Permit - CITY OF TIGARD MECHANICAL PERMIT
�, Ire DEVELOPMENT SERVICES PERMIT #: MEC2000-00202
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/26/00
PARCEL: 1S134DB-06000
SITE ADDRESS: 11027 SW 110TH PL
SUBDIVISION: JEFFREY ESTATES ZONING: R -4.5
BLOCK: LOT: 019 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:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install an air conditioning unit. A/C units cannot be placed within the required setback areas.
Owner: FEES
HANSON, FRED R + VICKI L Type By Date Amount Receipt
11027 SW 110TH PLACE PRMT GEO 5/26/00 $50.00 0002476
TIGARD, OR 97223 5PCT GEO 5/26/00 $4.00 0002476
Total $54.00
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
ORIGINAL •
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 952-411-0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -918 • ,
Issue By: ��= �� Permittee Signature:
Call (503) ; 9 -4175 by 7:00 P.M. for inspections needed the next business day
• Plan
CITY O F TIGARD _Mechanical Permit Application Rec'd By #
5_ 13125 SW HALL BLVLRECEIV Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
y (503) 639 -4171, x304 MAY 2 6 2000 Date to DST
P rint or Type Permit # 41 - 6 0 X
�iln UNITY DEVELOPMENT Called
omplete or illegible applications will not be accepted
Name of Development/Project Description
' (rwtS(Y TJOb Table 1A Mechanical Code Qty Price Amt
Job Street Address ( Suite# A) Permit Fee 16.00
Address I 1 C■D1 to ) 1 0 C - 1) Furnace to 100,000 BTU
including ducts & vents see footnote 1,2 9.65
Bldg# City /State zip 2) Furnace 100,000 BTU+
including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner I -I CiMVSC17Z including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
or floor mounted heater see footnote 1,2 9.65
1 I O 7 W )1 i 4 CA- . 5) Vent not included in appliance permit 4.75
City /State Zip Phone Check all that apply: *Boiler Heat Air
1 G Nz. X12 4 7 a 3 I t3c - c)5 0 For items 6 -10, see or I Pump Cond Qty Price Amt
Name (or name of business) footnotes 1,2 Comp
6) <3HP;absorb unit to
100K BTU X / 9.65 9 C1
G Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 - HP; absorb
unit .5 -1 mil BTU 24.15
N ame 9) 30 -50 HP; absorb
Contractor unit 1 -1.75 mil BTU 36.00
PC DLL N - i x @ Pr l C-- 10) >50HP; absorb unit
Prior to permit Mailing Address >1.75 mil BTU 60.15
issuance, a copy N i N F. Y11 1 wQt>✓(Ci e Ave. 11 Air handling unit to 10,000 CFM
of all licenses City/ tate \ Zip Phone 7.00
are required if tYt IC4Mc) G►2 ) O , d l.{ - 7331 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.75
database 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
4.75
Or Mailing Address
15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip Phone 16) Hood served by mechanical exhaust
7.00 -
Describe work to be done: 17) Domestic incinerators
12.00
NewS- Repair 0 Replace with like kind: Yes 0 No 0 18) Commercial or industrial type incinerator
Residential Bit Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
"/ 20) Wood stove /gas FP /other units /clothe dryer /etc.
a- 4-c f f .Cit (k'fl'tC;(/ f / m L.4_ . 7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas5k'' LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL; NIM
I hereby acknowledge that I have read this application, that the information • VYo SURCHARGE a :
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL ' '
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only � TOTAL = k aria
Signature of Owner /Agent Date ,. w • ,,,,�.� ' x
JAI( Other Inspections and Fees:
J( I( Vt _ .,P .1, 1/t('r c ti �`1 i 5. 0 � 3 • 0 C) 1. Inspections outside of normal business hours (mininum charge -two
Contact Person Na Phone hours) $50.00 per hour
i ]] �/ 2. Inspections for which no fee is specifically indicated (minimum
(?It I ✓l e ` c mi�li ) l Ct c .. ,.3L/- l •3
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge -one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. *State Contractor Boiler Certification required
**Residential A/C requires site plan showing placement of unit
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
—maw" �liyll ►�_
Location r I e MEC
Contact Person / WriZ' KS Ph b39 1 /5 - 72- PLM
Contractor JA/.n ��/ X15 - Ph SVI►
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: 3 FPS
Foundation
Ftg Drain SGN
Crawl Drain Inspection N tes:/ .a 4 r-
Slab ll�� /� SIT AdliA.,/A Post & Beam G �� . _ (d f ;; 4 , �1;?
Ext Sheath /Shear �/`��K f r!
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final /7r L
PASS PART FAIL V��'
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
lgss- -p RT FAIL
gCHANI
Post & Beam
Rough In
Gas Line
Smoke Dampers
= / FAIL
''. R L
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
in
,PART FAIL
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
Approach /Sidewalk
Other Date 7 / - 0.0 Inspector - � , Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.