Permit I, ga
CITY T I GA R D MECHANICAL PERMIT
lilt DEVELOPMENT SERVICES PERMIT #: MEC2004 -00565
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/2004
PARCEL: 2S 109AB -04400
SITE ADDRESS: 14362 SW 134TH DR
SUBDIVISION: THREE MOUNTAINS ESTATES ZONING: R -7
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Gas piping and 1 outlet.
Owner: FEES
MOLUF, CARLA Description Date Amount
14362 SW 134TH AVE [MECH] Permit Fee 8/19/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 8/19/200 $5.80
Phone: 503 - 579 - 8300 Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Final Inspection
Reg #: LIC 143335
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: 6q.,1 Permittee Signatur
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
, 10/03/00 TUUE 14:59 FAX 503 598 1960 CITY OF TIGARD Q) 002
)
t! Mechanical Permit Application
vTr Date received./ i/� Permit no. ii CC, e ,ol/' -d0 •► 65
f l City
ma " y of Tigard ProjecUappI. no.: Expire date:
City af'Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639-4171 Date issued: By: tai, Receiptno.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: —
. • TYPE OF PERMIT
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB ,SITE INFORMATION I • COMMERCIAL VALUATIOI SCIEDULE •
. Job address:,' -., Q \' ( ` V p, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: • jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: I & 2FAMILY DIVELLING. PERMIT FEE SCHEDULE
Description and location of work on premises: _ AND COMMERICAL/INDUSTRIAL EQUIPMENTSClEDULE
\r\ S) X.) 0. �, c. \l` N Fee(en.) Total
Est. date of completio t pection: 'J�3 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 Na Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
• . MECHANICAL 'CONTRACTOR , i Boiler /compressors
Business name. State boiler permit no.:
,�•� x C�J HP Tons BTU/H
Address: G\ "— Fire/smoke dampers /duct smoke detectors
Cit)( rY __A, 4,1_ EMI Z I ? N'A- _ - Heat pump (site plan required)
Phon�� �"➢�� ���mail: Install /replacefurnace/burner BTU/H
CCB no.: \\--11b� Including ductwork/vent liner ❑Yes CI No
Install/replace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
• Name (please print , A - f. 11111 I Vent forappliance other than furnace
- CONTACT PERSON 1 1 Refrigeration:
Absorption units BTU/H
Nam ta/X\ei -- Chillers HP
Address: G 5 cR A � \� p,�P Compressors HP
Environmental exhaust and ventilation:
Cit} � CA ■ State II ZIP: O\ ' .) Appliance vent
Phone, - -6 4,F. •,,, c ls 'G,e -mail: Dryer exhaust
owl' u. I Hoods, Type 1/ IUres. kitchen/hazmat
�
hood fire suppression system i
Name C- G J �( x �c \ Exhaust fan with single duct (bath fans)
• Mailing address: \y) ,'1'h Exhaust system apart from heating or AC _
City: �, St n . t ZiPCIt
...1:1. Type; piping and distribution (up to 4 outlets) As. Fax: E - mail: Type: LPG 1 NG Oil 5 \r
Phone
- !•Pal Fuel piping each additional over 4 outlets
ENGINEER . Pro piping (sc hematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: State: I ZIP: Insert - type
Phone: I Fax: E -mail: Woodstovelpellet
A Applicant's signa Other.
PP b'n :� I Date:g, �� �("}.,� Other:
Name (print): c. . -
"' Not all jurisdictions accept credit cards, please call jun tenon for more information Permit fee $
Notice: This permit application
0 Visa 0 MasterCard Minimum fee $
Credit card number:
expires if a permit is not obtained plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ ��ks]
■ Cardholder signature Amount 4404617 (600/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 ��� MST
BUP
Received Date Requested a.) 2 t _ 1141 PM = I •—
Location / q 6.D--- /2 T mil. i (O2' Suite E 9 D♦ -./Z-S -,
Contact Person Q Ph ( ) g`S - 7 - SL-(3?' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/041 ELC
Footing s Q d
Foundation �` ELC
Access
Ftg Drain : — — ' ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �--- 0 4 l D N _ C 9 L CA----
Susp'd Ceiling
Roof
Other: �
Final J 0 C 1 n ' =- S J` -- e
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 RT FAIL
PASS
0 A
Post& Beam
Rough -In L
ina I
Smoke Dampers
SS ART FAIL
I CAL
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: 0 Un f le to inspect — no access
Fire Supply Line ``..
Approach/Sidewalk Date 25 j Inspector Aii• � / _ Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL