Permit *CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00044
JI - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/31/2005
PARCEL: 1 S 134CD -02400
SITE ADDRESS: 11965 SW 118TH AVE
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 053 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: 1 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 3
> 10000 cfm: GAS OUTLETS: 3
Remarks: I
Owner: FEES
DIXON, BRADLEY S AND Description Date Amount
PE 965 SW 118TH [MECH] Permit Fee 1/31/200`. $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 1/31/200: $5.80
Phone: 503 - 590 - 3607 Total $78.30
Contractor:
G P & W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED INSPECTIONS
Phone: 360 Gas Line lnsp
Mechanical lnsp
Reg #: LIC 108176 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) -.. • • .
Iss ed By: ;, I ! /✓ ,� Permittee Signature: ' 0
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jan 28 05 02:41p GP &W Systems, Inc. 360 - 835 -5716 p.1
..
Mechanical Permit Ai Alett IV ED FOR OFFICE USE ONLY
City of Tigard A V R eceived / /fQ /I ....
Date/By: L 'V % ICI
13125 SW Hall Blvd., Tigard. OR 97223 Plan Review r '" '
Phone: 503.639.4171 Fax: 503.598.1960 JAN 2 ts ?p I '_r; 4 ; llRl ,,7 i ai1 DatclBy: Other Permit:
Inspection Line: 503.639.4175 _s,. e!1 ��� Date Ready/By: luris H See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIG NotifiedlMethod: ele./ Supplemental Information
U pt nK MVISION
�/ WOR COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ✓[ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the valve (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: S
� RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
LJ r and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist
El Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
f sou t / �'t� Air conditioning or heat pump
Job site address:
II i `p 5 SW [ I " " Ave_ (requires site plan showing placement) . 14.00
City /State/71P: 1 ,rCA q �3 Furnace 100,000 BTU (ductsivenis) ' 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Gas beat pump 14.00
- Cross street/directions to job site: Duct work - . - 14.00 - -
Bydronic 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
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace - 2... 10.00 2,6
L I i ♦ - • - n L.r p . dr _ Flue vent for water heater or gas
� fireplace ( 10.00 16
r r ." Log lighter (gas) 10.00
^ I] !S % 9, -� r Q � 9 Wood pellet stove 10.00
G�LC'• ' U ✓9 Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
0 PROPERTY OWNER ❑ TENANT Other. 10.00
Name:' n {- P.ennt� txa Environmental exhaust and ventilation
J ` Range hood/other kitchen
Address: , 1 41 6 5 S ( t vv. equipment 10.00
City/State/ZIP: �ie'r 4 e 7 2.2.3 Clothes dryer exhaust 10.00 .
J Single-duct exhaust (bathrooms,
Phone: ( ) 55Q - 3d^J Fax: ( ) toilet compartments, utility rooms) 6.80
(ABPLICANT f CONTACT PERSON Attic/crawispace fans , 10.00
Other 10.00
Business name , s t _I � silents * G 40
Fuel piping S• "
Contact name: 1. / !/'AJ& Nc, 55.40 for first four; SI.00 for each additional
3 L m � R Gas heat ea etc. pump
Address: .
Gas heat
City /State/ZIP: blico itau et Q (J 4 4,%•-fi Wail/suspended/unitheater ,
Phone: gay g3 S . 35 J(d l Fax: : CEr341.. S7 /6 Water heater
Fireplace 2
E -mail: Range I I
CONTRACTOR Barbecue
Business name: f0 Q (- S ei s s ��.c Clothes dryer (gas)
Other.
Address: _ MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal
Phone ( ) ( ) Minimum permit fee (572.50) . 7 2. 56
Fax Plan review (25% of permit fee)
CCB lic.: 6C'. //7 , State surcharge (8% of permit fee) 5 ..sa
.40 (G/'� I TOTAL PERMIT FEE 7 3 ,
Authorized si : '� This permit application expires if a permit is not obtained within 180
.. � - days after it has been accepted as complete
Print name: a a g _ Date: ( * * Fee methodology set by Tri-County Building Industry Board
P , : ■ — "co 0 ,o WWII 21 3 /i --Mck
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 503) 639 -4175
INSPECTION DIVISION Business Line: 503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location I q k Suite MECS D° 6/ C
Contact Person (. 3(00 ) - 7 7 - '- R PLM
Contractor / 'h ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: k A-7 � � � � �'
Ftg Drain -
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear `--� 1(2 ; /0 /0 s a
Framing
Insulation
Drywall Nailing /�
Fire Sprinkler fie
Fire Alarm
Susp'd Ceiling
Roof j` C_‘ PLiFt (S)
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service 'cat. :r■l. �'t
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Cool
Post & Beam
R.
� - Dampers
'ASS -ART 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: ` ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Z ( 0 S Inspector - 4 - Ext
Other:
Final DO NOT REMOVE this inspection record fro the ob site.
PASS PART FAIL —