSON .,. y ) 10.00
Attickrawl space fairs
Na J : r_ .c_ `�:: � l '�' <2,-_,.--V-. _ _ Other: 10.00
Address: (, 1 —t — Fue Piping ..
_ ll
Clty/St�lte/Zip: c. t ��:_:,` -'J v-, _••(55.40 for first 4, Sl 00 each additional), —
_ Furnace, etc,
Phone: ,
I Fax: Gas heat pump ••
-
E l- f • .... . _ ' •i
Qc
/ Wall/suspended/unil heater . "
'LF' "1'1�COIIITRAI';OR y;i;wr;i,"• :. _ . ,t <'i:i: .� Water heater . - _ _ ..
... :..;: ` .. sa
Business Name: c ;c 0 k0 Fire lace as
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`. \ , -� 1 -P - as
�F Ran c - - -
Address: 1 -1 , --1 .- L_ �`_ .. ` emu .-.,.• ,? 13B ••
City /State/Zip: 1_: -t Ic-i . 0,- . ( - i 1 .20 Clothes dryer(sds) _ ••
`i 1.23 i Fax: i3,`11 2 S - ' Other: " -
CCB Lie. #: I `) ` -L Mechaniaeal Permit Feet` _
Autheriz Subtotal: $ ��
Sigrtatur —75t.0.±(:)--1—
-- Minimum Permit Fee $72.50 $
�:v Plan Review Fee (25% of Permit Fee $ A
1 (Please print name) State Surcharge (8% of Permit Fee $
TOTAL PERMIT FEE 11131W1J
N otice: This permit application expires if • permit is not obtained within *Fee methodology set by Trl -County Building Industry Service hoard.
180 days after It has been accepted as complete. "Site plan required for exterior A/C units.
i :\Dsts\Permit Forms\MccPennitApp.doc 01/03 -.)--
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received _ 2 37 1" Date Requested ''` /5 i AM PM BUP
Location Suite M /1 A
Contact Person Ph (_ ) PLM
Contractor Ph ( ) (o 7/-0 Sri S SWR
BUILDING Tena • 1 - _ ELC
Footing ELC
Foundation Access:
Ftg Drain (3■ , \ ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall )S () � I 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
PART FAIL
L)
Post & Beam
Rough -In pp r
Gas Line ) ` � Z1V� � � .� \� jr n O ' 0 S 9
• = _ s ampers
Final
1 =- = PART FAIL
-
CTRICA
Service
Rough -In
UG/Slab
Low Voltage \
Fire Alarm
Ztab
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SIT El Please call for reinspection RE: r El Unable to inspect - no access
Fire Supply Line , \
ADA ry �^ Ins or .� + Ext
Approach/Sidewalk Date ) Inspector
Other:
Final DO NOT REMOVE this inspection ecord from he job site.
PASS PART FAIL
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