Permit CITY TIGARD MECHANICAL PERMIT
'6.11, 1i, DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00115
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/04
PARCEL: 1 S 134AC -02604
SITE ADDRESS: 11375 SW COTTONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R - 4.5
BLOCK: LOT: 161 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF 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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install furnace and heat pump
Owner: FEES
BOESCH, MARK L Description Date Amount
LINDENBERGER, BARBARA H
11375 SW COTTONWOOD LANE Permit [MECH] PeitFee 3/16/04 $72.50
TIGARD, OR 97223 [TAX] 8% State SurcharF 3/16/04 $5.80
Phone: 503 -590 -3232 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 66578
•
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
(50V46-6699.
Issued By: C,�/ Permittee Si nature _ � l ,
Call (50) 639 -4175 by 7:00 P.M. for inspections needed the ne t • usiness day
,
:Mechanical Permit Application
Received a) FOR OFFICE USE ONLY
Mechanical , .
.!. .
Dateni . Pen-nit No ///., , u , —et 7
City 0:: Tigard Planning Approval
Date/5 : Buildin
Permit No.:
13125 SW Hall Blvd- • Plan Review Other
Tigtird, 0 regon 97223
V uateiii .:
Post-Review Permit No.:
• -
Phone: .5 )3-639-4171 Fax: 503 Land Use
\8\1 O's bv lt A
Internet: www.ci.tigard.or.ttp
....
_11_11, e* I Dute/8 :
Contact Case No.:
Mill 1 R ' o P age 2 for
24-1-..our I: ispection Roc/3 'Nsi639-4175,11*--- Name/Method; Su. Iemental Information.
• \C?' r ._ b,c .,‘
O'Ck "( V- - \Or"
— .
-.."1 • TYPE OF \VOs • ..1\S . . , • CONI.MEIDULE , - USE CHECKLIST • ::s ,.:• ,
D New :onstnIction emolition
' (r_rD . -
\ ,,, Mechanical permit fees* are based an . the total value of the work
Il ....211,41111:1 Other: performed. Indicate the value (rounded to the neatest dollar) of all
" -•- t — • CATEGORY.OIT CONSTRUCTTON:;...::•• •;: !, . mechanical materials, ectuipment, labor, overhead and profit,
Wl. & 2 -Famil dwellin_ ElCommercial/Industrial Value: S
— See Page 2 for Fee Schedule
n Accet so }3uildinR a Multi-Family RESIDENTIMaQUIPMENT/SYSTEMS FEE
Description 1 qty 1 Fee(ea.) i Total
0 Mast( r Builder ID Other:
lleating/Cooling
:. :• :.:J013::SIT.E I FORIVIATION1di COCATION___,___ . .. • ...: .• :;.: .':: .: urnae ' - add-on air 00nditionine* I
14,00
Job site a 3dress: C i) )1/1, et kftioar.441- at pump I/1.00
Suit': #: Bldg./Apt.#: Duct work 14.00
Projixt N arne: fiydronie hot water system 14.00
— Residential boiler
Ct'OE 8 Stmet/Direction8 to job site:
(for radiator or hydronic systerri) 14.00
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue/vent (fot ally of above) 10,00
_
Subdivisi )n: ___ I Lot #: _f_qaairur 12.15
Other Fuel A fiances
Tax . map/ parcel #: • Water heater 10,00
''.. • ."':: .' DESCRIPTION OTWORK ‘ ,.;7::%, .•::' .:. : '7'
Gas fireplace 10,00
. 1 C Flue vent (water heater/gas fireplace) 10.00
L. t—.'-- . i FM Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplacc/insert 10,00
Chimney/liner/flue/vent 10.00
0.1 ktv OWNER .....:.'- ..-.1 1=1 2 • .:.:,...,,,.::.. _Other: . 10.00
Name: Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address:
Clothes ch yet- exhaust 10.00
City/StatiilZip:
_
— Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
p rInic ANT ... ' .:' ' '..::.. :CO '0
NTACTVERS : utility rooms) 6.80
aillIfiz.„_.;`6e ._.4 4 t.e sci--- Attic/crawl space fans 10.00
Other: moo
Address: C 0,
Fuel Piping
CiLy/S tato/Zip: .40 for first 4, $1.00 each additional)
Phone: s, >7 3 . 2 - ..?„.. Fax: Furnace, etc, . **
- ,
il: Gas heat pump **
E-Ma
**
Wall/suspended/unit heater
.. . .CONTRACTOR.::•. .... '•::!:',;:•:"..'••': ; .A''. :• **
.. • Water heater
Business Name: C pc c c4, 'h- t Fireplace . **
-
Address: 1 L- c y S 1 i Viz. r 4,- ( , Range 4..
EtBQ •,*
.., , City/Stat /Zip: rh . t (S I) GN- , .47 • '?-/ 2. ? Clothes dryer (gas) **
Phone: C.:1'o , : _ g e, c -)_ I Fax: 44 6 1 c i3 Other: **
CCB Lic. #4( . - ,Lec ?-A Total:
Mechanical Permit Fees*
Authorized
ti
Signature: ( . 1 '. \-(-C-i- ' - ' - ' 0 ` - ' - ' Date: 3-1.) Subtotal: S
• .
Minimum Permit I'ee $72.50 S
p I - ■!( - ," - &--• 0 r c:c'---• Plan Review Fee (25% of Permit Fee) S _
--
(Please print name) State Surchar e 8% of Permit Fee $ c--
_ -
TOTAL PERMLT FEE
Notice: This , ermit application expires if a permit is not obtained within *Fee methodology set by Tri-County Building Industry Service board.
180 days aftot it has been accepted as complete. "Site plan required for exterior A/C units.
1 :\DStS\Fernlit 'Orms\mccPcrmitApp.doc 01/03
2 ' GI BiL0 B6S EDS 2ui R'4TeToadS ei7T:OT 170 21 JeW
SITE PLAN
•
• PL
PL PL
PL
STREET
Specialty Heating & Cooling, In
9528 SW Tigard Street
Tigard, OR 97223.
Phone 501620.5643 Fax 503.598.0718
F:illsboro Phone 503.640.3607 Fax 503.681.0793
E'd B1LO 86S EDS �uz�eaH Fziei�adg eST70i
CITY OF TIGARD,. 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MSS
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received �/ q g. 3 I Date Requested 3 'Z2 A PM BUP
Location // 3 7 5 r m J.1 Jba Suite �• 54-6 // S
Contact Person Ph ( ) PLM
Contractor .1 /tt9 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear ---ry
Framing Mrt\ir R. L �� (= L— ' s G " ,1 S �.
Insulation
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
Sanitary Sewer / �,
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Dampers
PART FAIL
RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at Ci - . , 3125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: I rA Unable to inspect — no access
Fire Supply Line
ADA `� '
Approach /Sidewalk Date V 2 Inspector 4AA 41111b
Other:
Final DO NOT REMOVE this inspection rec rd from the Job site.
PASS PART FAIL