Permit -
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00436
AO- �� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/6/2004
PARCEL: 2S 104 B C -05100
SITE ADDRESS: 12840 SW ASCENSION DR
SUBDIVISION: HILLSHIRE WOODS ZONING: R -7
BLOCK: LOT: 062 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: 1 DOMES. INCIN:
ELE 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:
> 10000 cfm: GAS OUTLETS:
Remarks: AC unit install.
Owner: FEES
PIJPKER, GINA Description Date Amount
12840 SW ASCENSION DR [MECH] Permit Fee 7/6/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 7/6/2004 $5.80
Phone: 503 - 579 - 9436 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
•
Phone: 503 Cooling 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: Permittee Signature: a , 6 j,�y‘
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jun 30 04 08:30a PAM DFILBY
_.... 503-598-0270
, t ,,,,, ■ p . 2
ie
• ,,,
Mechanical Permit A _frp FOR OFFICE USE ONLY
City of Tigard vd., Tigard, OR 972
SW Hall CP
Receed
Date/By: f• ( .0 ri,f) Permit No.: ' 111 pt 00 /13/
13125 BlAE0‘N. m* Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 1 keltikel 0 Daie/ivy. Other Permit:
ate ea
inspection Line: 503.639.4175 \% °
- _AM,: Ali . Date Rdy/By:
..ww.,.. ......... foris El See Page 2 for
Ini.ernet: WWW . CI . tigard.Or.US Notified/Method: / IC) 1 Supplemental Information
■ r")
'..' • ''' ' c "'. • ';'.;....'''!"..- ' :''. ' :,:',.-...--'......'' .•;-:: \ -7- - ".kT. ' , " !: : 4'' , \' ' ;'`' ' ' ' ''' , : . .. '- '.. -= ' , f'..... c' V', ......; 1.. 61Y itI2C4AL ''.- E ' :St. ITE.. MAX, - USE OFTECKL EST
9)0 Mechanical permit fees* are based on the value of the work
0 New construction gAdditton/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of al
III Demolition El Other: mechanical materials, equipment, labor, overhead, and proilt.
Value: $
WAtGi,K:iO* '.,.. --;;,. -'.: , ii .r. .: • ' ..,..... .,. , ,......,„.... ,... .....- : ... . • —
' ' . ' ;:,..:...its.4...aikauir,,tytENT I sysTErvi .s FEES
11 and 2-family dwelling El Commercialhndustrial 0 Accessory building For speczal information use checklist
Multi-family 0 Master builder Iii Other: Description i Qty. I Ea. I Total
''::: ....I II' I' :::'z.' '... l.70IiI.§171:El.:.*.iO410N.:=Iii664'.4(0 '',.: l:•:%ll:: • •:;1;:::l.:ti.• ! ReatinWcooling
Air conditioning or heat pump 1 i I . I
Job site address: /,,,,„? y,y•D ', 560 4 s c.. 5 / 0-7-7 (requires site plan showing placement) 14,00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (duets/vents) 17.90 ,
S uiteibldg.lapt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: _ Duct work 14.00
Hydronic hot water system
i 14.00
Residential boiler (radiator or
• hydronie) I 14.00 ,
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: i Lot no.: Other: I 10.00
Tax map/parcel no.: Other fuel appliances .
.-:•-:::•:.,.."i."-''..,:';:-''''.:::;.',•4];',.., .::.:.)3i's6k1itioryi',•iii:.''‘';*/E)*:.,;:,)!'7'-::','-.1..:.::::..,i:::':::..;:.:„ Water heater 10.00
Gas fireplace 10.00
/,V5 AC-__.— Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10 00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
• • - • ....• - -•: : i -,. !• Chimney/liner/flue/vent 10,00
iM(fi f*'l:.'":,'-'1 ''
L i • ,,.....:: :-, Other: ...:.:: 10.00
Name:
C / A / / i ci /Z1-A..) Environmental exhaust and ventilation
Range hood/other kitchen
Address: / /41 A Qe < i',/-7/ equipment 10.00
.----.
City/State/ZIP: Clothes dryer exhaust 10.00
A 5:4.--L c/ ' Single-duct exhaust (bathrooms,
Phone: (5,9) 579 9y3 z...., Fax: ( ) toilet compartments, utility rooms) 6.80
/7,..-f.gr':.4•-•:'1:'.;,:''•--.:0.:k-ir1L1tkkf,,;.7.,::.:-.:,..:..:.:;=.5.,,-,-.7,,,:.,!..,,Aft-ik4i;-44;t:6,,,h,t9!,-7,,ii„,,,.„. Attic/crawlspace fans 10.00
Other: 10.00
. Business name: Fuel piping
I Contact name: Aq-A-? y $5.40 for first four; $1.00 for each additional
' Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ) 4/ .>. 7 a ,./ I Fax: : (3- 3 ) . c;?..;42 /7,1, • Water heater
Fireplace
1 E-mail: Range
•""-'''..--"" -:'",. • :•••':::..l'il:" Barbecue
li'ig .' s` : ;; . ' ' ' ..: '' ' : .' 4.Y :!.-..; . '' C °N T C Tc i.l c ..,,, ' ,.-: '
BUstresS name: (:::, /. (..,‘ ,„,,, o I ek.. , _ j4.,. „..._ ,,.....,./ e. f 4,,...., Clothes dryer (gas)
Other: I
. .
Address: 0 6, 3 5,Y1.-7 , •:•,....4‘,...-• MECRA.NICAL
City/State/ZIP: Subtotal i
Minimum permit fee ($72.50)
Phone: ... , -- ,60 ) 4 , 4 , 2 , i . 2 . 7 c , ,ye 1 - 1 , se .c.a 7' Plan review (25% of permit fee)
CCB lie.- 7 (..... 9,,,- 7 I State surcharge (8% of perm:t fee)
TOTAL PERMIT FEE ?
Authorized signature: ga.-■2 `2.---", This permit application expires if a permit is not obtai e ,..i thin I
days after it has been accepted as complete.
Print name: ) G P , , 4 7 4 4 ( 4 4 . 4- 41.1 (6/ Date: •6::: g _) v - Fee methodology set by Tri-County Building Indusxy Se-vize Bc,r:
ifdluilding\PcrrnimMEC-PcrmitAppdoe 12103 440 (11/02;COM/WEB)
Jun 30 04 08:30a PAM DALBY 503- 598 -0270 p.3
ee4W /eT4
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
JOB ADDRESS: / i'0 SA
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:_ ((6,,93) 639 -4
INSPECTION DIVISION " Business Line: (503) 639- 171 MST
J BUP
Received Date Req -sted / ( AM PM V BUP
Location / fi) I • ' S e 6 -DO 7 ,
Contact Person / Ph ( 6' x"°27 (3? PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC N Q
Footing
Foundation ELC
Ftg Drain Access: �r =t, ti
ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear (l
Int Sheath/Shear V ,� ` ■. U 2
Framing Y V `
Insulation � �! ? ��� Q ,4„--1
Drywall Nailing
•
Firewall •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling • 0' 1 O ii[Al v • a '
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
•
Under Slab
Rough -In
Water Service
Sanitary Sewer I'
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: •
Final
PASS -PART FAIL r,a
M HA_112►L
Post & Beam V
•
Rough -In
Gas Line
Smoke Dampers
PASS PART 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 ❑ Unable to inspect – no access
Fire Supply Line ' s
ADA
Approach/Sidewalk Date 0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record f o he Job site.
PASS PART FAIL