Permit ~ CITY OF TIGARD MECHANICAL PERMIT
i;� DEVELOPMENT SERVICES PERMIT #: MEC2002 -00224
_.� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/30/02
PARCEL: 2S114BB -13200
SITE ADDRESS: 16429 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R -12
BLOCK: LOT: 073 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:
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 furnace.
Owner: FEES
BOTTENBERG, PATRICIA D Type By Date Amount Receipt
16429 SW 104TH PRMT CTR 5/30/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 5/30/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
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
(f1!117dR -Q1 R•
■
Issue By: if'. L 4 Permittee Signature: Z5Af /C 7-4,"
Call (50 -4175 by 7:00 P.M. for inspections needed the next business day
May -25 -02 1O:09A P_O1
p
Mechanical Permit Application
34;'!C ,i i City of Tigard
RE CEI V EP Datercceived:5 /3d /Q �. I Gantt nn.: /`fee Z(JOZ ".0022
. , ' ojectJappl. no,; Expire r1 au;:
City (y-Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 to issued: Iiy (,( Receipt no.:
Phone: (503) 639 - 4171 MAY 9 R ?��
Fax; (503) 598 -1960 Case file no.: Payment type:
liU Building permit
Land use approval: _pwqmp4c
TYPE OF PERMIT
& 2 family dwelling or accessory LI Commereial/industrial U Multi- family U Tenant improvement
U New construction ❑ Addition/alteration/replace nent 0 Other:
JOBS SITE INFOR111ATION COSIMMERCIAL VALUATION SCIIEDULE
OEM r� �'
let! 1% toll Li ' • indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 2, °) Suite no.: 1 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit.. Value $
i.ot: BI ' Subdivision: •See checklist for important application information and
Project name: 1 110: • a ;_p _ 1 • . . jurisdiction's fee schedule for residential permit fee.
('aty,c nt : • .. ZIP; I 4 ,V. - 2 FAMILY DWELLING - PERMIT FEE 'SCHEDULE ..
Desert " • i and <ati f oil ..._ )n premises; _ r 0 1 0, C Q,.ra - \ _. AND COMMFRiC'AL /INDUSTRLAL EQIIPMENTSCIIEDULE
_ Fer(ea.) Total
Est date of completion/inspection: DeQcription — Qly. Rm.unly Res. old)
11VAC::
Tenant improvement or change of use: Air handling unit __ CFM
Is existing space heated or conditioned? U Yes ❑ No AircondnioninF (site plan required) —
Is existing space insulated? U Yes O Ni) Alteration of existing 14 VAC system O '
11IECIIANICAL CONTRACTOR Boiler /compressurs
State boiler permit no.:
I usiness name: 4, C U > ; e�r � _. HP Tons KTIJM
Address `," ,_ , 1 - _•.,l tS ' Fire /smokedampers/duct smoke detectors
City: ii 1 • - stagy ZIPc-17 `x- tientpump (site plan nttquired)
N
Fax: ' • 4 E -mail: install/teplaccfurnacelburnei ...... • '1'lI /H
— includinE; ductwork/vent liner ❑Yes • u
CC B i.: .. lnswlUtcplace /rctticateheateis suspenc . 1
City /metro lie. no.: :, wall, or flour mounted
Name (please print):�J ' • j/ ' • vim., C.-
Vent for appliance other titan furnace
Ala t e g ionu
CONTACT PERSON ef ri tiontmits l37U /H
_ _, _ . •
Address: , v j • —. Compt Chillers >'ssors _ 1 IP Hl'
Address: _ t'anmental exhaust and ventilation:
City: State; l ZIP: Appliance vent
Phone: Fax: E -mail: L)ryereihaust ._. .,
OWNER l liwds,Typc I/ 11 /res. kitchcn/hazmat
hcxid fire suppression systean .-- ...
Name: , C . 1 . ' / /. a Exhaust fan with single duct (bath fans)
jsQ:ailine, dtt ys' LT
I_ • r 1 Exhaust system apart from Beating or AC -
_ �' ` +� t � 1, Fite. raping and distnhnhnn up to 4 outlets)
P III $.1._ j • ,' : E -mail: Fuel pi in}r, each additional over 4 i nitlets -
ENGINEER Process piping( sc:hematieiequired) - - . 0 - 1 Number of outlets
Name: ... _ -- pp • 9 ip
Uttter�tvted appliance or c m mesh
Address: l ) ecorativefirep lacc
City: `State: 7.iP' insert — tylx% —
Fax: E-mail; paw Woodstove/pelletstove_ - -_ .
Phone! Other. .
Applicant's sig a u •' Da :� - , — Ut er. _ .
IN amc. (print): — • �rptL�w� —. .
p uri.uliction Cur more i iFiwnutivn\ f'eritill fee l .._
a all jwixlr M, accept atidr Cnrct:, ksx�+ call I Notice. 'Ilm permit application lication
o Via :, 0 Msiercard p 1 p P l niinunl fG ...,.,.,,.) S
/ 1 rxpireg if a permit is not obtained Plan • $1150.
cw.pr. cud ri mlxr' . .. _ 1 tan ri�vi�'.w (at �I" ..
Expires within I s4} days after it has been S tale surcharge (t %) .... $ • —
accepted a s complete' T OTAL
N,„,, At ca rdhold er as elpiwn nn credit c md P _
s I
cardhnlria s, attire , MVC,t,Nt
t.
V46°5
CITY OF TIGARD 24 -Hour
WILDING Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171 it
Zr BUP
Received Date Requested l c h AM PM BUP
Location / 6' t .. / 41 G - /1 --(1-< - - Suite - , O7 5 z i 4
Contact Person Ph ( ) PLM
Contractor _ Ph ( ) SWR
BUILDING Tenant/Owner 6 q-768? ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain // ` jec�
Slab Inspection Notes: to SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear CD q
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: V 2 ) ).-")
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 P T FAIL
NMEO I
Post & Beam
Rough -In
Gas Line
Smo Dampers
mal
PART FAIL
TRICAL
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 �/ 1
ADA
Approach/Sidewalk Date 7b 6 2 Inspector \ Z ) Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL