Permit CITY TIG RD MECHANICAL PERMIT
,,i � DEVELOPMENT SERVICES PERMIT #: MEC2004 -00824
N;1
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/22/2004
PARCEL: 2S110DC -02400
SITE ADDRESS: 11565 SW DURHAM RD 120
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
<= 10000 cfm: OTHER UNITS:
FURN > =100K BTU: GAS OUTLETS:
> 10000 cfm:
Remarks: Ductwork change.
Owner: FEES
MOODY HOLDINGS Description Date Amount
5701 NE 105TH # D [MECH] Permit Fee 12/22/20( $123.10
PORTLAND, OR 97213 [TAX] 8% State Surcharf 12/22/20( $9.85
Phone: 503 860 - 0235 Total $132.95
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 Duct Inspection
Final Inspection
Reg #: LIC 14008
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: 71 r ) � L% Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for inspections needed t ext busin 'ss ay
( ., i y44 ED '-.. ..- ,
Mechanical rermiA,' n -.-..4;: , .... . FoaOFFICE.:: Uct, ONLY . - .
City of Tigard Received
2 /NA
13125 SW Hall Blvd., Tigard, OR 97223 n cc, 2,
Plan Review
Phone: 503.639.4171 Fax: 503 598.196 t‘ Date/By. Other Permit
Permit NoA
, t VA iiir
Inspection Line: 503 639 4175 F A . t ' .■
A 1 ' Date Ready/By: Juns 0 See Page 2 for
Internet: www.ci.tigard or.us 4fr $ ! 0%g_ ----, -- Notified/Method:
Vi l kr Supplemental Information
IV:
1: Z OF WORK !'';':';;' ''PO*!ERO
Mechanical permit fees* are based on the value of the work
'Jew construction iPA /replacement
perfonned. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
0 Value: $ it z_csu _.....----
A' 140' 40o4cui*'-'::; -1 ........ ....., ,._„.,, ...:,....,,,,,_, ( ,..,.. , .,„
,:,,ApIppyri4,F(2u.ip .NENT '',',c
El i - and 2-family dwelling . );10Commercial/industrial 0 Accessory building
For special information use checklist.
El Multi-family 0 Master builder 0 Other: Descnption Qty. Ea Total
' 'Arsio=:06Topisi - ':,: ,,,', '"n- .;'5; - :1w-41 , 11 - Heating/cooling
Job site address: /7 5%' 5- Ali Rd- - e-- / 7-6
1- Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: - 77:9 C517.-- Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work
14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 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: Lot no.:
Other 10 00
Tax map/parcel no.: Other fuel appliances
' OF WORK ,— i : '= I. ,:= , = ' :': , Water heater 10.00
Gas fireplace 10 00
Flue vent for water heater or gas
CitiqtteM4—diAaAr" (A9-(?1 itC52')) fireplace
Log lighter (gas) 10.00
10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
' ' 'Piiiii'ili.filOWNEli , f ; &--' ; II : TE/44iNIT:: ;;'-',.:%;,,,O,;:„, Other 10.00
Name: EV-ia1--1 ..L9e-4/ i i L__e__ Environmental exhaust and ventilation
Address: Pb 6 0 / 4) Z-- 2— Range hood/other kitchen
equipment 10 00
City/State/ZIP: ,/2 ( 5-12, q 7 a) o Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( 003 ) t ? C) Lt — '3 5e0 Fax: ( ) toilet compartments, utility rooms) 6 80
40.t%!ar;i0i-hie.:*Oicii
: Attic/crawlspace fans 10.00
Other 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City/State/ZIP:
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
„ „
; 1,,, : , ..:R4-11t, ‘1go*wo,# ,-. 4 ,,, ::: ,:i ii „,, , , : , , Barbecue
Clothes dryer (gas)
Business name: got /-4.0..,, 0 Other
Address: pb i r+- / a 6e/5 '
:7„1 '-' ,, -,,,,.. ,, , - , ,h,:sg,,,,,,b,,,, , .w...'-',•• ,, , ‘, -
City/State/ZIP: ea-k ).,y Z9R 9 7,0/
3 , Subtotal 0 23, 6
Minimum 1 ./ permit fee ($72.50)
Phone: (55) 2.10(0 .---( 2_141 Fax: ( 5Zit) 21 — 3‘.
Plan review (25% of permit fee)
CCB lic.: / Z-- Of State surcharge (8% of permit fee) 49
TOTAL PERMIT FEE 4,72". g..5
( 0: ijo z_. ___ 6(. 0 )049._
This permit application expires if a permit is not obtained within 180
Authonzed signature: days after it has been accepted as complete.
Print name: / /* ,_.> C G" /,„ ( rroL Date. / 2-/2-7--k 54 * Fee methodology set by Tri-County Building Industry Service Board
i \ BuildulgTenni is \ MEC-PernutApp doc 12/03 4-10-4617T (11/02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Date Requested ) - J AM PM BUP
Location Suite_ / ZU MEC e9U7" S n
Contact Person < _ „/) Ph ( ) g 4 9 ORE PLM
Contractor Ph ( ) r 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 11111111=11MIMErg
/PASS •ART FAIL
PLUM: G 1111111111111AWW
��
_ • : Beam J
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
S „- Dampers
ti� PASS 1 PART FAIL
ELEC ' IICAL `
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call or reinsp. ction RE: ❑ Unable to inspect — no access
►�,
Fire Supply Line ,�,
ADA � Ins actor Ext
Approach/Sidewalk Date - A WJ g 1 �
Inspector r
Other:
Final DO NOT REMOVE this inspection record from the job site.
\ PASS PART FAIL