Permit ` CITY OF TIGARD MECHANICAL PERMIT
.- , =� DEVELOPMENT SERVICES PERMIT #: MEC2000 -00216
a,. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/01/2000
PARCEL: 1S135DC-05200
SITE ADDRESS: 11830 SW 95TH AVE
SUBDIVISION: TANGELA ZONING: R -7
BLOCK: LOT: 007 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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace an existing gas furnace with like kind.
Owner: FEES
RUTHERFORD, JANET M TRUSTEE Type By Date Amount Receipt
BY ETHEL M STAN PRMT GEO 06/01/20C $50.00 0002615
11785 SW 95TH 5PCT GEO 06/01/20C $4.00 0002615
TIGARD, OR 97223
Total $54.00
Phone:
Contractor:
SPECIALITY HEATING + FABRICTN
9528 SW TIGARD
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt lnsp
Phone: 620 -5643 Final Inspection
Reg #: LIC 00066578
OR
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 -0080.
You may obtal copi - ' he - 'les or direct questions to OUNC by calling (503)246 -9189.
Issue By: e /` Permittee Signature: , �� ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Plan Check #
CITY OF TIGARD Mechanical Permit Application Rec'dBy
1731 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 -774 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit #� 0065 iVG
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
S treet Address _ / Su;te# A) Permit Fee ; 16.00
Address �!
Job �'p/ 1) Furnace to 100,000 BTU
3 "S q 7 6 s including ducts & vents see footnote 1,2 1 9.65
Bldg# City /State Zip 2) Furnace 100,000 BTU+
Or ? )-2-1 including ducts & vents see footnote 1,2 12.00
Na a (or name of busin J / [ 3) Floor Furnace
Owner a- nz t - ireehiltri el including vent see footnote 1,2 9.65
ailing Address 4) Suspended heater, wall heater
7�/ ��" or floor mounted heater see footnote 1,2 9.65
��2 0 �,f /I�LJ 5) Vent not included in appliance permit 4.75
City/State Zip Phone Check all that apply: *Boiler Heat Air
X01 q d e q 7Z 2 3 6 ;3t / z r4 For items 6 -10, see or Pump Cond Qty Price Amt
Nark (or name of business) - footnotes 1,2 Comp
/ n0eCL - _ (X n 6) <3HP;absorb unit to
(.L 100K BTU 9.65
Occupant Mailing Address 7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name 9) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 36.00
S ,PC / - PleUl0 10) >5OHP; absorb unit
Prior to permit Mailing Address �^ j >1.75 mil BTU 60.15
issuance, a copy qsa 6 / /ya el ST 11 Air handling unit to 10,000 CFM
of all licenses state // Zi Phone Sc! 3 7.00
are required if 4 0 < 4202 640 - s - 414s 12) Air handling unit 10,000 CFM+
expired in COT Oregon Co st. Cont. Board Lic.# Exp. D to 11.85
database �P 5 7 5 / / 13) Non - portable evaporate cooler •
Architect Name 7.00
14) Vent fan connected to a single duct
Or Mailing Address 4.75
15) Ventilation system not included in
• appliance permit 7.00
Engineer City/State Zip Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes,VNo O 18) Commercial or industrial type incinerator
Residential Commercial O 48.25
19) Repair units
Additional information or description of work:
8.40
� a , �� _ / ,��'T�11(C.CC 20) Wood stove /gas FP /other units/clothe dryer /etc. 7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas talcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas LPG 0 electric O 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL ° '$° - - ,-O ---
I hereby acknowledge that I have read this application, that the information 8% SURCHARGE ' w x .' e4
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only �_
TOTAL ��/�
Signature f Owner /Agent Date /
J 4 �/� Other
1. inspections outside Inspections of and no business hours (mininum charge -two
Contact Pe Name Phone hours) $50.00 per hour
2. Inspections for which no fee is specifically indicated (minimum
jd3/ c ?b . charge -half hour) $50.00 per hour
Foon es for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge -one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. 'State Contractor Boiler Certification required
"Residential NC requires site plan showing placement of unit
I:\mechperm.doc rev 7/19/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 4/ 7 (Z) AM PM BLD
Location e;0 RSA Suite MEC Z -0021 c
Contact Person l��5�'I'I � -�� Ph (O22 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: G 9 / FPS
Foundation
D cz , cox, f. �
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ECH ANICA
Pos
Rough In
Gas Li e
Smo e�Dampers
a PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for r inspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date (t/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.