Permit CITY 'TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00163
�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/1/2004
PARCEL: 2S114BB -12200
SITE ADDRESS: 16387 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R -12
BLOCK: LOT: 063 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: 1 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:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace, add AC.
Owner: FEES
LALONDE, JOE Description Date Amount
16387 SW 104TH AVE [MECH] Permit Fee 4/1/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 4/1/2004 $5.80
Phone: 503 693 - 0309 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223 Heating Unt Insp
Phone: 503 624 - 2704 Cooling Unt Insp
Reg #: LIC 76359 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: )60 , Permittee Signature: CT)) O - 2 /1„..€111-7h
4
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Apr 01 04 09:09a PAM DRLBY 503 -598 -0270 p.2
' Permit Application FOR OFFICE USE: ONLY
Received ' Per nit / Mechanical
Date/By:/ /e y it No.f)7EG� °O`I - -'a° /�
City of Tigard �`` Planning ppr vat Building
Date/By: Permit No.:
13125 SW Hall Blvd. V� Plan Review Other '
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503 - 196 cb `w ,0 Post - Review Land Use
Internet: www.ci.tigard.or.us * � 4 ` , r ' i,' Date /BE Case No.: •
!A I Contact Se Page 2 for
24 -hour Inspection Request: 503-639-4175 s 1
G V 4 Name/Method: I / Supplemental Information.
• TYPE OF WORK : t' ICOISIMERCIAII USE:CHECKLIST
New construction El Demolition Mechanical permit fees* are based on the total value of the work
A ddition/alterationheplacement [: Other: performed. Indicate the value (rounded to the nearest dollar) of all .
f 'CATEGORY 'OF CONSTRUCTION" • ;l. "` mechanical materials, equipment, labor, overhead and profit.
1 & 2- Family dwelling i E Commercial /Industrial value: S See Page 2 for Fee Schedule
Accessory Building [] Multi Family ' RESmESTI.WHEQBERMEl T /SYS7:EMSi SCHEDULE
Master Builder Other: Description I Qty Fee(ea.) Total
JOB SITE INFORMATION and•LOCATION Heating/Cooling
Futgace - add -on air conditioning *• 14.00 ' '
r- lOb site address:
/GS g.7 ,(.. /b ye•" - • Gas heat pump -- 14.00
Suite P: 1 Bldg./ Apt. #: Duct work 14.00
Project Name: I Hydronic hot water system 14.00
Cross street/Directions to job site: Residential boiler ff
(for radiator or hydronic system) i 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00 I '
Subdivision: ' Lot #: Repair units _ ' 12.15 ?
Tax map /parcel #: Other Fuel Ap 'lances
Water heater 10.00
�
/ l DESCRIPTION OF WORK • • Gas fireplace 10.00
i /G-e /// ft 9
e///.4r 4 5 �e.t.A.,vt A a c . Flue vent (water heater /gas fireplace) 10.00
' /n.-"s Tot e / .a4- Log lighter (gas) 10.00
1 Wood/Pellet stove 10.00
j Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
ROPERTY OWNER • ... CaTENANT, : . .. . Other: 10.00 •
Name: 30 . L-09- /OAJ,p L ., : Environmental Exhaust & Ventilation
Address: /4.3 ,52.0 /oa,�,r- Range hood/other kitchen equipment 10.00
City %StateiZip: T9�°t Clothesdryerexhaust 10.00
30 Single duct exhaust
Phone: F ax: (bathrooms, toilet compartments, ■
fl APPLICANT D:•CONTACT PERSON•.'' • utility rooms) 6.80
Name: . Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
' City /State /Zip: * *(55.40 for first 4, S1.00 each additional)
Phone: Fax: Furnace, etc. ««
E-mail: Gas heat pump ••
Wall/suspended/unit heater «•
CONTRACTOR '. • • • •• Water heater *6
Business Name: (/ h ra r 1,1 -1.i6 ,L Coe /44/6 Fireplace ••
Address: i°0 i; e ) ..?:301V1 Range
City /State /Zip: �/ 4.,4�n a,4 g7Ayv4,3
Clothes dryer (Ras) **
Phonet5 G ay al, Fax: .5 03,,r 0..76 • Other: ••
CCB Lic. #: Total:
•
Authorized Mechanical Permit Fees*
Signature: 0 ,� -!')� Date: ezi,t-05! Subtotal: S
Q�7 / Minimum Permit Fee 572.50 S 7? . ST
A Ate /A 11 I A f 6 Plan Review Fee (25% of Permit Fee) S �)
(Please print nam State Surcharge (8% of Permit Fee) S l
TOTAL PERMIT FEE $ / y _ 50 I
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days a fter ii has been accepted as complete. •*Site plan required for exterior A/C units.
::`•Dsts'Permn Fo'ms\MecPerrnitApp.doc 01/03
Apr 01 04 09:09a PAM DALBY 503 - 598 -0270 p. 3
•
edritneTA
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
Of
Army/
•
•
JOB ADDRESS: /6' J 2 7 / .f 1
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - 45 1- 45 1 10 � � AM PM BUP
Location f l0 3 e �� -7 10 ` At) Suite MEC - - Cc:J 1(03
Contact Person Ph ( ) b Zt — 2 7 7</ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear i
Framing
Insulation �i .yam �/G
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Si'. . - Dampers
s
- ART FAIL
TRICAL _
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: r Unable to inspect — no access
Fire Supply Line
ADA - -/ 5 ' = C'
Approach/Sidewalk Date -- Inspector 4 ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL