Permit � 'CITY OF TIGARD MECHANICAL PERMIT
mio , DEVELOPMENT SERVICES PERMIT #: MEC2002 -00506
'�'I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 11/13/02
PARCEL: 2S 103AA -01910
SITE ADDRESS: 12330 SW 106TH DR
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 019 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:
ELE 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: REmove and install heat pump and electrical furnace.
Owner: FEES
PEARSON, RICHARD E + MARY ANN TR Description Date Amount
12330 SW 106TH DR
TIGARD, OR 97223 [MECH] Permit Fee 11/13/02 $72.50
[MECH] Permit Fee 11/13/02 $0.00
[TAX] 8% StateTax 11/13/02 $5.80
Phone: [TAX] 8% StateTax 11/13/02 $0.00
Contractor: Total $78.30
A -TEMP HEATING + COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: Heating Unt Insp
hone: 650 - 5014
Cooling Unt lnsp
Reg #: 71878 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 ou to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00
1
d ili Is ed By: i ��=! .-mar, !� /G /, Permittee Signature hy�Q
Call (503).639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application ,�
Date received:// / j Permit no. 1 0 . ,�}�
, .
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.4 .1 Project/appl. City of Tigard
Project/appl. no.: Expire date:
CityofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
At & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 19. 51A) (4 % Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $
Lot: [Block: ISubdivision: *See checklist for important application information and
Project name: — jurisdiction's fee schedule for residential permit fee.
City /county i I ZIP: • 11. I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and 1 ton f ork on remises: IL-.1 t AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
t1 - } 9 � . Q . v vw. ' ' • *L. Fee (ea.) Total
Est. date of completion /inspection: , Description Qty. Res. only Res. only
IIVAC:
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned? El Yes ❑ No Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: •,�� C1 , HP Tons BTU /H
Address: 1 , .9 to g4 - Fire /smokedampers/duct smoke detectors
City: 0 . J .�-.l ' • t1 / r ,..: B site p t sired)
Phone: ( ( , _ Fax: E -mail: InstalVreplacef t Burner BTU /H r
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: l i Install / replace /relocate heaters- suspended,
City /Metro lic. no.: I f'( Lt t wall, or floor mounted
Name (please print): P\ .G• • ■., , _ y . 1 A.. Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON
Absorption units BTU /H
Name . J .. .. e Chillers HP
`� 1�Q , Compressors HP
Address: Environmental exhaust and ventilation:
City: le: J I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/11 /res. kitchen/hazmat
hood fire suppression system
Name: 1 r Exhaust fan with single duct (bath fans)
Mailing address: 1 • d 0 :1 -1.P ` -- l. - Exhaust system apart from heating or AC
Fue p p ng and . 1st but on (up to 4 outlets)
City: N, .ta.� i� �� �D v_a Type: LPG NG Oil
Phone: , 1 • , i'l Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Woodstove/pellet stove
Phone: Fax: E -mail: Other:
Applicant's signal - Date: 13 E)Z Other: .
Name (print)b 4\t„ --k '.1
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Notice: This permit application
Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: Plan review (at %) $
within 180 days after it has been 0
E xpire: y State surcharge (8 %) .... $ �•
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ 7g
Cardholder signature Amount 440 -4617 (6/00/COM)
1'
A -Temp Heating and Cooling
site Plan
Prepared by: I)ato: l
Customer Name: L250" Address: J g-33
Customer Phone• (4at Lfr 4r
pi uperty Boundary nine
H/paiiip
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Street
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location f a 3 3 /D (n !l > L) Suite oogo
Contact Person Ph ( PLM
Contractor Ph ( -) SWR
BUILDING Tenant/C // -66 6 oS
Footing CO a d - 7g ELC
Foundation Access:
Ftg Drain
Crawl Drain 6ciAR /i /T / 66 7 . ELR
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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 ART FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
/) PART FAIL
Service
Rough -In
UG/Slab
Low Voltage
Fi - larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line �,
ADA
Approach/Sidewalk
Date _ Inspector )/..."1" Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL