Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00653
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/2004
PARCEL: 2S111 DC -02900
SITE ADDRESS: 15685 SW ALDERBROOK CIR
SUBDIVISION: SUMMERFIELD NO.8 ZONING: R -7
BLOCK: LOT: 476 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace.
Owner: FEES
HOFFMAN, FRANCES M Description Date Amount
15685 SW ALDERBROOK CIRCLE [MECH] Permit Fee 9/29/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 9/29/200 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
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: _ 7 s �� .v Permittee Signature: .L.c, 0
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Sep 23 04 11:25a PAM DALBY 503 - 598 -0270 p.2
Mechanical' Permit App m� \ FOR OFFICE USE ONLY
V l3 I 2 S of Tigard EI Dalc/B y � � y / '� PerntNo. � (� �f�y ,5
f� 4
131 25 SW Hall Blvd., Tigard, OR 97221 Plan Review
Phone: 501.639.4171 Fax: 503.598.1960 ( � ( "� ql l dy �; e Date/By: OtherPerr nil:
inspection Line: 503.639.4175
JC L .j,l r7 W Date Rcadyaly: lurb El See Page z for ;
Inter,.e;• a ^.v .ci ttga:d.Or.us CITY OF TI Notifsed/Method: IT �r I Supplemental tnformacon
'.h .. - iy'J `.-C:'" ,� ,..,� \ iEa�,Y� ,�.. Cis •• tr!:;i �'..� ^t'''.,: , '.� M': - t
ea' : : :..' : ':tot : is ... Y';' . ... .t` ;Y::COMhERCT: :%BEE. C'EED_i5L.E' 'USDCHEC CHECKLIST
❑ New construction 'Addition /alteration/replacement Mechanical permit fees• are based on the value of the work
• performed. Indicate the value (rounded to the nearest dollar) of al: :
❑ Demol: :ion ❑ Other: • mechanical materials, equipment, labor, overhead, and profit _•
:, :h:,; ^ .A;.. 4•Aitfltvetcl - V 0 @.O�IV TRf ...., . "'• i,rt _'l. " :�',_:!.r Value: S
,...:'"'':rr.F:•••'' r ,' 5 ,.., �.....,• ;w -•..., IOIN:"s - ,a.:, ..,.... f....r. ti • , ::.: r. +r ,S DF EQUIRMEN'1 ' SYSTEMS FEES' •
I • I - and 2 - faruly dwelling ❑ Commercial /industrial ❑ Accessory building '
For special information use checklist
❑ Mul :i family ❑ Master builder ❑ Other:
Description 1 Qty. Ea I Total
Jp 'B:SIJ,;0,0p)w,4Tt10 $, t0 ATl1'O .. : ,:;:.':;:,':, Heatingcoolin
r Air conditioning or heat purrp
iob si :e address. /� g ,5 ! /. ✓ .,,L e" . - (requires P showing )
5 re wires sit tar. showin placement) _ 14 00 i '
Ctry /State /ZLP Furnace 100,000 BTU (ducts /vents) _ / 14.00 1
Saitebldg.lapt. no.: Project name: Furnace 100,000+ BTU (ducts/vents) 17.90
•
Gas heat pump 1400 •
Cross street/directions to job site: Duct work 14.00 1 .
Hydronic hot water system I 14.00 ' •
' Residential boiler (radiator or j
hydronic) 14.00 I I
l Unit heaters (fuel -type, not electric), i
in -wall, in -duct, suspended, etc. 10.00
Subdi •isroc: Lot no.: • Flue/vent for any of above I 10.00
Other: 10.00 I .
Tax rnapi -arcel no.: ' Other fuel appliances
;'- ; .,. ,
c a 't' Wat er heater 10.00
.
:.Y.�' /; ; •; w`;:• •; :c;G .. ;r.? : µ )r�'• s. f` n . r, k :¢,�' E, � u ^r•. . k., .., ; �
` ''?. `. ;:ZS',': ,.;t, : :t�•••;= !:; .^' ;, r §CI IPTi( •
t''07 /n E?I
"`x_ a: ; '> ' , .1; : ,... . '':r; - .
Gas fireplace 10.00 ; _
/7,e, /A{,/ • fit,' /t _. lue vent for water heater or gas fireplace '10.00 i
Log lighter (gas) I 10.00 ! _
Wood /pellet stove I IO.00 :
' Wood fireplace /insert ,0.00
.c z .. rn -w'• : srr. w.. s . .. .. , y /liner/(111e:v 10 00
r `_.!• - ):,. {: r Sy: (; , . t Chi me e ^.:
�':e �`�. ... :`Q,, .ti.c .�,I+[ �r•'f'; ..,: '_i`' ,. -•, ,:Sr,:. r rxc' Other IC 00 l
Name: ���� L /„ � Environmental exhaust and ventilation
' Range hood /other kitchen
Address' f 7
S/ r c� /� /,,e/).64.4),,y< avi", equipment 10 00 ,
C':tyiS:ate /ZIP: � � Clothes dryer exhaust • 10.00 I •
Single -duct exhaust (bathrooms, •
1 Phone 503 ) 63q r Fax: ( ) toilet compartments, utility rooms) 6 80 I i
_ _,_; 4i.; ,.p / Af z. v "'tr s:; ct-::p. t s - ,, ..aa:t r . -. Attic /cr awlspace fans 10 00 1
_ =�. ®w "AEPI(:A?y '- �a, �: C` 1 . :,, s `
Business name: Other: IO.CO t
Fuel piping I
Contact name: f ( ■7) b I 55.40 for first four; 51.00 for each additional
I Address:
Furnace, etc.
Gas heat pump I '
City /Sfa:c /ZIP: Wall /suspended /unit heater
Phone: (7 ) (J ay 0, 0 , (� Sei i GA D . `Tearer hea
T / Fax:: Fireplace
E -mail: Range I i
t .h•!:e. �7rcr•. .r•k�:c�, .tA_. Vey :: ��.,_ ,�s;.yt•a:,.,,, ...
ly;;.:i_:'Tir�. :;f�f`d, :r. CS� n:.t.t }::! /r: Barbecue I
-� , ' s. �, . -. "} ?•:':' ti.�- . -ti -. ,a�S>4'.- -m. ;v..�1. .- .L.;'r.. : -�`:r i
Business name: o (u I` 6 pd . 7 L.� {A .. n �� .� e / x /V4 Clothes dryer (gas) 1
Other I i
I .Address: 0 6 o x c% 3b 3 97 " e;',4 t' yes ::;1MMEC A 1CA1 PERMi7':EEES** 1
City /StateiZL°: 7 / 4- A -,a-l> 02. 97 ,.3 Subtotal
Minimum permit fee ($72.50)
1 Phone:( ) Fax:( ) G (25% �� " /i o? e { r,Z I v �03 S? Er oZ 7 D Pl an rev (25 /e of perm:; fee)
CCB tic.• 7 0,5 9 I State surcharge (8% of permit fee)
TOTAL PERMIT FEE 1 75 k so',„3
/ This permit application expires if a permit is not obtained within ISO
\cthorizcd signature: �LIiYJ/ '2 L1 - P�l�
days after it has been accepted as complete.
I Print name: Date: 0 ,1 1 ' Fee methodology set by Tri- County Building Industry Serv,ce Ooa:d
r' fiuddicc tPcrm:u'.N-EC-Pcrm :tnppdoc 12/03 a40.461 ST r fl /C2iCOtt1WESi
CITY OF TIGAIRD 24 -Hour
BUILDING Inspection Line: (503) 639 -
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date eq es ed A -g AM PM BUP
Location / S 7 g ; 6 ---- Suite 4 L_ 90
Contact Person / Ph (_ ) 6 �.� � �a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC A 'L --
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam D6-S c-e
Shear Anchors ✓v\ 9-v\ -i`
Ext Sheath/Shear �
Int Sheath/Shear \ n n EL 7s-924--
r 1
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 RT FAIL
M H AL
Pos Beam
Rough -In
Gas Line
Smoke Dampers
ma
P PART FAIL
EC TRICAL
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
ADA
Approach/Sidewalk Date /0— k --o Inspector • Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL