Permit a
CITY OF TIGARD
MECHANICAL PERMIT
- , DEVELOPMENT Tigard, S SERVICES 2 C E S ) 639 -4171 DATE PERMIT #: ISSUED: 6/3/2004 -00333
PARCEL: 2S103DC -04300
SITE ADDRESS: 13775 SW 114TH AVE
SUBDIVISION: VIEWMOUNT ZONING: R -4.5
BLOCK: LOT: 031 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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install AC Unit and replace gas furnace
Owner: FEES
AMY EMERY Description Date Amount
13775 SW 114TH AVE [MECH] Permit Fee 6/3/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/3/2004 $5.80
Phone: Total $78.30
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 71878 Cooling Unt Insp
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: � � � j — Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
JUN -01 -2004 14 25 A TEMP HEATING 5035572990 P.02/03
Mechanical Perwit Application Received FOR OFFICE USE ONLY
ch
Mechanical
h r' y l Permit No.: E , -zoo* 003
V P Approval Building
City of Tigare �oot} Date/By _ Permit No.: -
13125 SW Hall Blvd. ni 1\ \ . Plan Review Other
Tigard, Oregon 97223 ' �" • GP `F��N Dateray_ Permit No,:
Phone: 503 -639 -4171 Ftl Post- Review Land Use
ti r „ ; , l l ; n D Post-Review Case No.:
Internet: www.ci.tigard.ar,81�0`q - asli t e: ' I l Contact Juris.: ® See Page 2 for
24 -hour Inspection Rcque'st: 503 -639- 4175 "` Namc/Metliod: Supplemental Information
TYPE OF WORK COMMERCIAL FEE E",SCHEDULE = 'uSE;
�,40 ew construction _ Demolition Mechanical permit fees' are based on the total value of the work
II Addition/alteration /replacement Other: 'performed. Indicate the value (rounded to the nearest dollar) of all
' ;' " OF CONSTRUCTION • . mechanics' materials, equipment, labor, overhead and profit.
9I & 2- Family dwelling Commercial /Industrial Value: S See Page 2 for Fee Schedule
RAccessory Building Multi- Family . RESIDENTIAL /SYSTEMS�FEEt•>SGHEDULE ..
t Description i Qty , Fee(en.) 'I Total
Master Builder _ Other: �A�ii• cocoa: . .:;.v, ' 41 1 a0WSITE INFORMATION and LOCATION • Fu i - add -o F r canditioni ! 14.00 . • a
Job site a ddress: I 7, L, ‘ ` =t-teil ., as heat pump 14.00
Suite #: 1 Bldg. /Apt. #:. Duct work 14.00
Hydronic hot water system 14.00
Project Name: a .. Residential boiler .
Cross street/Directions to jobs e: (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 . 12.15
Other Fuel Appliances _ _
Tax map /parcel #: Water heater . ' • 10.00
• ' ■•:'.'i `" , "DESCRIPTION.QF WORK Gas fireplace • '10.00
_ 1 ti (`� /� f1 _t Flue vent water hcater /:as fire. lace) 10:00
- ` `�"-� f � Log lighter (gas) 10.00 , W—A-V U Wood/pellet stove 10.00
� Wood fireplace/inscrt '10.00
�,p
Chimney/liner/flue/vent • 10.00
CJ -P,ROPERTY'OWNER .' . : • I '0 TENANT • , Other: _ . . 10.00
Name: Environmental Exhaust & Ventilation ;
�� .`� y Range hood kitchen equipment , . 10.00
Address: 1 "5'7 — 1, - 5 0 I, (1--1 ÷ /1--, _ Clothes dryer exhaust - 10.00
Cit /State/Z�: Si ng l e d uct exhaust
Phone: o 5' _ Fax: (bathrooms, toilet compartments,
' Q APPLICANT.' 'CONTACT PERSON _ utility rooms) 6.80
Nam Attic/crawl s.acc fans 10.00
Other: 10.00
Address: _ Fuel Piping
City /State/ _ • **($5.q0 for first 4, $1.00 each additional) •
Furnace, etc. **
• Phone: Fax: Gas hea�utnp 'i •
E -mail: • wait/susended/unitheater "
';`,'••','R',1,:'?.,7a CONTRACTOR Water heater •`
Business Namea - '0. '}'t Fireplace as
_ ,l :�� Range a
Address: . (.D • • S� `1L e, w Range
«,
City / State /Zip:C_XOt c>!,rn� a t p Q. �'Z� 1. Clothes dryer (gas) _ "' ^
Phone: o a 9 . O Fax: p _ ' - a Other: "
CCB Lie. #: t--( /y . .: _ Total: _
L ! Mechanical Permit Fees • _
Authorize / I Olt' Subtotal: S
Si alure: : v l Minimum Permit Fee $72.50 S "a
yye_ . _
Q � Plan Review Fee of Permit Fee) 5
(Please print name) State Surcharge (8% of Permit Fee) S ,
. TOTAL PEIRMIT FEE $ • ri T (0
Notice: This permit application expires if a permit r i
. is not obtained within *Fee methodology set by Trl- County Building Industry Sece Board.
I8a. days after it has been accepted as complete: • **Site plan required fur exterior A/C units.
i:\Dsts\Perntit Forrns\MecPermitApp.doc 01/03 .
JUN -01 -2004 14:26 A TEMP HEATING 5035572990 P.03/03
e •
-
A -Temp Heating and Cooling
Site Plan
Prepared by ` Date: t I 1
Customer Name; knj Address. 3(4.) I l --
Customer Phone 3 / -
.Properly I3ou►xlary Line
House
SW ILL- 4, •
Slrcct
TOTAL P.03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 -4175 MST _ r
INSPECTION DIVISION Business Line' 03) 639 -4171
BUP
7
Received • Date Requested AM PM BU •
Location 5� / 1 — Suite EC - 16 00
Contact Person Ph ( ) 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: 6701 -0{Z 6 ii V,EwMouKr
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 4 /)'
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear 447,\J'%-e-1:9\ w LC *7-.4) 0 L - OQ 3 4 .-
Framing �1
Insulation
Drywall Nailing
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 / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
S • . - Dampers
q 'AS = PART FAIL
- RICAL
Service J
Rough -In t
UG/Slab
Low Voltage:
Fire Alarm
Fi
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 1 7, L. /
Approach/Sidewalk -� 1
ADA D v Inspector — L ra. Ext
Other:
Final DO NOT REMOVE this inspection record the Job site.
PASS PART FAIL