Permit +•` CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00290
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
PARCEL: 1S135DC-03600
SITE ADDRESS: 11700 SW 95TH AVE
SUBDIVISION: FIRDALE ZONING: R -4.5
BLOCK: LOT: 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:
OIL 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 new oil furnace.
Owner: FEES
ADAMS, HAZEL L Type By Date Amount Receipt
11700 SW 95TH AVE PRMT CTR 08/15/20C $72.50 272001000C
TIGARD, OR 97223 5PCT CTR 08/15120C $5.80 272001000C
Total $78.30
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 234 -7331 Heating 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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 - 9189.
Issue By: Permittee Signature: /r (7 /. J 1i L / J
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
J lG
Mechanical Permit pplication
.�
: Datereceived:. �� 1 Permit no.: / _ ,., /I _.., , ,,
141 g
City of Tigard RECEIVED
`J Project/appl.no.: WAIII Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 -4171 AUG 20C Date issued: By: Receipt no.:
y
Fax: (503) 598 -1960 J w Case file no.: Payment type:
Land use approval: COMMUNITY DEVELOPMEN1 Building permit no.:
TYPE OF PERMIT
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / fj Qt so o, 41... Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: TT Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $
Lot: Block: I Subdivisio • *See checklist for important application information and
Project name: I N jurisdiction's fee schedule for residential permit fee.
City /county: T � O• ZIP: 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and locaAon of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
o • 1 AAA 1 "4"4C4....
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: , iv e0 4 3 AA . State boiler permit no.:
HP Tons BTU/H
Add ess: St- � i 0 h Q Fire/smoke dampers/duct smokedetecto�s
City. I S I ZIP: q I�Q Heat pump (site plan required)
Phon Fax Email:
I f 3905 . Instal Ure Iacefumace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.:
Install/replace/relocate heaters —suspended,
City /metro lie. no.: wall, or floor mounted
Name (please print): • _ INN C Co en., C Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
• Absorption units BTU/H
Name: OttZ VN 01 C C) r IAA • C Chillers HP
Address: Compressors HP
Environmental Av City: As I State W �Ly: nvironmental exhaust and ventilation:
_ Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name! (x 'g' V'' S Exhaust fan with single duct (bath fans)
Mailing address: 1170* t Exhaust system apart from heating or AC
City: • ■ Statteel I ZIP: `t 3 F le piping and distribut (up to 4 outlets)
Phon: Fax: E -mail: Type: LPG NG Oil
Fuel piping each additional over 4 outlets
` ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert — type
Phone: ' �s:'�i�41A - Woodstove/pelletstove
� ti1.(��1 Other:
Applicant's Si: a •.•_at hl � � r tae: W Other.
Name (prin 4 , ✓�C et • L
Not all jurisdictions accept credit cards, please call jurisdiction for mote information. Permit fee $
Notice: This permit application
0 Visa 0 MasterCard
Minimum fee $ IYZi
e xpires if a permit is not o btained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) $ - -?7
Name of cardholder as shown on credit card accepted as complete.
TOTAL
Cardholder signature Amount •
s �
�
7 ( - /COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION 11Pir
24 -Hour Inspection Linty: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ! ' AM PM BLD
Location / / -7°6 / Suite MEC ? e e:O a - C)
Contact Person Ph 013 7 "733/ PLM
Contractor Ph X a(4 1 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain /�/� SGN
Crawl Drain Inspection Notes: c �� %C - � S J ,�
Slab V SIT
Post & Beam
Ext Sheath /Shear ( 4-J 2,
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
MECHANICAL
Post & Beam
Rough In
Gas Line
Smo ea pers
*ASS PART FAIL
E - RICAL
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 reinspection RE: [ ] Unable to inspect - no access
ADA / Approach /Sidewalk 1 Z.114 Other Date Inspector �- Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.