Permit CITY TIGARD MECHANICAL PERMIT
. I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00748
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/17/2004
PARCEL: 1S135CA-01900
SITE ADDRESS: 11330 SW 97TH CT
SUBDIVISION: BOETCHERS ADDITION ZONING: R -12
BLOCK: LOT: 001 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install gas stove & vent.
Owner: FEES
CARROLL, SONDRA Description Date Amount
PO BOX 231025 [MECH] Permit Fee 11/17/20( $72.50
TIGARD, OR 97281 [TAX] 8% State Surchart 11/17/20( $5.80
Phone: Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503-646-6409 Misc. Inspection
Final Inspection
Reg #: LIC 51469
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: LI --? q V �
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
NOV. 13.2004 12 :25PM 0.779 .2/3
Mecha ical Permit Application /
Received // /� 4 1 Permit No.: p``d / OJ 74-/ 3
City 9f igard _ „ nateBy:
13125 SW : 1 Blvd.. Tigard. OR 97223 - plan Review Other Permit; 503. ,]! r9.4171 Fax: 503.595.196°H E C E- I V ,` i Date/By-
Inspection L c: 503.639.4175 ,,,t,14, 'i 1 Ready/By: r„rta S ee pale 2 for
Internet: .ci.tigard.or,us Notified/Method: ' / Cr Snppkmental tnfarn
2004
TYPE OF WORK R f COMMERCIAL FEE* SCHEDULE -- USE al:mm.IST -
Mechanieal permit fees' arc based on the value of the work
❑ New o+n suruction dition/alteration/replacetnedt performed. Indicate the value (rounded to the nearest dollar) of all
❑ OCrtlol 'on ❑ Other. Mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQ Value: S NT / SYSTEMS FEES*
and %flintily dwelling ❑ CommerciaUindusu'iai ❑Accessory building For special information use checklist.
❑ Multi - i ily ❑ Master builder ❑ Other: Description I Qty. Ea Total
JOB SITE INFORMATION AND LOCATION Healing/cooling
.*e,,,) 9 7 T� Air conditioning or heat pump
Job site ad Bess: // 330 (requires sire plan showing placement) 14.00
City/Sta :IP: 0/2 9 7e2c7 3 Furnace 100.000 BTU (ducts/vents) 14.00
T/.oQrC�2 / Furnace 100A00+ BTU (ductsiventsl (7.90
Suite/bldg. apt no.: Project name: r . O //, heat pump 14.00
Cross sire directions to job site: Duct work 14.00
- — Hydronic hot waterystem 14.00
Residential boiler (radiator or
hydronic) 14.00 -
Unit heaters (fuel -type. not electric),
in -wall. in -duct suspended. rte.. 10.00 10,00
-
Flue/vent for any o f a
Subdivisi : Lot no : Other 10.00 ,
Tax map/lartel no.: - Other fuel appliances
DESCRIPTION OF WORK Water healer 10,00
Gas fireplace 10.00
...Z_ Jr ./ o Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove n ey / , 10.00 !R. ao
Wood replace/insert 10.00
Chimney/linedfluclvent / 10.00 /� as
:1.'' PROPER •OWNER I ❑ TENANT Other: _ 10.00
Name: Qh , ,e a.... - ` r a /V Environmental exhaust and ventilation
Range hood /other kitchen
Address:. ` 06 — cqumment _ 10.00
City /Ste - ,,ZIP: 7 cg 4/z 4 7 3 Clothes dryer exhaust 10.00
Q �' Single-duct exhaust (bathrooms -
Phone: ) ct3 .. 7 Sep Fax:( ) toilet corn nts. utili mom 6.80
y 0 CONTacr PERSON Attic/crawl pace fans 10,00
t • F - Other. 10.00
Business ume: V .0'' M Q r9 5 Fuel 0ipi5 -
Contact ame: � o / ' Q C Xr /. $5.40 for first tour; 51.00 for each additional
l ��
Furnace. etc.
Address: /c9 l0 7...c n ze, seag_dtraa Ai Re (3as beat pump
Wall/suspended/unit beater
ciry/sta - l' s �< <q fir 7 f �2 9' 7 COQ Water �
Phone: ( .. ) 6G'j/i ep 07 Fax.: (5 5 di 3) G - ePa heater .3 5/ W h -
1? -mail: glit Range
CONTRACTOR Barbecue -
Clothes dry_ a )
Swirl name c I+7 Othe 1
Address: MECHANICAL PERMIT FEES*
Subtotal a� tD10
City/Stale/ZIP:
-
Minimum permit fcc ($71.50) ?,02,6t7
Phone: ( ) Fax: ( ) Plan review (25°% of permit fee) •
CCs licit / if q? -. c A3 4. State surcharge (8% of permit fee) , S0
TOTAL PERMIT FEE 7 g 3
e Thi permit appli cation expires if a permit is nut olhtaiacd within tan Authori�Cd signature: days alter it has heen accepted as complete.
PnfI n ary: kt. /. — - flare: //—/3 - 0rl + Fee methodology set by Th-Counry Building Industry Service Soard
CITY OF TIG 24 -Hour ..
BUILDING 7► Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION ( - Business Line: (503) 639 - 4171
BUP
Received Date Requ sted 1 ( �� " AM PM BUP
Location % / 33 O / `
Suite Ec q- 67 e
Contact Person 9eryi,
Ph ( ) 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC N
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear ,��(_ C e (_ / 04
Framing t/vl/I�� ��ll J� /T
Insulation
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
P RT FAIL
CNA AL
Post & Beam -
Rough-In 47 1 ��� .Y
Gas Line
Smoke Dampers J
PASS)-PART FAIL
ELECTRICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date / Inspector - Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL