Permit .'
CITY OF TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00827
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/2004
PARCEL: 2S 110AD -05400
SITE ADDRESS: 14862 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R -12
BLOCK: LOT: 047 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:
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: Furnace & A/C unit.
Owner: FEES
HAHN, BETTY Description Date Amount
14862 SW 106TH [MECH] Permit Fee 12/23/20( $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 12/23/20( $5.80
Phone: 503 684 - 2724 Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt lnsp
Reg #: LIC 1441 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: at_ Permittee Signature: SQ �,, C
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next \w iness day
FROM, : Ja cob sHea t i ng FAX N0. . Dec. 22 2004 05:15PM P2 /2
� C ti0I1 I Oli ...wt.: l'til? Ovi.S'
vi ty o f gar PermitU E I j Rece • 7 e y e j / PamtitNe.: G • I �ity of Tigard t V E Date./13y - �� J/ --) �� /�� � , �' (
3125 SW Hall Blvd., Tigard, OR 97 2 flan Re other Permit:
'hone: 503.639.4111 Fax 503. 598,1960 I Detenr: •
i DEC 2 3 200 i I fl t o R ead l y /ly' hl fa gee Page 2 for
napection Line: 503.639.4175 �� , $upptetnentst Information
Notified/Method: nternet: www.ci.tigard.or.us } y
`' ���� op - -.:, , 2 , . *.fit *tln,1�Y4`_.f 7 1,, r,iiil . /-', owe � ' ' 0 •1�RIL...__ill '` C ttil'Li 1' - 1135)Ef citE.C'Ki- ST .. • l , ,r + r r ti ryl , 11 1 Te + i ( ^.M�•u ,1Y. ,' 'f 1d llrl + I i . . . " t 1ua t��_,. ___
�ie,u _ c., raetir.:.+.7c,.ruc.�►. - Mechanical permit fens" are based on t value of the wor
0 New construction a` * .10 :0) •' L (01.9 performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other mechanical materials equipment, labor, overhead, and rofii,
Demolition _
ry�T� � e Value: $
triT I j ' iT ' ! ,:� ;t,7ll ,.' rt !' iT,;1; ' ''8'. r 1.7•41:1.' ': . ,ir;,r #'A,A�i1N�1: ? 11"r rj i.. ., a ' " r' SYSTEMS ,r; ��1 .�,I . ....f.L,4 3 1, ' :'. y �, -tit' EL:: „_ -S; I; - t� l `i' 4.,.,, ,` i.1' 1 Y/�} 10 temENtJ'. / YSt'EMS•F LS* ._
irA. d 2- family dwelling ❑ Commercial /industrial Q Accessory building For special information use checklist.
■ Muiti- fulncily ❑ Mater builder ❑Other: + Description ] Q(y. l Ea' _ [ oral
t ; , ti, r }} f r } : �� S } w � j ' 7 g g14 : .1q :,fir, y v ) -" IIeatin coolln
', .0 ■, : . d M iX 1. ' a u n2blRr' iv t+lm ' ' I � • 4 ;plot ! '. "'t1. tt/ K
I Air conditioning o hest pump
Job site address: . z i, 011 •. Air site •fan n or he : •iseenxtmt 14.00
IS Furnace L00,000 BTU (d uets /vnnee) i
' 14,00 ,
t
City/State/ZIP: 17.90
Furnace 100 BTIJ� ducts /vents
Suite/bldg. /apt. ntc.: - J �Project name: - „ Gas heat pump 1 4.00 .,-
Cross street/directions to job site: Duet work 1 `t' ). . -_. -
Hydronic but water system _ 14.00
-- Residential boiler (radiator or w -
_ 14.1X1
hydronic • -
• Unit heaters (fliel.typc, nut electric),
- ._ —V ln.wall, induct, suspended, etc. 10.00 —
- Flue /vent for any of above •
Subdivision: Lot no.: 10,00
Other: .. -- - —
Tax map/parcel no.:
Other fuel appllune es • „
s 1^ � • + ,'1 aer eatcr 10.00
n s.1 •r ry Y. i .r o r, '`_, a t.` , ' ,t ; ;Ji ' .`, ,: Water h .
9 ` "� � �, r. ...Mt: � ' .�.,, , � t a <' �li'•' "a/�a- _.. ,._ - ---- 10,00
, il a l W W 1 ' j. a 1 :� at' , t a (ins 1ii'eplace —.
Flue vent for water healer or gas
tirepincc_ ._ 10.00
Lop lighter (pas) I t1.U0
Wooxl /pellct stoye - 10.00
_.
• W- Wood fireplace /insert 10,00
Chimney /bncriflue/vetut - - 1000 - -- —
0 In , ' v- "vr r�n,�it; g- t ' i V.yr t 210 • • • N 'c - .. — 10.
i „) $ 1 ,� ( r * 0.y ts'i): ,. 'NT' -' `'NJv• Other
.Y •.,. rA >aF: -rd' , t _ .. •- _ —
Name:
7, 0 , T Environmental exhaust and ventilation
,� Range hood /ooh .t kitchen
Addresa: 1 equipment • 10.(X) __
City /State/71P: l � v i 2 , exhaust ... ,
. _- ... .._19•.°P.___.
.... - --
�` . -
- — Single -duct exhaust (bnthionns,
ph 6 ) r 1 _ nix 1 Fax: ( ) r toilet compartmcnls, utility rooms) _ 0,80 °-
$��► es • e ,r . .. ',� : _ q u it /crawlspace fans 10.00 y
•,c , 1 - ti) , ,i �Rlr .., l'.. o,1
. d' "i' ii' e '' is ;} ��' 1 i ∎ i ii t I !0; - --
i �,} ?' 4 ls i i Q it. nn:� , via ,.' l. , lk. 4: , . - .. 0 -- -' - 10.00
i
r " ,' n, +r '
,,'.�� � . � �1. � .rrm , . � � i )then, ....
R»aittess ram •
: '.�t `� _ K q 1_ _.. Fuel piping_. ... - --
., - l n ¶5.A0 for first tour; 51.00 for each additional
Contaot name; v t '
Furnace, etc, -
Adduces: —1 M •
1,.,_f, a . Gan heat pump _
City/State/ZIP: •� —4 v ' U6 ._ Cn1 ,, (3 _ _ Wall /fer stuthea p /unit heater ..- _—__ ..
_Wa _ —
Phone: F ax: ( ) 62
-
E -mail: Rang - .. --
,,, t : , 1 , r ,. . 1v��F,r�' ,� c '� r E M I'q p:1,..4 {.. i , i 't t >• Barbecue. - _ ...
, .i : + r � ?a1,!al,, 5,11 .-4,,Kr,�a .,i'. .�',„ tr ' .. i i 4 ' . } ' ,. ,
,• � . fi - �.'. �« � clothes dryer ((tuts) ,�
Easiness name: C. C • I I . • -� _. , Other:
Address ; ;,.:' z !r`Ei + ..
Cloy /StatclZtP: Su h(Olfll
- Minimum permit fcc (572,50) " _ - ... .
Phone: ( ) — [ Fax: ( ) Plan review (25°/ of permit fee)
CCB tic.: 14+ Stale surcharge (8% of permit fee) • t
p TOTAL PERMIT FED
i
2l i • _
-- 'MMit permit Delineatio expires if a permit le not obtains
Authorized signatur days af ter tt bo a be ac cepted ea complete.
. t Date: - Pee methodology set by Tri- County Redding 1nd,eiay Service o:,r
Print name; • •- ` � ,.,- - - -- ,._... - - - --
- - - _ ---- .... -- -- 440-461 rr (i vovconsiws>•r
is 1Aui1din * ■Pertnit.\M.BC- PermaApp.dQ 17J03 6-11.464(4,
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line' 03) 639 -4175
INSPECTION DIVISION Business Line (503) 639 -4171 MST
BUP
Received Date Requested 1 _ AM PM P
Location ° 6 4_ • ) 1 , 11 t EC Suite
Contact Person 'h ( ) PLM
Contractor 'h ( ) R
BUILDING Tenant/Owner 6 / - - a ELC CQ — 6 6 8 a. -
Footing „—
ELC
Foundation
g Access:
Ft 6 f 23 ELR
Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ,,
Ext Sheath/Shear
Ina Sheath /Shear u Z � N„i l n
Framing /
Insulation ,4'47A1P \ d_A/ryj
Drywall Nailing
Firewall
Fire Sprinkler 41,1 c– c ' r / Aj
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 O , `',
Gas Line ��
Smoke Dampers
at ? PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
TE Please call for reinspection RE Ei Unable to inspect – no access
Fire Supply Line 'C
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record fr e job site.
PASS PART FAIL