Permit � CITY OF TIGARD MECHANICAL PERMIT
IA DEVELOPMENT SERVICES PERMIT #: MEC2002 -00072
''` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
PARCEL: 2S1 14 A0 -01500
SITE ADDRESS: 17005 SW 92ND AVENUE
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: 1 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Restroom with sports storage - Phase II of Cook Park Master Plan expansion.
Owner: FEES
TIGARD, CITY OF Type By Date Amount Receipt
13125 SW HALL
TIGARD, OR 97223
Total
Phone:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 692 -1565 Final Inspection
Reg #: LIC 5193
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 -0QS0. You may obtain copies of these rules or direct questions to QUNC by calling
rnR» _cl I R4
Issue y: � ( Q , Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
. - - ST--iDOH ,a " /VoQ..fs �-ToL `k.-
J" MechanicalPemmit Application ,
Date received: 7 e 1. Permit no.• Kfeaooa -o®o7
jiti
i � City of Tigard Project/appl.no.: Expire date:
City nfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Cut 2Zot 000p ( Building permit no.:
'`' , - ,, . , TYPE OF PERMIT v- •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
LI New construction ❑ Addition/alteration/replacement ❑ Other:
•4 k ' �
• s- JOB SITE INFORMATION _ ' . -' `: , -''.. ` °-COMMERCIAL VALUATION' SCHEDULE: .f ,
4" 5..
Job address: l ?c '5 3 GJ "702 ' I OC , 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: (Block: I Subdivision: *See checklist for important application information and
Project name: ,, KRq, ep4t , -- ` ,.L jurisdiction's fee schedule for residential permit fee.
City /county: do /}/zej L( )4., . ZIP: GI 1 3 1 & 2 FAMILY DWELL ING PERMIT 'FEE SCHEDULE
Description and 1 ion �f mirk on pre ise : AND COMMERICAL/INDUSTRIAL EQUIPMENTSCUEDULE
. `jTo NOe oOQ}(t Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? ❑ Yes LI No conditioning c unit CFM
onditng onditioning (site plan required)
Is existing space insulated? ❑ Yes LI No Alteration of existing HVAC system
" - MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
r HP Tons BTU /H
' \' ARROW MECHANICAL Fire /smoke dampers/duct smoke detectors
10330 SW T RD Heat pump (site plan required)
Install/replace furnace/burner BTU /H
TUALATIN OR 97062
Including ductwork/vent liner ❑ Yes O No
PH: 503- 692 -1565 CCB #: 5193 Install /replace /relocate heaters— suspended,
wall, or floor mounted
Name (please print): Vent for appliance other than furnace
't CONTACT PERSON
,' . ' Refrigeration:
a _ Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: 'State: 'ZIP: Appliance vent
Phone: Fax: ' E -mail: Dryer exhaust
<. - OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: F : 1 E -mail: O W 000 stove
Applicant's signature: , I Date: a -/1 -0a. Other
Name (print): 3--!; . 4. 1e
Not an jurisdictions accept credit c: , , please ca urisdiction for more information.' Permit fee $
LI Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Pl review evie (at %
Credit card number ( %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount i 440 -4617 (6/00/COM)
CITY OF TIGARD 24 -Holur 1
BUILDING - Inspection Line: (503) 639 -4175 "
INSPECTION DIVISION ` ' Business Line: (503) 639 -4171 `
0,
Received Date Requested uested I 7 / AM PM BUP
d
Location 1 on , S q9, IU 17 Suite " 60 7 3
Contact Person 'i/ ltPA/ Ph ( ) 9 ? ' 15 1 0 5 PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner ELC
Footing
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
Susp'd Ceiling
Roof
Other:
Othe
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan 0 \
Other:
Final /
PASS PART FAIL og,
MECHANICAL
Post & Beam
_c NGaas Line ne 1 d
Smoke Dampers
Final
PASS jPART FAIL
areTRICAL
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: Unable to inspect — no access
Fire Supply Line --a--
ADA
Approach/Sidewalk Date / O nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL