Permit CITY TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00618
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/16/2004
PARCEL: 2S103DB -01100
SITE ADDRESS: 13415 SW 110TH AVE
SUBDIVISION: MIRA PARK ZONING: R -4.5
BLOCK: LOT: 007 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:
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: Installation of A/C & gas furnace.
Owner: FEES
PHILLIPS, CLINTON J + Description Date Amount
RHONDA L [MECH] Permit Fee 9/16/200 $72.50
13415 SW 110TH AVE [MECH] Investigation Fe 9/16/200 $72.50
PORTLAND, OR 97223 [TAX] 8% State Surcharl 9/16/200 $5.80
Phone: Total $150.80
Contractor:
JET HEATING INC
1935 SILVERTON RD NE
SALEM, OR 97303 REQUIRED INSPECTIONS
Phone: Heating Unt Insp
hone: 363 2334
Cooling Unt Insp
Reg #: LIC 3944 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: Permittee Signature: , r �? C*
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
[ \7
Mechanical Permit itItlr9fra FOR OFFICE USE ONLY'
City of Tigard r0Q‘l Received / y n�' U y _ , gy p
13125 SW Hall Blvd., Tigard OR 97223 Date BY: (3 o /1/ Permit No.: ,G _to 0 , i
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review `�
Date/By: Other Permit:
Inspection Line: 503.639.4175 `' ,i y
\ -�y O \ `; _l •' �.. Date Ready/By: Jam: See Page 2 for
Internet: www.ci.tigard.or.us G D \ NC, Notified/Method: f I C f Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction ddition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2- family dwelling ❑ Commercial/industrial El Accessory building
[=I Multi-family El Master builder El Other:
For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 . 5 1 - i i,r.) 1 a . 14.00
�1 ,A . '
(requires site Plan ss -b R Placemen i
City/ State/ZIP: ` te ., �; �� 1 6' q a�� Furnace T00,000 BTU (ducts/vents) I 14.00 1L.\
�"' Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
__ _ — Gas heat pump ___ 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
1pEst:ItIBT, ON OF 'WORK Water heater 10.00
Gas fireplace 10.00
— 1 - i1 Q A 1 N l(XN AIC, t a ( fO C.Q- Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
1' P ROPERTY OWNER ❑ ANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: j j) -m\ ‘Vi ^3 Environmental exhaust and ventilation
Address: Range hood/other kitchen
3U x�;u k t A .lc equipment 10.00
City/State/ZIP:7" ` a , O - ci 1 �a 5 Clothes dryer exhaust 10.00
Phone: v^ Fax: Single -duct exhaust (bathrooms,
(� � - ?o' g ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: J Furnace, etc. i 5-AC
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other: -- City/State
Address: MECHAN PERMIT FEES* - ' '
/ ` ZIP: `' s- ^ ' / ` Subtotal �c.IP t^ C a1�b?� tal 50
Phone: Fax: ( Minimum permit fee ($72.50) Iy.kaS_OD
�n� ��� ~ Plan review (25% of permit fee) 5• O
CCB lie.: State surcharge (8% of permit fee) A4..6'Q
TOTAL PERMIT FEE
Authorized signature: 2
/ i > permit / This permit application expires if a peit is not obtained within 180
(�J� days after it has been accepted as complete., 0
09/14/2004 12:45 5033632622 JETHEATING PAGE 03
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 1 �� Date Requested /b /c/ AM PM BUP
Location /350 /ro Suite igg 0 7 ' 006/6'
Contact Person Ph ( 5 �- ) 793 — 5 SC/4Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - 40,Y--oa
Footing
ELC
�,a,ae
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Sheath/Shear 12:k)
Int Sheath/Shear
Framing
Insulation
Drywall Nailing /
Firewall /� ! `�� n A- ft
Fire Sprinkler rr �!
Fire Alarm ,4-y Fus t 5 E e AI A f c � 7
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 f
Storm Drain
Shower Pan
Other:
Final
PAS PART FAIL
ECH L
Post & Beam
Rough -In
Gas Line
Sm• _ Dampers
- AS PART FAIL
Service
Rough -In c
UG/Slab
Low Voltage
Fire Alarm a
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA / 0 • ,
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection reco m the job site.
PASS PART FAIL