Permit CITY TIGARD MECHANICAL PERMIT
A Ai l k . DEVELOPMENT SERVICES PERMIT #: MEC2004 -00211
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/22/2004
PARCEL: 1S135CD-03900
SITE ADDRESS: 11909 SW 95TH AVE 4
SUBDIVISION: BOETCHERS ADDITION ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R1 VENTS W/O APPL: VENT SYSTEMS: •
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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:
> GAS OUTLETS:
10000 cfm:
Remarks: Furnace replacement.
Owner: FEES
HOUSING AUTHORITY OF Description Date Amount
WASHINGTON COUNTY [MECH] Permit Fee 4/22/200 $72.50
111 NE LINCOLN ST #200-L [TAX] 8% State Surchari 4/22/200 $5.80
HILLSBORO, OR 97124
Phone: Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 66578
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:
CZX
i Permittee Signature: A (}gym
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
t ' 1 FOR OFFICE USE ONLY ,
f,' ckta:R ic Permit Application
• ,� �� Received , / / i Mechanics -- 00,7.1/
RECEIVE
Date/B • a D ' A' Permit No.
City Of l 8I'a Planning Ap. ■val Building
Date/B : Permit No.:
13125 SW H:tll Blvd. 2 Plan Review Other
Tigard, Dregs to 97223 AP, ' Datc/B ._ permit No.:
Phone: 503•t.39-4171 Fax: 5O3- 59S -l960 Post Land tJse
/�a*e,. 2 �i +' ��
• RD Datc/B : Case No.:
Internet vvw u.ei.tigard.or.us '.�' � IN, Contact kris,: 6 See Page 2 for
2=i -hour • Insp( ction Request: 503 - 639 -417`" - `� "' •— " "" II Name/Method: so? teemea fllr'linatlotl.
1 TYPE OF WORK. •• COMMERCIAL. FEE* SCITEDULE - USE Ch ECKLIST • .
n New cor struc 'E Demolition Mechanical permit fees" are based on the total value of the work
■ Additior. /alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
.--y C ATEGORY OF CONSTRUCTION mechanical materials. equipment, labor, overhead and profit,
n18, 2 -Ft roily dwelling n Commercial/Industrial Value: S See Page 2 for Fee Schedule
❑ Accesso y Building ❑ Multi - Family RESIDENTIAL.EQUTPMENT /SYSTEMS FEE' SCHEDULE •
Deccrip.tinn I Qty f Fee(ea.) 1 Total
n Mager I luilder . — 1 Other: l eatin Coati O
'.JOY SITE ENFORMATION and LOCATION - ' • urnace add-on air conditioning** 14.00
Job sit(: add •ess: !,I ! o'� j .5',.. tic.' S 1- , 44 ii at pump 1400
Suite r: Bldg. /Apt. #: Duct work _ 14.00
PTO's el Nan le: Hydronic hot water system _ 1 14,00
Residential boiler
Cross .treet'Directions to job site: (fun tatliatui or ydronic system) I 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) l 14.00
Flue /vent (for any of above) I 10.00
SubdiNision : 7 Lot #: Repair units 4 12.15
Other Fuel Aypiianees
Tax mite /parcel #: Water heater f 10.00 _
_____ • • DESCRIPTION OF WORK Gas fireplace 1 10.0(1
. Flue vent (water heater /gas firc_placc) I 10.00
— - Log l htcr(gas) 10.00
„
r; "Z 1 l `: a" ;' =` Wood/Pellet stove I 10.00
l � _ _ Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00 _
r4 YROYEER. fY OWNER ' TENANT Other: J 10 00
Environmental Exhaust_& Ventilation
Name: i. C..1 • _'7:.1+: t,Lw7':v [ 17' L ;.1 11, -- j c( ) Range hood/othe e
r kitchen equipment 10.00
Address: > t .r- Clothes dryer exhaust 10.00
C it /State/ Z i
.�' Single duct exhaust
Phone: (+ ie f'l -- Li k .M• Fax: (bathrooms, toilet compartments,
MI API' LICe+PIT ' ' O'CONI.A.CT'PERSON " - utility rooms) 6.80
Name: Attic /Crawl space fans - 10.00
Other: 1 0.00
Address:
Ss: Fuel .piping
City/Stare/Zip: 7185.40 for ttrst 4. $1.00 cacti additional)
Phone: Fax: Furnace, etc.
• Gas hea pump I "*
B mail.: Wall/suspended /unit heater h.x •
• CONTRACTOR Water heater
Business'Uarrie: S 1: (i e-_ •h " -H r Fireplace '«
- �'— Tian • a ""
Address: 1 Lc' C+ 1 C SC t v'Z t' c_ f. _ •
BBQ City /State, Zip: 14 • (S L G'tiTi , , 0 7 -, 2 -T Clothes dryer (gas)
Phone'.:�f- io - s'c c - Fax: • O? Other: I .4
CCB Lic. : ., - y 'total;
Mechanical Permit Fees' _
S ignature : i!G� tL1"z� �!� �� D a t e: � ' " <31.� Subtotal: S
t -- Minimum Permit Fee 572.50 I S . `Z) �,
P " I•.:,L - L.` (.) t C ., - -.--, Plan Review Fee (25% of Permit Fee) S
(Please print name) State Surcharge (8% of Permit Fee) S L , C. _ _
TOTAL PERMIT FEE S 2 . Q - ; J
Notice: This 1 crmit application expires iC a permit is not obtained within •Fee methodology set by Tri -County Building Industry ervice Board.
180 days after it has been accepted as comptete. ""Site plan required for exterior A/C units. .
i:\Dsts\PcrmitIon-na\MecPcrmitApp.doc 01/03
2 ' d B I L O 8GS COS 2u T zeaH Rz i e t oads e82 : BO 170 T2 -+dd
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received /eX 03 Date Requested �� AM
c‘,4" BUP
Location / r � // / p o 95 Suite MEC, OD Zl
Contact Person / k Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner � &b4 ��"�,,, �C Q�cc. ELC
Footin ` i '
9 ELC
Foundation Access: --
Ftg Drain ELR
Crawl Drain t l
Slab Inspection - .,ls: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall Xo
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
PASS PART FAIL
MECHANICAL Dr „�`
Post & Beam
Rough -In
Gas Line
Smoke Dampers
mow'" 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 f
DAoach /Sidewalk Date / O v Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL •