Permit { \.. CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00524
, �- Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/02
PARCEL: 2S1 10D B -90952
SITE ADDRESS: 15437 SW 114TH CT 95
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO ZONING: R -25
BLOCK: LOT: 095 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:
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: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install piping, 1 outlet and gas insert.
Owner: FEES
RAYMOND GEORGESON Description Date Amount
15437 SW 114TH CT #95
TIGARD, OR 97224 [MECH] Permit Fee 11/22/02 $72.50
[MECH] Permit Fee 11/22/02 $0.00
[TAX] 8% StateTax 11/22/02 $5.80
Phone: 503- 624 -6104 [TAX] 8% StateTax 11/22/02 $0.00
Contractor: Total $78.30
LUDEMAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 646 Gas Line Insp
Mechanical Insp
Reg #: 51469 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)246 -669
Issued By: A I .� _ _ m Permittee Signature: 4" _ 0- L
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
••.. �� ���� : :v •.a.a r.r V1 Vi V1 11801U VU..
, J
`' Mechanical Permit Application
• D a l e r e c e i v e d / l - 2 L Permit no.: "` ,? .',
City of Tigard
o�gard Address: 13125 SW ft ] appl. no.: Expire date:
City Phone: (503) 639 -4171 ' Date issued: PM v Receipt no.:
Fax: (503) 598 -1960 NOV 1 2002 Case file no.: Payment type:
Land use approval: Building permit no.:
• 1 1laASO
l Pl. OFIERMII
-
1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family DI Tenant improvement
O New construction Addition/alteration/replacement 0 Other
JOB SITE INFORMATION - COMMERCIAL VALUATION SCHEDULE
Job address: - y 3 7 • ) / / c 1 / 7 ' f 5 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials. equipment. labor. overhead.
Tax map/ax lot/account no.: profit Value $ .
Lot ,Biotic i Subdivision: *See checklist for important application information and
Project name: oa • jurisdiction's fee schedule for residential permit fee.
7 j q
City /county: - 2 'ZIP. 9 -7aa y 1 & 2 FAMILY 1)I1 ELLING PERMIT FEE SCHEDULE
Description and location of work on premises: • r rt fa // --=eND -(I- MM€3t4C i t !LM1 - - I • t -
Zr)SCr - Fee(ea.) Total
Est. date of completion/inspection: Disaipdnn Qty. Res. only Res.only
Tenant Improvement or change of use: HvAe
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit cFM
Is existing space insulated? O Yes ❑ No Air rati of existing t s n t g plan required)
Alteration of existing IIVAC system
MECHANICAL CONTRACTOR Boiler/compressors
Stare boiler permit no.:
�'i. .. . HP Tuna BTU/H
Address: / _ .: _ • e - . Fire /smoke dampers /duct smoke detectors
City: __ E State:O - ZIP: - 7005 Heat pump (site plan required) _
-. r�� - l s E-mail: Instal -. lace • toter : TU • O
E�horte�j � Including ductwork/vent liner Ycs O No
CCs 110.: _57V( o.: _ "� i a,3 a-
install/replace/relocate beaters- suspended,
City /metro lic. no.: _ wall, or floor mounted
Name (please print): /, di 44 vast for a , ftanceotherrhan furnace
CO\ IACT PERSIri Refrlgeratio>r
�/ Absorption units BTURi
•
Name: �s h/ 4G A4/2 </2 Chillers ' HP
Address: c--54,41 Co •.. • HP
• tmtal exhaust • • - • . au: •
City: I State: I ZIP: Appliance vent
Phone: Fax: E-mail: b erexhaust
OWNER • • . ype 1 Tres. en/haxrnat
hood rue suppression system
Name. t .q �/ /7) n n G eQ r6 p• n Exhaust fan with single duct (bath fans)
Mailing address: / r e/, 3 ) j / V 7!w' C f .E 95 Exhaust em :.: from bcsdng or AC
City: /6q Stare48 ZIP = a Ftret and • on (up to 4 outl
- .[ Tyx- NG Oil ets . U D
Phone: 67 • - Co/0 E-mail: Fuel piping each additional over 4 outlets
ENGINEER. recess piping (schematic required) -
Number of outlets
Add i ! t 1. . a . , , • , or equipment:
C;../iii State: ZIP: n- type 7) <9 ) / /p4 - 0 /O. (To
• • one: Fax: E -mail: • • ' . _ . _ -..
Other.
Applicant's signature: Date: / /- /(, -4a_ other
Name (printtero; AA4C�r/C •
Not m jwisficriress accept neck mar, please cat jurisdiction for it iofonntim Permit fee - ---------- -- ....... $ /m - S"d
O Visa a Notice: This permit application Minimum fee $ 7 2 SO
Credit vied clamber / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been
Naas or eaei ider ea on card accepted as complete. Stale surcharge (8%) .... $ J e CFC:)
s TOTAL $ - 7X 30
Amami 6104617 ( M)
0
// - 0 C-
CITY OF TIGARDr-' 24 -Hour _
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
J BUP
1
Received _ Date Requested 0 � `� AM PM BUP
Location AS (/ 7 // °A-t Suite MEC ' ' 5 6 2 c/
9 Contact Person 4.11.L Ph ( ) 6 ezi6 PLM
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner ' LC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: et i SIT
Post & Beam
Shear Anchors ( 7 414 — Cat D
Ext Sheath/Shear CC
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 PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Fina
c - A RT FAIL
ELECTRICAL
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: . El Unable to inspect — no access
Fire Supply Line
ADA ! �
Approach /Sidewalk Date. _ /--62 Inspector j Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL