Permit CITY OF TIGARD
MECHANICAL PERMIT
'0, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00447
I' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/8/2004
PARCEL: 2S104AD -02100
SITE ADDRESS: 12585 SW 128TH AVE
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 048 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install exterior A/C and gas piping. Do not place A/C within the required setbacks
Owner: FEES
AARON HUGHES Description Date Amount
12585 SW 128TH AVE [MECH] Permit Fee 7/8/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 7/8/2004 $5.80
Phone: 503 997 - 6403 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 284 - 2173 Final Inspection
Reg #: LIC 222
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) 39 -4175 by 7:00 P.M. for inspections needed the next business day
• FOR OFFICE USE O \1.1'
Mechanical Permit Application Received Mechanical
Date/By: Permit Noi7 /C Z' i<- 4 ¥y 7
City of Tigard 1E../1--• �" Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 n 2004 Data/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 fir , r Post Review Land Use
. � Contact Case No.:
Internet: www.ci.tigard.or.us ° ; '.' ; Contact ]uris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
R New construction ❑ Demolition Mechanical permit fees* are based �n the total value of the work
Addition/alteration/replacement I:I Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equip ment, labor, overhead and profit.
J & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
IQ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description i Qty I Fee(ea.) 1 Total
Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** f 14.00 l Li .
Job site address: \ S U \ Zg --`{ Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: \-k \A LS Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (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: I Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
k.S
DESCRIPTION w O ^ F ' WORK Gas fireplace 10.00
k. U �t r " . ■ N7
�' \1 �`1t �) Flue vent (water heater /gas fireplace) 10.00 •
v1 e t- G S P 1 p \ r`eS a Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
%PROPERTY OWNER • I 0 TENANT Other: 10.00
Name: V1/4003'01,1 \*‘A.V.eS Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 17..g5 Sw l Z&hn OIA Clothes dryer exhaust 10.00
City /State /Zip: Ty CuCd S - CV-11,22:. Single duct exhaust
Phone: tVki - l.p Fax: (bathrooms, toilet compartments,
0 APPLICANT ® CONTACT PERSON ' ` utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *(S5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. **
Gas heat pump **
E-mail: WalUsuspended/unit heater **
CONTRACTOR Water heater **
Business Name: 1A t 1- 1e1V l i. Fireplace **
Address: . 2J v\E MlI -3V ‘Dkiet Range i ** t •40
l3Q **
y
Cit /State /Zi l p� C � I7`(��1.� (� a 1 UZ Clothes dryer (gas) **
Phone: a�5 -t- a Fax: a2 - -1c.352- Other: **
Total:
CCB Lic. #: -2.1 Mechanical Permit Fees*
Authorized + r�� p Subtotal: $ q 0
Si \j 1- --F'� v ""t Date: -1 I (I 124 Minimum Permit Fee $72.50 $ ' O
U , C- v''& V i'-ia- t Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 'KO
TOTAL PERMIT FEE $ '1 , ..E,
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i :\Dsts\Permit Forms\MecPermitApp.doc 01/03
AAA HEATING & COOLING
2915 NE MLK 7R. BLVD
PORTLAND, OR 97212
503- 284 -2173
FAX 503- 284 -1552
CCB #222
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503),639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
-\ BUP
Received Date Requested AM PM BUP
Location / s 0-S , g Suite / (IV- , e 0 V - e 6 W7
Contact Person cJ ��� Ph ( ) Zd T - a / 7.3 PLM
Contractor c Ph ( ) / SWR
_BUILDING Tenant/Owner ELC Wk--(.. Footing ?9 7 - ( 4-j I - ) ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: a SIT
Post & Beam .
Shear Anchors 3 ) 4ni-e_y, U _ _
Ext Sheath/Shear
Int Sheath/Shear - EL, 6 Gp , _ i r 5
Framing L� / '
Insulation
Drywall Nailing
Fire Sprinkler
30\ �� o V \ ' c�'v�`' \>
P
Fire Alarm
Susp'd Ceiling
Roof l h ) /� ` l ' ' / l `- /
Other: —10 e (AA g .-\ )c7' L ) `-1�' L- � � `IV
Final `
PASS PART FAIL � � �/ ,
PLUMBING l�
Post & Beam
Under Slab
Rough -In ( /
Water Service
Sanitary Sewer ■I: ' V N '' '� !� ►► +
Rain Drains '
Catch Basin / Manhole
Storm Drain /
Shower Pan `�'� ),57
Other:
Final
PAS
A RT FAIL
A
eam (� / C (
Rough -In Vic 5
Gas Line
Smoke Damp rs(/
RT FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
4 Alarm
'� PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector 44_' Ext
Other:
Final DO NOT REMOVE this inspection record from the site.
PASS PART FAIL