Permit n
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00222
� e ��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/29/02
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PARCEL: 2S104BD -06000
SITE ADDRESS: 12621 SW 138TH AVE
SUBDIVISION: ROSE MEADOWS ZONING: R -7
BLOCK: LOT: 019 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: 1 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: AIR HANDLING. UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of exterior A/C unit. Cannot be placed within the required setbacks.
Owner: FEES
OSTROW, DINO S + JENNIFER M Type By Date Amount Receipt
12621 SW 138TH AVE PRMT CTR 5/29/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 5/29/02 $5.80 2720020000
Total • $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 620 -5643 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 -0080.
You may obtai copies of these rules or direct questions to OUNC by call' g (503)246 -9189.
Issue By: / / U� � � Permittee Signature: /%t, 4,0 _ L I - � Call (503) 639 -4175 by 7:00 P.M. for inspections needed th —next business day
May 23 02 10:03a Spec• -i-a, t 1 Heating 503 598 0718 p.2
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Mechanic ermut Application EirifEMENI Permit no -: fit* - DGLIZ) -- -
,„a Cr : �f Tigard ( '� J VE � � ! t:cdappl. no.: Expire date:
Ci o Tr and Address: 13125 SW Hall Blvd, Ttg Proj
rY f Phone: (503) 639 -4171 Date issued: By,, :imp, Receipt :lo.:
Fax: (503) 598 -1960 • . MAY 2 3 2002 Case file no.: Payment type:
Land use approval: City up. 11 . Building permit no.: „y ^_
Al 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family CI Tenant improN ement
CI New construction Addition /alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHE
Job ark r e: / e r2 Si j ,Q f. Indicate equipment quantities in boxes below_ Indies to the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, )verhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: 7 S ow/ jurisdiction's fee schedule for residential permit fee.
City/county: Tit 64,,4_, /f ZIP: %' 70,2 I & 2 FAMILY DWELLING PERMIT FEE S i EDULE
Description and location of work on premises: Cato .au AND COD'IiVMERJCAUJYNDUS1`RIALJ QUIPMEN . CHEDULE
5 Fee o Total
Est. date of completion/inspection: nl Res. only
� oY Description Qty. Res. only Res. only
Tenant improvement or change of use: IEivA •
Air handling unit CFM
Is existing space heated or conditioned ?Yes C1 No Air conditioning (site plan required) f •
Is existing space insulated' (Yes CI No • Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business nam • / i 4L . 0 11 Q ei # 41 17 hL State boiler permit no,:
Address: 5 .S if ale s r / - Tons 13T
Firdsmolcc dJmPcrgldu<t smoke do Lectors ra
City: iT6'624 Q State: p 41 ZIP: q 7„.a.3 Heat pump (site plan required)
Phone;t3(0,0644.44Fax; 98 -0 V / E -mail: - install/replaceturnace/bunter BTU /1-I
Including ductwork/vent liner O Yes CI No
CCB no.: - — ._....
S � T (� Install/replace/relocate heaters - suspended,
City /metro lit. no,: ,/ 6 — wail, or floor mounted
Name (please print): • a rtr 101- eiS vent for app Lance other than furnace
CONTACT PERSON Refrigeration: .
Absorption units BTU/H
Name: 4-1 L-e__e /`( / n n e A. Chillers - HP
Address: q-5.9- R' (.<D' - 7 -- /A-.4 ell S 7- Compressors - HE'
' , ice o StaIc:0 ZIP: L7 7oi
Environmental v enal exhaust and ventilation:
City: 7
J Appliance vent
_
Phone Sp 3 6. 20 `r -.,(�, ' Fax: 59 -0118' E -mail: Dryer exhaust .
OWNER Hoods, Type 1/ II/res. kitchen/hazrnat
- hood ( NO 05 0 t4/ Exhaust st fan with singe d iem
Name: l Exhaust an with single duct (barb fans)
Mailing address: I;;‘,.., , I S (;t ) ( g 0 (r - Exhaust system apart from heating or AC
City: 7 / (�� State: 0X ZIP: q 7 3 roil piping and &tribution (up to 4 outlets)
y Type: LPG NG Oil
Phone: ? . 9 ~ (a3 Fax: E - mail: Fuel piping each additional over 4 outlets
ENGINEER ' recess piping (schematic required) �-
Name: Number of outlets
Address: Other listed appliance or equipment:
Decordt�ivefire Iaee
City: I State: I ZIP: ns l ert - type - - .. ,
Phone: ax; I E-mail: Woodstovrfpellctstove
Applicant's sig rue: /O ,pate: ,_4/a 3/0.- - Other.
Name (print): r° frt t-f 0 6e. f j tSkilwli�(I'. ...
' Not/ m
dt jurisdictions accept credit et:, please call jurisdiction for more it for nation Permit fee _2( `TO
eff Visa ❑ MasterCard Notice: This permit application Minimum fee $
., expires if a permit is not obtained • Credit card n Plan review (at %) $
apices within 180 days atkr it has been State surcharge (8%) -___ $ J Z-
Np e u wet tin cre t card accepted as complete.
s TOTAL S _ "n U
■ L ardhordec sir�atm Amount i 4, 0.461'7 (6/00iCOM)
May 23 02 10:03a - Specialty Heating 503 598 0718 p.3
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CITY OF TIGARD 24 -Hour
B£3$LDING._ Inspection Line: (50 639 -4175 p
INSPECTION DIVISION Business ss Line: (503) 63 9 -4171
MST
� (� BUP
Received Date Requested AM PM BUP
Location /�"� �' f J 58 - Z 2
Suite MEC �-
Contact Person Ph ( ) 6.3—e � PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: � �
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear \ ,� ,� / 2 /j, I
Framing V Y l ���.a�! "� (,
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof )9/
Other:
Final �--J
PASS PART FAIL
PLUMBING /
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer (f
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In iX V
Gas Line
_Smoke Dampers
PART FAIL
E CTRICAL
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: Unable to inspect — no access
Fire Supply Line ( � /
ADA Approach/Sidewalk Date / / Z Inspector s v Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL