Permit CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00192
DATE ISSUED: 4/16/2004
'�'j --I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103DC -00200
SITE ADDRESS: 13585 SW 110TH AVE
SUBDIVISION: FAIRHAVEN COURT ZONING: R -3.5
BLOCK: LOT: 001 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:
OIL 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 oil furnace.
Owner: FEES
WALKER, VERNON E + CAROLYNN E Description Date Amount
13585 SW 110TH AVE [MECH] Permit Fee 4/16/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 4/16/200 $5.80
Phone: Total $78.30
Contractor:
SUNSET FUEL CO
PO BOX 42287
2944 SE POWELL BLVD REQUIRED INSPECTIONS
PORTLAND, OR 97242 Final Inspection
Phone: 503 234 - 0611
Reg #: LIC 2374
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: / Permittee Signature: 6i✓ f / /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
04/14/2004 12:06 0000000 ABAB:AAAAAA AA PAGE 02/02
Mechani Permit Appl ication FOR Q 01' h l t. h: l :SF, O N L Y
i-r Received / / Mechanical l/
® Date./BY: //r r - Permit No.: , 7ECZ00 9 9.Z
City of Tigard RECEIV Planning Ap royal r
Date/By: Building
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ��ppQQ y 4 2004 Datdair: Permit No..
Phone: 503- 639 -4171 Fax: 5(t13-58 -1960 Post- Review Land Use
{
Date/By: Case No.:
Internet: www.ci.tigard.or.us ( r YIGAR,I •I I ` Contact Suria_: El See Page 2 for -
24 -hour Inspection Request; 50343 7 ' - -
BUILI6 �1VI Name/Method: �� Supplemental Information.
1 . .
��R'�e 'NV(�l�Ki ^'�i:;�+Y�;: „ . - rt �; •. ,,.. 1r ,irtear. ' r' .gin ".,9 f4ftli1.1� �„ur e - ;.. ; c
IN
New construction I. Demolition Mechanical permit fees* are based on the total value of the work
(�;� ' ddition/alteration/r .lacement Li Other: performed. Indicate the value (rounded to the nearest dollar) of all
k; "'sET N ; Fl e.l�, f xi i, g't3 ' i ,+ ,';',,,1 mechanical materials, equipment, labor, overhead and profit.
rg 1 & 2 - Famil dwellin_ ■ Commercial/Industrial Value: $ - See Page 2 for Fee Schedule
Accesso Buildin_ .:), 11 47 1 1 N`.e_�f 01F:2 , a k r Mr L ,r
r Master Builder 111111 Other: Descriptio Qty Fee(ea.) Total
i W�'„ � �` ^i 9 - i �3r �Q� ��I�� � 9 �' � b l fs� �^"^�� aid � i f ' IlestlnR/CoolLag ,� .. , .
,.,,._ �.1.�f- _. ":.1:.�: , i; “Q),�, t). • .�_ . ;.i.(..,ii..��.,P� , .,µ , :s1 Furnace - add -on air conditioning ** 1 14.00 14 DO
Job site address: OS: 11• II Gas heat pump 14.00 ...
Suite #: Bld:. /A•t. #: Ductwork 14.00
Pro'ect Name: • Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
-
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00 _
Subdivision: Lot #- Repair units 12.I5
Tax rt1a. / . axcel #:
: '' - ;" Otbr itel , c 1Lancas.: , :,: ; ;4_,$:'
Water heater 10.00
L EM ll f' R i 1 !1 i.;f e i. 710.c `E i i, . a :'
Gas fireplace 10.00
t /.• ! Wl ii ...1111M Flue vent (water heater /gas fireplace) 10.00
Log Ii: 'ter :as 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
C /ftue/vent 10.00
`7,5 : , t -SO'„ f ,, ,, ;: t ', [7 d a i , +1 i! ? ' ' S ' , -' i Other: 10.00
Name: ' J �a ■ _ r r, . Envikounentilt�, " r' litii& Irontit : , � ; : -;-
Address: t �-1- Range hood/other kitchen equi 1 0.00
Clothes dryer exhaust 10.00
Phone: •CC • 2: 0 Fax (bathrooms, duct exhaust
i � �� 1 � �`... � d : ` :, i_:ti5; i r� (bathrooms, toilet compartments,
i EFL3 .� ... a i 2 �f,. \ ! y.1.4, I .ti ". j ii,:: i i4 0 t .; i (.. �_ l ,' I 1 utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 1o.00
. , pilet.r.figa r , ;;4;x:1,.,..:
' ••05.40 for first 4, 51.00 each additional)
Phone: Fax: Furnace, etc.
Gas heat pump **
E-mail: Wall/sus_pended/unit heater **
. ;'. 0. c::! ' ...E`% l r r . " : ::1, Water heater ••
Business Name: SuxiSe..-t- h.&€ Fireplace *•
Address: 2 U` - E "ow e[ 1 i` R Qe .« -
Cit /State /Zi.: • e D , 07 a2._ Clothes dryer (gas) ••
Phone: s - . • 11 Fax: 6 25 . U , Other: «.
CCB Lic. #: 02314 Total: -
Authorized 1 Mechanical Permit Fees*
Signature: � - Date: 'tI I1410 : Minimum Permit Fee 572.50 $
SMut� - i� Aw►br - Plan Review Fee (25% of Permit Fee) $
(Please print name) Statc Surcharge (g% of Permit Pee) $ 6 - sC
TOTAL PERMIT FEE $ -jeg,_Q
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by TA-County Building Industry Service Board.
180 days after it has been accepted as complete. '*Site plan required for exterior A/C units.
iADsts\Permit Forms\MeePermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 11 . 2 7 A Date Requested r / � AM PM BUP
Location / 3 d s //.O Suite MEC■ q - (2 /9 2
Contact Person 0,e...4M CM Ph ( ) 9 2p7( PLM
Contractor cc Ph ( ) SWR
BUILDING Tena Owne ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing t ri 6¢ `gCf
Insulation ��
Drywall Nailing �Y/2 ./-/ C-- n
,en-z
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 / Manhol
Storm Drain
Shower Pan
Other:
Final
PASS PAR FAIL
MECHANIC L
Post & Bea
Rough -In 1= 4 " 4.(21
Gas Line
Smoke ampers
Final
APART FAIL
L EL±CTRICAL
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 LI Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date S �� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL