Permit C ITY OF TIGARD MECHANICAL PERMIT
j DEVELOPMENT SERVICES PERMIT #: MEC2003 -00701
1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/9/03
PARCEL: 2S111 DB -12500
SITE ADDRESS: 15285 SW 94TH AVE
SUBDIVISION: SUMMERFIELD NO.12 ZONING: R -7
BLOCK: LOT: 652 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
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: Install furnace and other appliance vent.
Owner: FEES
CAMILLE THOMPSON Description Date Amount
15285 SW 94TH
TIGARD, OR 97224 [MECH] Permit Fee 12/9/03 $72.50
[TAX] 8% State Surchar€ 12/9/03 $5.80
Phone: 503- 620 -4741 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503-453-4822 Mechanical Insp
Final Inspection
Reg #: LIC 62196
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: Qom/ , ,G / }-770
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Dec 08 03 11:45a climate control 503 968 7224 p.
r
Mechanical Permit Application OFFICE USE ONLY
1 City of Tigard Date received:/c2 9 d3
A
Permit no.:/t( i 03 -, • 70/
City of Tigard n : Project/appl. no.: Expire date:
Address: 13125,S.W Half B'1vd,�Tigard, OR 97223
Phone (5 ) 63. �4.171N 167' ` Date issued: By. t j u A
Fax: ( 50 3 ') 598 -1960 Y• �� Receipt no.:
: i Payment type:
o'� Case file no.
� r
Land use 2
Building permit no.:
tr �T
TYPE OF PERI IT
• 1 & 2 family dwellings e s
y D Commercial /industrial il
New construction 0 Addition /alteration /replacement D Multi-family
0 Other: D Tenant improvement
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
J6b address: (rj2�j g W •
g ,
Bldg. no.: Indicate equipment quantities in boxes below. Indicate the dollar
Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.:
prat. Value $
Lot: Block: Subdivision: # '
Project name: See checklist for important application information and
See - Thove,115
c-A,-Q Jurisdiction's fee schedule for residential permit fee.
City/county:- �,��
ZIP: c7 ?any. I ,' 2FAMILy DWELLING PERMIT FEE SCHEDULE
Description and lo anon of work on premises: 1I
'Stz�E f •c'i,,.v vk r
I vl A ND COA1A41 RiCAL /INDUSTRIAL EQi1IP1lIENTSCHEDULE
Est. date of completion /inspection: 1 . - - 'S -03 Fee (ea.) Total
Tenant improvement or change of use: Description Qty. Res, only Res. only
H VAC:
Is existing space healed or conditioned? 0 Yes ❑ No Air handling unit CFM
Is existing space insulated? 0 Yes 0 No Air conditioning (site plan required)
MECHANICAL CONTRACTOR Alteration of existing HVAC system -=
Boiler /com pressors
Business name: c I irvla,� fi �' State boiler permit no.:
Address: 1.(.0t500 Stv `J�vtcJ� � HP Tons BTU /H ■
Fob - •te ZIP, �7a Fire /smoke dampers /duct smoke detectors
City:
City: Spa t.(53- `fsoa eat pump (site plan required) --
- Fax: 'R - � . Install /replace furnace/burner • BTU /H
CCB no.: t - 0 � 19. Includ;ng ductwork/vont liner '74 Yes CI No + IL. c I °O
City/metro tic. no.: I LI l` Install / rep ace /relocate heaters - suspended,
Name (please print): !l✓ ✓1 L (�y wall, or floor mounted
t Vent thr appliance other than furnace
CONTACT PERSON Refrigeration: to-
Absorption units BTU /H
Address: Chil HP
Compressors HP
City: Environmental exhaust and ventilation:
State:
116111
Phone: Appliance vent I=
Fax: E -mail:
Dryer exhaust
• OWNER ' Hoods, Type 1/ II /res. kitchen /hazmat
Name: C� i (� TV-10 t'1t 5 hood fire suppression system
Mailing address: It j Z Exhaust fan with single duct (bath fans) •
S S� 9`0 - t- - 1 Exhaust system apart from heating or AC
City: - 7 - -, ��� State:0 (Z ZIP: 9 '7 a.a. Fuel piping and distribution (up to 4 outlets)
Phone: 5o� �1y Fax: E -mail: Type: _ LPG NG Oil
ENGINEER Fuel piping sac additional over 4 outlets
Proeess -
piping (schematic required)
Name: Number of outlets
Address: Other isted appliance or equipment:
City: Decorative fireplace
State: ZIP: losers - type
Phone: Fax: E-mail: Woodstove/pellet stove
Applicant's signature: cQ Other: '
Name (print): , � � � i �"`" Date: I �- 75--0-3 Other:
61 l' I
Not all jurisdictions accept credit cards. please call jurisdiction for more information.
0 Visa Q MasterCard Notice: This Permit um fee
fee $ a(] .
permit application Minim
Credit card number: / expires if a permit is not obtained $ a- 'S
Expires within 180 days after it has been Plan review (at %) $
Name of cardholder as shown on credit card State surcharge (8 %) .... $ _
5. -6-0
accepted as complete.
Cardholder signatuee $ TOTAL $ - 713 . 3c)
Amount
440-4517 WOO /COM)
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (6D$)'639 -4171 MST
'j G Ar
BUP
Received / qi_� Date Requested b AM PM BUP
Location Suite 3 O r
Contact Person /) 'ie . �/ _ / Ph (_T ( 7S - 3 �P22PLM
Contractor l L(,r�_ � -(7 ' l/t - '1- ---e- Ph ( ) SWR
BUILDING Ten t/Own er ) a-444-4-62-e ELC N Gtk\-fi'
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam (;)/= A ' �1�t c --*
Shear Anchors j /Ow1
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing -
Fi rewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam f
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
J J
Smoke Dampers D CC- < n') v�.,�
F a
__ FAIL
Service
Rough -In
UG /Slab
Low Voltage (L-C
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: 111 Unable to inspect — no access
Fire Supply Line
ADA
v
Approach /Sidewalk Date v v Inspector ‘e■ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job ite.
PASS PART FAIL