Permit C ITY OF TIGARD MECHANICAL PERMIT
VELOPMENT SERVICES PERMIT #: MEC2001 -00462
Al. I 13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 12/18/01
PARCEL: 2S1 03AC -07200
SITE ADDRESS: 12999 SW 113TH PL
SUBDIVISION: FONNER WOODS ZONING: R -4.5
BLOCK: LOT: 008 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: DOMES. INCIN:
LPG 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: 1
>
GAS OUTLETS:
10000 cfm:
Remarks: Installation of gas insert.
Owner: FEES
MELISSA PETROV Type By Date Amount Receipt
12999 SW 113TH PL 5PCT CTR 12/18/01 $5.80 2720010000
TIGARD, OR 97223 PRMT CTR 12/18/01 $72.50 2720010000
Phone: 503-598-9038 Total $78.30
Contractor:
FIRESIDE DISTRIBTRS OF ORE INC
18389 SW BOONES FERRY RD
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Misc. Inspection
Phone: 503 - 684 -8535 Final Inspection
Reg #: LIC 40979
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 -00 Is; •. ou may e stain copies of these rules or direct questions to OUNC by calling
r!n2» 4 R -Q 1 RQ
Issue = . 1_ s � I � , Permittee Signature: ,,, ,,2�AQf
Call (51 •39 -4175 by 7:00 P.M. for inspections needed the ne t business day
12'12•'2001 10:51 FAX 51):t5981960 CITY OF TIGARD Z 00
. .
Mechanical ei ] ®n
Date rezeived . / r /'/ D/ Permit no.: fr7f e ' / V10g
...,., i 1 ` Pro std t n n. ' ..4 1 Clty of Tigard 1 A pp . Expire dart:
Address: 13125 SW Hall B eigii4OR2ae 3
Ciry ofTiga: d Date issued: By. 1 Receipt no.:
Phone: (503) 639-41'71," -
Fax: (50? i 59S -1960 a %r 7Y ,
JARD Case file no.: Payment type.
+��G u+ ISIO Building permit no.:
Land use apprc.wa :
TYPE OF PERMIT •
0 1 .5.:. 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 Tenant improvement
O Nev. construction 0 Additionialteratiotheplacement 0 Other:
- JOBSITE INFORMATION L.wMNIERCMAL VALUATION SCHEDULE
j Job address: a - ' r ts) ‘ lr3 • Indicate equipment quantities in boxes below. Indicate the dollar
I Bldg. no: Suite no.: value of all mechanical materials, equipment, labor. overhead,
} Tar, rr.:sp :ax lot/account no.: profit. Value $ __ -
fix: ;Block: ! Subdivision: "See checklist for important application information and
Project name: jurisdiion's fee schedule for residential permit fee.
City /county: ....,___5111111 Z1?: 1 & 2 FAMILY DWELLING :PERtti1IT FEE S:CUIEDULE .
nd locat n of worlt n premises: AND •COMMERICALII LQI.I PM ENTSCIIEDULE,
� �5 ° ` � i n 1 ]Fft(ea.) Total '
Est, date of completion/Inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use:
j p Air handling unit CFh?
Is existing space heated r conditioned? 0 Yes 0 No Air corxlrcenaag (sue plan required
Is existing space insulated? W Yes 0 No ,y!tcration of existing HVAC system
1%IECIIAN1CAL'CONTRACTOR Boilcuco•prrssos I i
SOAK-16,7541A11111111 State boiler permit nc.
Business name: ■ c�'•v ' t • HP Tons BTU /la Ill r t , Velt S 8.,aL , . 4 1;_ .w —Y Fire/smoke dampen/duct smoko detectors - - -
City: ,_� a � � StItM. G ! ZIP. _ , all 1-leat pump (sitc plan required)
Phone:Sol. bsstL -- 33 Fax. b3 co } . A. E -mail: installreplacefurrtace/btrmer BTLritl j _____I
Including ductwork/vert liner 0 Yes ❑ No I ! _��
i CCB no.: 4 a 7 g nsta replace /relocate nesters- suspendca, i
Cityimetm lit. no.: wall, or floor mounted
i Name (please print): ..Q61 --i rip•._ Gu U o..- vent or appliance Darer an formic
CONTACT' PERSON Refrigeration
J
Absorption on units _ BT U/14
Name: QJM ta
_!._ d Chillers HP IS I f
� CO. m -SOLE —.— 1 I
Address: tV, r 1 w f�u�� 7 '� Tnviromuentstd exhaust as • ventlIation:
City: State: ZIP: Appliance vent
photie: Fax: i E -mail: Dryer a cult
OWNER Hoods, Type N res. utchen'hazmat
. hood fire suppression system -;
Name: I1 $. S0. pf3-1- • V Exhaust fan with single duct (bath fans) • I
aust system apart •rt heating or AC i
Mailing address: � .. �
41- twang and distribution up :0 4 out st<, i I
r State: ZIP: Type: LPG NG _ Oil --1 1 Phone: SRr6- qua-, ( Fax: I E -mail: put . r • to - , additions over 4 ou - Jets =_
ENGINEER Process piping (schematic required;
Number of outlets - —i I
I Name: O theerList : app , ,ceorequipment:
i Address: Decorativeirenlace i • .a *
CEtrr_: State: ZIP: Insert - type ' ' • , -
hone: i F. : E -mail: oodstove/pellctstov
Other:
Applicant's signal la�� _ - ° Date: t 0. I , O other: .,
Name (print): • ■ro, Gar r - Q.. t•
No :.rl Iwicdnlu cAr
u i;t encl a
ramie, pre tali j,aiutictioo to mac inioaration - Permit Ice -- $ IC) -2.
Notice: This permit application Niinitnum fee $ 12 . SO
0 \,s UMastetCxd pspires if - a permit is not obtained
csedit cars auaibG ' / / _ Plan review (at %) $
fi within 1$0 days alter it has beer. State surcharge (8%) .... $ an NS= vi cardackior as sawn ,so atilt earl accepted as complete.
TOTAL $ g . 30 _ 3
cordr,aaer tiptattat "mow 4404417 (6 cost)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Busipess Line: 639 -4171
/ BUP
Date Requested /�� D AM PM BLD
Location ED—cl ED- q°/ l - PL. Suite MEC 0 2(.4) / (-g 2
Contact Person Ph PLM
Contractor Ph g L FS3 S SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear 4-t✓1eL.12
Ina Sheath /Shear (' Q 4 S
Framing i � Au t±:"Xc S tn�
Insulation /
Drywall Nailing (2 -) C-c■ /M A 1 Lt. A- C_Lc
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS FAIL
ANIC
Post & Beam
Rough In
Gas Line
Smoke Dampers
gtt - il•ART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
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 /" V Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.