Permit sue:
_tiPe ,
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004-00799
c'f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/2004
PARCEL: 1S134CB-13600
SITE ADDRESS: 12109 SW ANTON DR
SUBDIVISION: ANTON PARK NO. 2 ZONING: R -7
BLOCK: LOT: 063 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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas furnace and gas piping.
Owner: FEES
LEWIN, KAY F + JAMES S • Description Date Amount
12109 SW ANTON [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 12/6/200 $5.80
Phone: Total $78.30
Contractor:
ADVANCED HEATING & AIR COND
5825 SE FOSTER
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Heating Unt Insp
Reg #: LIC 98573 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 -01 I •r• •h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503 46-6699.
Iss ed By: ` / ( .,t1, l P Signat � %,•/ ���
Call (503) 639 -4175 by 7:00 P.M. for inspections needed" hen z t business day
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Mechanical Permit A lication r FOR OFFICE I,ISE ONLY
,1 Dateray: 1 • ff D Wg )t 6
City Of Tigard necked P etru it N o.:
13125 S W IIall Blvd., Tigard, OR 97223 p... Rovlcn+
Phone: 503.639.4171 Fax: 503595.1960 Darr/gr r, OtherPrnnic
LnapeedonLino: ]UL-n: 9,4L73 [[((�� �} (� ' �J !I ``
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' Now construction ,. •
[] Additi , • 11 «� j�lac�t Mecbanlrsl pertnit toes' are based on t he value of the work
❑ Demolition ❑ pt#rer; pcnormod, hp:gears the value OSU MI:4 OS Om =atom dollar) of all
�_ o hanks! maurids, equip 1, t, labor, overhand, and profit.
i :a, ;;tl4)1,.";• •- � ° Igo • i ' • ' r i. - • u '''.�S a �,.a s Vatter 3 • : ' •.' - ' .I. �� -- s,"d l `•�!L. �i. :La1r o ,•.•. ''. rtrsK• , ° •.a u. • ' .. ?E'1Jt:, ' :'1 •rt d , l{''r , l , : r �•!' • .. :'1j th i. li. �. y -r,
g 1 • Ind bfamily dwelling 0 Comrinesrialiuldustrial El Accessory buildi og 11.1:%: `.�' w�[n . { ' L " i�Qrsi > 1 ,S RF� ' : . •
0 Astlld -family Fur special trt armasien use- checklig
y ❑ Master builder ❑ Other:
� Description 173171 Er Total
q ,, , ,1L48a TiifaK: r __ L. • . i • y , ' .' t h a At. , .i , ,. Heatincleaullh0 _
Sob siteaddters: Air 000ditionirtg or heat pump
(requires slie plan Mowing placement) 14.00
eityJSra eiZ P: "1�Q � D go ir. 9 ,smote t00,o04 OW tJ (QucUl+wnral 14.00
SvitePoldgJapt no.: -r Project es Furnace 100,0001-BTU(ductsr.�eacr) 17.90
J _ Cra31►a{t 14,00
Cross street/directions to job silt Duct Work 14.00
Hydrnnic hot waters stem 14.00
__ Residential boiler (radiator or
• hy4 unit) 14.00
Unix heaters (fuel -type, not electric),. •
in.w II, induct suspended, etc. 10,00
• Subdivision no.:
Plur/rm6 fur w.�u[ obi» 10.00
Tartmap/pocd oa,; Others 10,00
Other fuel appliances
,114,1., ,„: 9 i_' I ld: " T ,` ;; �' 1 :A M' Gy' I,, i q y li :Pig . 'r? : :- _ Watt[ hwtcr 10.00
�jt1:' SR:"'' tn i l�':4'A'•'�r11 9 : :e. _•e :' -
CM fireplace 10.00
Flue vent for water heater or gas
rireplace 10.00
Log Writer (gas) 10.00
Wood/pellet, stove 10.00
�� � � y kk Wood fireplace/insert __ 10.00
'e F. . i'CU1, a .E a !z I,�YC�`I Ir �F- l :� R i '; ..... -- II Chilttnu inerfilu event 10.00
amC: r Other: _ 10.40
. . Ai Environmental exhaust and ventilation
Address: d 4' j 1 equip ent . thcr kitchen
., 1+ L� aquiLrmertt ...._.... _ 10.00
City/State/2LN • r � . j♦ afr L S Clotho dt'Yer exhaust 10.00
Phone Single-duet exhaust (bathrooms,
r e Tr x °" F ax ( ) mike ee oarnp rt util roo ) 6.B0
I i I L, arc ... --
- ' ° "` '�' -. - � h'!• �c d ! �IR�, Ct?PPi�(�,T {�E$R9�OI+f "�_ •.4 AidcJcrawlspace 10,00
Business OSime: i - Other - r MOO
a /, .f <I. .0 IP Z Feet .1 la:
Contact 5 #21 55.40 for first four: 31,00 for aneh addi •
Address_ -, 0' - , y Furnace, etc, 1 j 6776
_ ,
City/State/ZIP: /stateiz�: I . f - ... _..__ __Gs here �u f
j' # 9 4 Wall/sus
Ybone: 0 ■ — f , , Fax:: ( .774/' i / .gt Water healer .•
E-mail: Fireplace
- r. ,.- . y ru } � �d!i ° n't .7PrL,F.,' •i`7iI - {.II!'�I '� -. i Ran e
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,..'4iill:(ii!'Vt' I I•. ' ' R S „1!,'1''1 'ir.- ' y+• ; II ,;,
•.;�: _�: . - �- ( e ve ' -.,, � ��„h 1 ,p i l ".. <; ' '•I,'' ii!ai� � _'� ���� � eIbGGUC
Lsusiness name: 4 �J . Clotho dryer (gm)
_ ' s j� ire • / Other:
Address: y
' y �.,�,�� �,�
City /StatdZ1P: 0 .
I/ ice/ d �' , / ^' Subtotal
Phone: 103 )7xr�, f f Fes ( ) Minimum fee i$72.50) f,2, e
CC8 / Plon rdvidw C2 5% of permit fc%)
state Surchsrge (8% of permit fee) S 0
T rwL FEF.1wfi 2r
Authariaod 3i art 'I TI, . c . I Uuu c. r. if a crmtc U ant oUL) I.0 within o
J� (MP after tt hst bees accepted a eotupkte.
-
Print name: /,, m t.e C ate: /4.—..k-61(1' • Fee methodology tec by Tri- Cauzrt B sliding tndusay 5craice Band
1 TO deJad � ONII.V3H a N AQk/ TEEbt.LLEOS Z9:LT b09Z /98 /ZT
CITY OF TIGARD . 24 -Hour
BUILDING t \ ' ,: Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date quested / B
Location / 2 / o Yt� L Suite �°. ;60 / _ _79 1
Contact Person ✓LO Ph ( ) 7 ? z-t - PLM
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner ELC
Footing
Foundation ELC
`Access: } . fi — yr (j4,,4-L‘ �-0n
Ftg Drain
v�,o ELR
Crawl Drain
'2Q d e.
Slab Inspection Notes: /� SIT
Post & Beam �� „' '
Shear Anchors
Ext Sheath/Shear a °� ` De
Int Sheath /Shear
Framing
Insulation ` e 7 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 ) 61.
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA T FAIL
CHANI L -
Post eam
Rou - n
as Line
Sm e ampers
1 1, • _ _ - T FAIL G �
LEC �' . _ ° t^) e 4\{y) I,-. l L)-vi ' /
5
Rough -In va.4 ` \' \ m\ k,, 60 S
UG /Slab
Low Voltage
Fire Alarm
PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, .13125 SW Hall Blvd.
SI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /..� / b , Inspector Ins f — Ext
Approach /Sidewalk Date / p
Other:
Final DO NOT REMOVE this inspection record • rom th - site.
PASS PART FAIL