Permit CITY F T I CA RD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00594
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/2004
PARCEL: 2S1 10 D C -02400
SITE ADDRESS: 11565 SW DURHAM RD 110
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: B 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: TI: Adding ducting to new package units.
Project value $2380.
Owner: FEES
MOODY HOLDINGS Description Date Amount
5701 NE 105TH # D [MECH] Permit Fee 9/7/2004 $81.70
PORTLAND, OR 97213 [TAX] 8% State Surcharl 9/7/2004 $6.54
Phone: 503 - 860 - 0235 Total $88.24
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: �,4 �� 1• Permittee Signature: p,�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date /B y y " ? / L /� Permit No.: (,
13125 SW Hall Blvd., Tigard, OR 97223 C _ /4 9
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
ril-d'IWi ,( '\ Date/By: Other Permit:
Inspection Line: 503.639.4175 �i Y ' y
__ Date Ready/By: H See Page 2 for
. Internet: www.ci.tigard.or.us Notified/Method: MINI Supplemental Information
z ,r" .......... ", c,FS;;ag:,., ., .. F,,,..,Y =iun" , 't >; RCIAIs € FEE*HEDL7I:E�:= :iTSECHECI{LST'?
Mechanical permit fees* are based on the value of the work
® New construction ❑ Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical matenals, equipment, labor, overhead, and profit. ,
4` ° `° i:.:.. :«?;u " - < *;" : r s.° V alue .
: ' r . : 1. F , dAtEGORYM,UF CONSTRF)CTIONsr_`" =` „k.l, 1 e:a . in ; $
❑ 2-family dwelling Commercial /industrial ❑ Accessory building ```' '' g .0 T: /'§X5'FgIVISI_ ES :°, '
1- and2 -fam . - ..... 3 .:,.,. , ��;_
For special information use checklist.
❑ Multi - family ❑ Master builder
❑ Other:
Descnption Qty. I Ea. Total
f, ,SI
x TE INFORM&TION' AND LOATIO ` " f'u „ -'; `'� t,F.
'��:� a.,�- ';��_. ;w�� ��'4 , ;`;JOB„ ,., -, ... ,����.....A. �,..,. >._ . ,... .��. G
.. �, .. ��� M =_. >..,. >� �.., -, . ,�a Heating/cooling 4
Job site address: i s Air conditioning or heat pump
t t C .- . fti : I / �� (rr /i�s`.d'y"s ICJ ' (requires site plan showing placement) 14.00
City/State /ZIP: , I C, ,, / e'.> 97 2 2 g Furnace 100,000 BTU (ducts /vents) i' 14.00
n / Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: I V Project name: L; ,, tie j 41 Gas heat pump 14.00
Cross street/directions to job site: 9 CI ) q__ ' b ay 1,1(ti k iA f;,-, 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
(9 v^4,: Lot no q Flue /vent for any of above 10.00
Subdivision:
LC) -,1 ,lot- ,; �ba ^, "; i.u1 ., T Other. 10.00
Tax map /parcel no.: Other fuel appliances
s� >- ,SCRIPTION OF:;�:WO i:e , „ : -. ��:> ' ;; "�:': Water heater
� §��' . ,. -,x _, , �,�.t:. o '�r�2�a:'
�« �. ._ , , .. � 44, ,... _ ..� ��,r?„s.t, •�,.,�.- �r= vw�6 " '<,p .. �, ‘ k 10.00
Gas fireplace 10.00
-L- _ _ . ,- `s 0 A t. e A 6 `Cl r v?. l; ,1 (' '-(- , td c . Flue vent for water heater or gas
" -() k ; eQ,0 . 11)A C 0-4C (( 't l J fireplace 10.00
s - Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
-,-:- f ,l h ,:a` --,<.-,..',. -. : a , - - ; ,- , , ,x. . "�:, r ,, :: i s Chunney/liner /flue /vent 10.00
.. ,PPROPERT_ Y';:OWER- .f "r= x , 5 'E Nill+i I '. *. ;
/ ' zx "'�� -` Other. 10.00
Name: ,�� p�'`1 jir� J ..,i`r Environmental exhaust and ventilation
Address: J Q / fV r ( l /6 (2j. V Range hood/other kitchen
equipment 10.00
City/State/ZIP: .k ," 0 2- Clothes dryer exhaust 10.00
�� Single -duct exhaust (bathrooms,
Phone: ( ) V �, 0 l'` 3 Fax: ( ) toilet compartments, utility moms) 6.80 _
.;fir ; ' x 6z ;.; ,:... q isij > , f E � . v q ..,. wt, fans
� ` � � �,",� -�� , �� PI:I s; �� H �`,�,� # ; �,�, I � s;CO1�ITAC =,„�PERSUNq� ,�:, Attic /crawls ace 10.00
Business name: `,
Other 10.00
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:
rry `u a °'e - =<v °` °i =ig ?s:r ;s",<, :', `" - y °: ' . v a F Range
-CONTRr1GTOR, ., i, ":`'''
,�»�- z:.s . ze�.�ia„� ��. �.e:� °° °.<x' '�'��' ; �y��� ,�.,. � - , n.. A:�.�;r` f.��%'r'� ::b�3 "��s =.�. < ; p ���x'�.%��"".�','�..t, Barbecue
Business name: > ,a* /7L�i �, Clothes dryer (gas)
Address: , r Other.
'> t ° 141ECHAI�IICAI; E_RMITk13EES *�`(3� "..''"' ^: t - ft
6, 7o r 3 :7m ..r F " Subtotal on, :..
City/State /ZIP: Subt
(5 ) 7 Z _ /„ -4 �q ( 5 / 15) 24/a _ 3 /'' P Minimum permit fee ($72.50)
Phone: c — toti � / Fax: , ` f"
CCB lic.: / DO/ State review (25% of permit fee)
State surcharge (8% of permit fee)
i
TOTAL PERMIT FEE
Authorized signature` �f �� This permit application expires if a permit is not obtained within 180
■ • l days after it has been accepted as complete.
Print name: 3 0 i /' )4 . Date: / )'7 ! ) ^ * Fee methodology set by TO-County Building Industry Service Board
CITY OF TIGARD 24 -Hour __.
BUILDING I Inspection Line: (503) 63 • ,l, „1 1
71 MST
INSPE, --) DIVISION Bus iness Line: (50 ' • /..
G . / '! _2o o y - S f 1 J
Re/ Date Requested A PM
i / ocatV ((S7 ,1 u.A../�G' Suite ///) moo 6l -GO a()
C /ct Person (X111 -(. Ph ( ) a - % ' 1r M n -
Contractor Ph ( ) R - I A l✓
BUILDING Tenant/Owner ELC I ' C
Footing � ”
Foundation _. ELC
Ftg Drain Access: , /I / 4- , in , ELR _ ir,
Crawl Drain ��
Slab Inspection Notes: SIT ,
Post & Beam
Shear Anchors
Ext Sheath/Shear .�
Int Sheath /Shear \ /n e c — —1 c _ b / / q Cre-&) 3 - .r c
Framing �
Insulation 1S - ti' p' — Q S 1 /� r I Li
Drywall Nailing lJ
Firewall
Fire Sprinkler � •
Fire Alarm - - -eA VO 0--V - L,L t -f 4C Z 5.-S k V
Susp'd Ceiling r /
Ot of l v ' c /-c }- v\,2 ./'. C(? ��1� (7 -L1
1 � t !
4110 A A I rfsln.a � AM ` G)\i > Z
PASS PART '
PLUMBING I lir
Post & Beam R
Under Slab MET_ `� �j C� -7 /
Water Rough-In
Service ' E �- v '" C ! 0 6 < __ C" T) ` v Q \
Sanitary Sewer c`UXS-A V 1 (
Rain Drains
Catch Basin / Manhole
Storm Drain �' � � �\ l
Shower Pan Vw G 6 ' t4 Q Q G c L--( t 1— 5,
Other:
Final P
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
F PART FAIL
• RICAL
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 I I Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line t
ADA
Approach /Sidewalk Date ' Inspector \ , Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL