Permit t ,!: it
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00230
F � 11 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/30/2004
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PARCEL: 1S134AC-02608
SITE ADDRESS: 11335 SW COTTONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5
BLOCK: LOT: 165 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Replace gas furnace w /like kind.
Owner: FEES
SKIDMORE, ROBERT F Description Date Amount
JOANNE E [MECH] Permit Fee 4/30/200 $72.50
11335 SW COTTONWOOD [TAX] 8% State Surcharl 4/30/200 $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 222
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)2(36 9.
Issued Permittee Signature ,8. -<____,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
� pg Received Mechanical ' y�
' .• 1® �./ ' A®.� Date/B : ,ff40 ;i 'ennit No.: _r /' '�
CI Of Tigard
Planning Ap.r.va Building
City Date/By: Permit No.:
13125 SW Hall Blvd. APR 2 9 21 ( Plan Review Other .
Tigard, Oregon 97223 Date/By.: Permit No.:
�tF Ti r�
Phone: 503 -639 -4171 Fax: 503 -5 .,, m 11 Post Review Land Use
:A.� iii' o.:
Internet: www.ci.tigard.or.us 31LDING ,! . i :� Date/By:
.1 � ` � Contact See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ` --- Name/Method: �0 pplemental Information.
.. . • ; TYPETOF. WORKx ;? c= = .... _ • ` COMMERC ' I'. FEE *iSCHEDULE - USEi_CHECKIAST. r=e
❑ New construction ❑ Demolition Mechanical permit fees* are based On the total value of the work
N. Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
_ . 1;° :'CATEGQRV:OFCONSTRUCTIO1�;.; ..- - . mechanical materials, equipment, labor, overhead and profit.
� •
IN 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family >-RESIDENTI:'►L EQUIPIVIEN ,T /SXSTEMS,IFEE VSCFIEOULE `-'
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/coolin,
t.: JOB` SIT E'IINFORIIMATION Furnace - add -on air conditioning ** 14.00 1 4.1111
Job site address: l 1 335- I Co min wrrod L Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: 5/e 1 'd m OI_e. Hydronic hot water system 14.00
job site: (for orid radiator boiler
Cross street/Directions to
l ( radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units 12.15 _
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
„• :- .. SCRIPTION OF WORK'. <?' :: Gas fireplace 10.00
ct rL 5
pz1.44-- /pit. t"Ce -t / Ga_t f t t. J -tv? (.L Flue vent (water heater /gas fireplace) 10.00
W Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER'. , - •.: ® ,TENANT -* �_ Other: 10.00
Name: p 1 1 ie:... - c3 I'd rr7 OI C Environmental Exhaust & Ventilation
Address: C n woad Ln. Range hood/other kitchen equipment 1 0.00
ddress: t l
3 �� � �� Clothes dryer exhaust 10.00
C / y: � ( tate /Zip: / , 4 Q,K.e/ 6---4. 972,23 Single duct exhaust
4: jO- / (p18 Fax: (bathrooms, toilet compartments,
® APPLICAN1 �'' i R', a;` .0'CONTACTPERS:ON:'?= utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 10.00
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E-mail: Wall/suspended /unit heater **
:CONTRACTOR : " " - - Water heater **
Business Name: -4-A $ - L 47' - 'p-74 44 (1 41 f)1 y Fireplace **
Address: a q ! 5 f E !m i ie `'Vie I c� 1 Q Range **
BBQ **
City /State /Zip: join r «' 87e- "/"Ma... ** dryer (gas) **
Phone: 563 t/- an 3 Fax:5 -24W /55Z Other: **
CCB Lic. #: 2-ZZ Total:
Mechanical Permit Fees*
Authorized / ,/ Subtotal: $ !/d
Signature: ) 1144/24411€.4-Date: '��Er.` -Date: L Z7f0'J"
r Minimum Permit Fee $72.50 $ - 7 2.. S()
`7'1/1/4 li"" Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5. 130
TOTAL PERMIT FEE $ 7 8_ so
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Pernit Forms\MecPernitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
,/ �
BUP
Received Date i � AM PM BUP
Location 11. 3s C te .4 - Suite 60 Y - o 6 - 3 a
Contact Person (D_PiYl /Y)tx� Ph_( -- — 123 1 4 — . , Z (73 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC N
Footing ELC
Foundation - Access:
Ftg Drain 43 _TT . ELR
Crawl Drain
Pos & Beam _ Inspection Notes: Nt� r_ . rb ‘2.44\9 SIT
Shear Anchors �y ^ �� 0-14
I
Ext Sheath /Shear L _ J� , ( - Q j , t
Int Sheath/Shear 7
'�Cr }� ,3
Framing
Insulation �>�J t./
Drywall Nailing
Fi rewal I
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 PART FAIL
MECHANICAL (�
Post & Beam t./
Rough -In
Gas Line
•
' oke Dampers
1 PART FAIL
l:111C N A A.
Service CP
Rough -In
UG /Slab
Low Voltage
Fi - larm \ `
4's Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA 6 Ins ector Ext
Approach/Sidewalk Date p f' --
Other:
Final DO NOT REMOVE this inspection record from the jo site.
PASS • PART FAIL