Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00271
J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/13/2004
PARCEL: 1S135CD-14200
SITE ADDRESS: 11785 SW 95TH AVE
SUBDIVISION: GREENBURG PINES ZONING: R -4.5
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: 1 DOMES. INCIN:
LPG 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: Furnace and AC install.
Owner: FEES
RUTHERFORD, JANET Description Date Amount
11785 SW 95TH AVE [MECH] Permit Fee 5/13/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 5/13/200 $5.80
Phone: 503 639 - 6386 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 66578 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699. �,�
Issued By: / g∎ i T Permittee Signature: `
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Pe>r . tsI at on FOR OFFICE USE ONLY .
Received i fr pa Mechanical
Date /B : D ,TJt) Permit No,: ly AO — r,
City o'. Tigard tI'.4' 12 2004 Planning Ap.tnva Building
131 : >.S SW Ha11 Blvd, t ' t-ii Date/5 : Permit No,:
Tigard, o regnn 97223 CITY OF TIGAR Plan Review other
DatrlB : Permit No.:
Phone: 5 Fax: j $.NpispIVI . S Post - Review Land Use
'tl tetnct: NWw.Ci.ti ard.or.us ∎ � t A i � Date/B
g —'n' 1 Case No.:
}tour I] i5pect10II Request: Sf)3 -630 1 75 ti� ^ ..r Contact . � di c,.e Poge x for
Naine/Ivtcthpd (---] 5u.. [mental Information.
II TYPE OF WORK [ COMMERCIAL rlrt;* SCHEDULE - USE CE(FCKLIST
New construction ❑❑ Demolition Mechanical permit fees* arc based on the total value of the work
❑ Addit on/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION, • " .. mechanical materiuIs, equipment, lnbur, overhead and prot1L
• 1 & 2 •Famil dwellin • ❑ Commercial/Industrial Value: S See Page 2 for Fee Schedule
ETAccesso Bulldin• Il Multi - Family RESIDENTYAL.EVTJIPMEN -p /SYSTEMS FEE* SCHEDULE -
❑ Master Builder n Other: De eriptio„ l Qty I Fee(ea) Total
~J JB SITE INFORMATION afid LOCATION '�'o, s est'n Cootitta
Job s ite ;i� idress: 0 r �- O ,,� « I e - :dd-on a conditionil��� , I �I.OU
14.00
- '� � � five. \ as he+ oumo
Suite #: I Bl /Apt. #: Duct wo
14.00
Fro e t t N:1me: Flvdronic hot water system 14.00
Cros :; stre .t/Direetions to job site: Residential boiler
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
in wall, in-duct, sus.cnded, etc.) 14,00
Flue /vent for any of above) I 10 00
Subdivisti n: Lot #: Re air units 12.15
Tax nlapi arse) #:
Other Fuel Ap .Iiances
—_ DEsCRIPTIOi`( OF WOR.N Water heater ! 10,00
Gas fireplace 10.00 r
Flue vent (water heater /gas fireplace) j 10.00
r - •.c._, `t- /9, ,,,e Loiz li h[er as) . 10,00
W ood/Pellet stove
/r _Wood fireplace /insert i 10.00
,2 1 6 AS i�c'l�' .�S,` f 10.00
l• PRDPE T'Y OWNER O t h er: /liner /flue /vent 10.00
LO TENANT Other: I 10.00
Name: A _ jl Environmental Exhaust& Ventilation
Address I t Range hood/other kitchen equipment k 10
Clothes dryer exhaust I 10.00
CIt /State 'Zip: Cce..,
�hOQt': y Single duct exhaust
� .,,', 74 /— sP 1H° Fax: _ _ (bathrooms, toilet compartments, ,0 APl'LLIC.►NT • [J t. PERSON.' - utility r
Name.: o. su
Attic /crawl space falls 1 0.1)0
Address: —
Other; i 0.00
Cit /S.;tate, Zip: Foci Piping —
*`($5.4o for first 4, 51.00 each additional)
Phone: Fax: Furnace, etc. _ 1 .*
E -mail: Gas heat sum — i ,*
Wail /suspended/unit heater *- ..
CONTRACTOR Water heater . ■
Busin.ss 1'carne: . ai . i am— (-{kC H r Fireplace
Address: __ Le- C.• L1 L_ v ` v' ge )z
(. 0nAe I .*
!!!!!!!!!!
City /State /Zip: 7Z 1 . eeQ —
�/ I..? Clothes d cr (Gas)
Phone: t i t: _ 5 ` y Fax: (vi.- t _ o i3 Other:
CCB Lie. 4 ` e Total: MI
Authorised Mechanical Mechanical Permit Fees*
Signature: 1 (21--A-C.-z---- '-: _ Datc: J �'-
�' J
(p/ 0 Subtotal: S
r� t„`l, i' :_'� L, Ice, - Minimum Permit Fee $72.50 S
Plan Review Fcc (25% of Permit Fee) S
(Please print name) State Surcharge 8% of Permit Fee) I S
Notice: ]'his permit application expires if a permit is `lo not obtained within TOTAL PERMIT FEE 5 °
No days "Fee methodology set b y Tri -County Building Industry Scrvice Board.
ys after i• has been accepted as complete,
i : \Dsts\Pe,-rnit R rms\MecPenni * *Site plan required for exterior 1/C units.
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SITE PLAN
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,tREET
Specialty Heating & Cooling, +Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793
E'd BTLD B6S EDSuzzeaH RzTezoadg e82:L0 1,0 21 BeW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7: �� A Date Requested 5 V PM BUP '' //
Location / / 7 Y S / 5 '�~ Suite MEC V Z7I
Contact Person Ct./A Ph ( ) lD 2 ) 7PLM
Contractor Ph ( / SWR
BUILDING Ten• row e £: / l rt c ELC /V oK-t-
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:
Z � iI i� SIT
Post &Beam �/
Shear Anchors
Ext Sheath/Shear G,
Int Sheath/Shear L ets e / Y 6 j 9Z 66
Framing
Insulation Fi " l , /WC
Drywall Nailing
FirewallS *". ( / 35 / 02,
Fire Sprinkler �`-
Fire Alarm tig I D
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rou s h -In
'MEM V41/
Smo e ' ampers
(Ein
AS PART FAIL
RICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final D 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 (j 1�
Approach/Sidewalk Date / 1'-7 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL