Permit CITY TIGARD MECHANICAL PERMIT
1, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00386
9 ' I-- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/18/2004
PARCEL: 1 S134DC -02200
SITE ADDRESS: 11670 SW 114TH PL
SUBDIVISION: 114TH PLACE ZONING: R -4.5
BLOCK: LOT: 015 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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: Install furnace
Owner: FEES
MARTIN, WILLIAM + OLSON, CINDY Description Date Amount
11670 SW 114TH PL [MECH] Permit Fee 6/18/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 6/18/200 $5.80
Phone: Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
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)246-6•••.
Issued =y: / J. N r� t_ Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
FROM :JacobsHeating FAX NO. : Jun. 16 2004 08:57AM P2
, - pr
08/16/2004 08:08 FAX 6035981980 _ . CITY OF TIGARD L0 03
Mechgalsal Permit Application t, l ltt 01 i 1( is i ,..di c l' t
*sea um
City of Tigard Dateril 1 Affej111111 • Permit No.; I C ,,. - e .0
13125 SW Hall Blvd., Tigard, OF1, 97223
Phone; 503,639.4171 PVC 503.598.19150 rit:
OlberFaa
Inspection Line- 603,639,4175 1
CC www.aL6 °''�'" • � + . Data Ready/By: � � Sae tape 3 4br
ate anus BEG BE - tconnoMMetbudr 4 , 14ppl•mansa1luterreecon
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❑ NOW oonstintctlott ❑ Additlaa/alie> ation/rapincement Mete a cal permit fete* air based on the value of the work
❑ NOW C Demolition ❑ Other perrfbrmed. Indicate the value (rounded to the nearest dollar) of all
ARC) mechanical mileage's, equipment, labor, overhead, and profit.
;;s, :, - 1 -- .7" - 7 i � I 1,4' Velue:5
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{� L- 6!115 2-family dwelling ❑ CommenciaUfndnstriel [] Accessory building
❑ Multi - family I:1 Muter builder 1:1 Other Description COY Ea. Total
l: 7s i, , ' m. s NL.., tf 'ci . 7 N( Qjl �ryif., i 1
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Job eta address: if D A tit + 1111 14,00 r
City/State/ZIP: . , •'4 ✓ . , t locum .. 4.00 IIIIIIIII
Siritrhldll 1apG no.: Project nun; Q/ 0,7 Furnace 100,000* BTU duatsIveats 17.
(}as heat • • r 14,00
Cross atrcet/direedow to job site: Duct work = 14.00 INN
,, ., tonic hot water • -' 14.00
•_,,,_,.■., Residential beer (radiator or
h • • a 14.00
irl in-du + dad ate. 10.00
subdivision: Lot no.: ► I Li : I
Tax map/parcel no.; Other
' E . { ' 1' ' ' U , . � �I l 1. , 1' � ♦, , ' °, `I . '1n ►111`, it 1 V., f , ,,t ho� fttiv11.01 Q�� 1 11
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:2. S6
10.00
Flue vent •• water heater or gas
fireplace 10.00 11111
allirl Log lighter (gee) 10.00
Woo. . let stove 11111. 0- IIIIIII
wood fir ,lic&insert 10.06
-, , 4 , " r - - +' � i , I Ch 10.00
h _ c �_ _r_. , - ;,o : _ . ,, 1. :...:;1r% , . Other 10.00
Nam= 4 a o / t EaVlmnmental Wt and ventilation
Range hood/other urban
Addrus: be A equipment 10.00
City/Sttn /ZIF; , j , / ` - Clotho dryer exhaust 10.00
Phone: (503 0 � I -; .. 0 toilet c�uoi mts. Toony�) 15.10
/ �.. ■ I n - ,7,;,„. Imo: R , ti ! , r'7 If
h • I m .. ' ,� �' 4 I .h � 9 f � S 3 -� � 1 ! I . ,. :..'. `� : ��' � , � 1. �� Attic/craw] � e AIM 10.00
L �
Bttaiaoia name: ( cob 14t4r ► t r1,0 .4" IliC- _ Oth 10.00
COMMA nem= 5ht4 11 r") MC rri'11 51.00 for with additional
„
Furnace etc
4 E ti ..S • - (ias heat Ournp
City/state%ZIP: r, 0 p - i 0 Welt/attependedhu►itheater
Phone- (523) Z34 - " Palo : ( ) ;04 67 Warerheater
F awe III
l i ie.il:
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Buainneas_namtk �y /[•J i 0 it /� / ,,, •# 0 4 9 'l Clothesdryer(I��s �
Omer
Addreyi- I�1T i 'e 'I1,J/ `��• re. ri Ye' 1 N - 7:7 I T,
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-
Phone: (50 ,,, . • A Fait. (50 3) . • ." 's'7 plan review (25% permit fee can.. n) it ha) tin
CIS 11c.: 1 •
��A
. TOTAL PERMIT r ,
Authorized d � g 'INO � P Thi rlett ApplItaden aa Wage IY.. age to se eOtaieed within Zia
// ( "/ days after it bate bean mowed as annotate,
orate,
l Prim m - in I Date: Zoo _14, _ D( /, . • Fee tnedwdeiegy teat by lti -County Bmlding htdaaa y 6•rvice Barad
111awaltaa1Yaraitt1MSC• AK 12/03 444.461.7r0tro2/ootrvW1151
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 - Z d AM PM BUP
Location MD 7n Suite MEC 4 / - 66 2.3 , � 0
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
//��
BUILDING Tenant/0 v�e L--endet ELC
Footing S 9 7 7e
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear
Framing ' ELx�L� CAL- i1/44d/Z- l� -+�� 64A-e C�/o
Insulation
Drywall Nailing 67 39/5
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
Smoke Dampers
i dgrIP
4 PART FAIL
TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7- �" Inspector 2 Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL