Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00369
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/01
PARCEL: 25111 CB -00300
SITE ADDRESS: 14875 SW 103RD AVE
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 002 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:
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: Gas furnace replacement.
Owner: FEES
ZINDA, TODD M Type By Date Amount Receipt
14875 SW 103RD AVE PRMT CTR 10/25/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 10/25/01 $5.80 2720010000
Total $78.30
Phone: -
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 620 -5643 Final Inspection
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling
mm)9a.R_Q1
Issue By: f AP ` Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busi ess -day
Oct 22 01 01:51p Specialty Heatinc 503 598 0718 p.2
•
•
A.A.,* Mechanical Permit A 'cation
I Date received: I0 6ln t Permit no.: IA • , d_7 / _ ii
�#� ti t 11 City off Tigard 1, /� /
► J y g Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigar , R 9722
Phone: (503) 639 -4171 Date issued: B I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT I
)2'1 & 2 family dwelling or accessory U Commercial/industrial D Multi - family O Tenant impro' .;ment
D New construction P'Addition/alteration/replacement O Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHE I MM.
Job address: 1y ir. 7$ SC-.; / D rte 4 Indicate equipment quantities in boxes below. Indic; .:e the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, :overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBlock: IS ubdivision: `See checklist for important application informatior and
Project name: // C? 19" 7 0 jurisdiction's fee schedule for residential permit fee
City /county: jj9L(, a - I.G'AC /y, I ZIP: g 7 1. 2 -3 1 & 2 FAMILY DWELLING PERMIT FEE S 1 1 Q ULE
Description and location of work on premises: c. ' re AND COMMERICAL/INDUSTRIAL EQUIPII- E SCHEDULE
g 4 / ". ac ..e.-.
Fey I;cn.) Total
t. date of completion/inspection: i 6 4.2 7 F / Description Qty. WI : only Res. only
Tenant improvement or change of use: HVAC:
•
Is existing space heated or conditioned ?.1;Yes D No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? glees 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business names Z itPCj y ep. (� i/� ¢ • / 7 hl State boiler permit no.:
•
Address: Q .- cSLL) % l i) e ,c r / HP Tons BTU/H
Pire/smoke dampers duct smoke detectors
City: 1 et I State: o 41 ZIP: q 7g v.3 Heat pump (site plan required)
Phone Fax598 O /ti E -mail: Install/replace furnace/burner 51:;,- U/H
Including ductwork/vent liners Yekfl No '
CCB no.: 4,4.5 7 8 Instalvreplacelrelocate heaters -suspended,
City/metro lic. no.: /b 9C wall, or floor mounted
Name (please print): ,, r p'4- 01....• €(S Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: /1- TI.L tee N Si4in ✓ e /l; Chillers HP - •
Address: ?$,;. g- SC J l R' 6" 7- ComFressors HP
Stale: (�� ZIP:
Environmental exhaust and ventilation:
City
72 2 Appliance vent
•
Phone 3 ,co - 5 • Fax: 59g O1 ' E - mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system ,
Name: "odd /) ')a'L�,,,- Exhaust fan with single duct (bath fans)
Mailing address: t if ,f'' 3 - 5 ck.i 1 L' 3r.:1 4-1/ Exhaust system apart from heating or AC L
City: cs / a? Stat ye_ ZIP: c; ) .1.3 Type:
piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone:6'9' f- ? i/ Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required) I
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: j State: I ZIP: Insert - type
Phone: Fax: I E -mail: Woodstove/pelletstove
Applicant's sign. re: ✓ D ate: / G " 2 - lG % Other: —
�' . � j �: AA _.t Other: _
Name (print): f E (`l cce41l�Cr d i
No�1 jurisdictions accept credit cads, please call jurisdiction for more information. Permit fee $ _ ,_
Visa 0 MasterCard Notice: This permit application Minimum fee $ _ 7 � - - S
4,-v-3/ .- y 0.5F Leery (5 14 Loy expires if a permit is not obtained Plan review (at %) $ _
Credit card number: E xpires w 180 da after it has b (J
Sher t I , flAtitln�_(,S State surcharge (8 %) .... $ _
� pp Naut o f shaven on etc card
t accepted as complete. TOTAL $ _
ldGidRte � � 't �h0(ti/ $
ar dltolder signature Amount
.10 -4617 (6eC70 /COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested // — 9 AM PM _ BLD
Location ` Li8 75 / d 3„ 4,&(-c___ Suite MEC -SOO/ bO 3 ( 0
Contact Person Ph PLM
Contractor Ph Co 2 d 4 3 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /Az
Fire Alarm CA gi Susp'd Ceiling
Roof 1
�
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
Smoke Dampers
A RT 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 reinspection RE: [ ] Unable to inspect - no access
ADA
e
Approach/Sidewalk D 1�- 9 �� ( In �. Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.