Permit , CITY OF TIGARD MECHANICAL PERMIT
I, DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00095
..�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/4/04
PARCEL: 2S 104AA -05400
SITE ADDRESS: 12225 SW 127TH AVE
SUBDIVISION: BELLWOOD NO. 2 ZONING: R - 4.5
BLOCK: LOT: 075 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install furnace and exterior A /C. Do not place A/C within the required setback
Owner: FEES
ROBINSON, CRAIG W /DENISE E Description Date Amount
12225 SW 127TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 3/4/04 $72.50
[TAX] 8% State 3/4/04 $5.80
Phone: 503 -590 -8084 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 66578
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:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nex b siness day
‹•"." a ; . er FOR OFFICE USE ONLY
- Mech a 'ermit A )plication , Received Mechanical
Date/3/0V ii Permit No.: n1E.C.,9-00.-/-0C
'). RECEIVED By: ,f
— planning Approval Building
City,41 1 r,,...A. rd Dates : Permit No.:
131 . SW: r. - . Blvd. Plan Review Other
Tig gon 97223 MAR 0 , I:4 Date/BY: Permit No.:
Phone: 50: -639-4171 Fax: 503-598-1960 ..\ Post Land tile
,i ■t Date/Hy: Case No.: -
Internet: Ix ww,ci,tigard.or.us CITY e„1 ,-, i : Contact Julia,: El See rage z ror
24-hour In pection Request: 503 ;' : '"*. . , Name/Method: -77 4 Supplemental tnformation.
• ;:,. '• • TYPE'OFWCi/M.'.. • ,..;.'..-..• • • • • : • • . • • • . COMMERCrAE:EEESCITEDULE', IISE.CHECKLIST;;:'.!
r___Licw
construction [ Mechanical permit fees* are based on total value of the work
-- —
5PAilditit111/BiteratiOnirejAacement - ,='her: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORVOYCONSTRIIRETION
. - mechanical materials, equipment, labor, overhead and profit.
. ..' • .•:'. • •:-4:,;-• —
M SL 2-lzamily dwelling 0 CommercialandUSIrial Value: S See Page 2 for Fee Schedule
U Ai:loess La Building 0 Multi-Family . RESIDENT rAWTIMENT/SYStEMS FEE*.SCREDITEE.I..- '
Description 1 Qty 1 Fce(ea.) 1 Total
0 Master Builder 0 Other:
ting/Coolin
.*: • : j(ilillSITE INFORMATIONiiinkl:CATION.:•:,.. :.:' - , • urnac add-on ir conditioni !** 14.00
Job site ad dress: 112.-2 -CD )P- "v -
ittl pump 14.00
Suite #: Bidg./Apt,#: Duct work 14.00
Projeet a me: Hydronic hot water system 1400
N
. , Residential boiler
Cross stret t/Direetions to job site: (for radiator or hydronic system) 14.00
()nit heaters (fuel, not electric)
(in wall, in suspended, etc.) 14,00
Flue/vent (for any of above) I 0.00
Repair units 12.15
Subdivision: Lot #:
Other Fuel Appliances
Tax map/11 areel #: Water heater 10,00
.:". •• . • ' n.'::" ' DESC:RIPTION '• ' Gas fireplace 10.00
--.. !S rt c...„
f — Flue vent (water heater/gas fireplace)
L o li 1_arEj 10.00
Wood/Pellet stove
Wood fireplace/insert 10.00
10.00
10.00
Chimney/liner/flue/vent 10.00
El TRIREF Ty awNErt... ..:.... .1.; 0 3.E.Nisactm::: '4j, . • Other: 10.00
Environmental Exhaust & ventilation
Name: i"_ kxv,:)..1. k , '.. C.,ie•P'-k-i 12-0 i' ea 01.■ Range hood/other kitchen equipment 10.00
Addntss: Scr.....in.-.St. •-•
Clothes dryer exhaust 10.00
City/State 'Zip!
Single duct exhaust
PhODO: .5 - e i 0 -- Fax: (bathrooms, toilet compartments,
0: 'AP.J.Lic,; k.i1F.r. ,. . .::,.::;.: '. • .; gi !CO.NIII:it€1 utility rooms) 6.80
NalTte: Attic/crawl space fans 10.00
Addatss: Fuel iot g
_
Other: 10.00
. • . P
City/State 'Zip: **($5.40 for first 4, $1.00 each additional)
Phont:: Fax: Furnace, etc.
Gas heat nun) *4,
E-mail: Wall/suspended/unit heater **
. .
0 ONTRACTOR ,,,.• ;: ';•:•:iti ‘: . .:: • • - Water heater
. .
**
. : . •
Business Name: C e ..,.. e . c -..._. k , -f-t. i.--k c-i- r' Fireplace **
Address: 1 Lc (s) 1 Sc P.,' vz r 4,,f , Range .4.
813Q s*
City/S tate 'Zip: Hi • 1, (Sk cv-0 cw_. , 4- i-/ 2.7 Clothes dryer (gas) **
Phone: t.... -( -"g 0 . I Fax: 44:1- o 1-- 53 Other **
CCB Lic. 1 #: L. tf C ?",.:S' Total;
Mechanical Permit Fees*
Authorized / D \ r j i -
Si gnature: , Cts.ALA &Lc ,--- 3 19. i 01
,, .. Subtotal: S ....,...—
— Minimum Permit Fee $72.50 5 Fr 3:■
a 1.,_,..-z_._ U I c'e--. Plan Review Fee (25% of Permit Fee) S
f '
(Please print name) State Surchargelyo of Permit Fee) $ F(1)
TOTAL PERMIT FEE $ 2. . 3 0
Notice: This r ermit application expires if a permit is not obtained within *FCC methodology set by Tri-County Building Industry Service Board.
180 dari after it has been accepted as complete. **Site plan required for exterior A/C units.
i:\Dsts\P:rrnit I ornal\MeePermitApp.doe 01/03
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SITE PLAN
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STREET
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Specialty Heating & Cooling, Inc.
9528 SW Tigard Street F
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793
E'd SILO 86S EOS 2uz4eaH OaieioadS d66 :20 *O 60 ueW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ` 3 / ! f 3 i j 3 a t e Requested 3 ( q — U A.- PM BUP
Location / Z Z Z 5 / Z 7 ' ACJ Suite y U2 9 S
Contact Person Ph ( 6 .-) & «' — 3 &O 7 PLM
Contractor Ph ( ) SWR
BUILDING Tena Ow CJ'L ��] /ie 4.L4 -e �— � 44.,AP-■_ ELC
Footing '`� U 3 - z-90 - PQ ELC
Foundation Access: /2_ Ftg Drain ELR
Crawl Drain
Slab Inspection N e : SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
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 FAIL
os Beam
Rough -In
Gas Line
e Dampers
S PART FAIL
T RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El 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_9 / £ Inspector Ext
Other: 666
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL