Permit Ili ` ii . CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00209
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/1/2007
PARCEL: 2S 102BA -02000
SITE ADDRESS: 12353 SW GRANT AVE ZONING: R -4.5
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT: 045 JURISDICTION: TIG
PROJECT: GRANT STREET ELITE CARE
Project Description: gas line hydronic heat. Value: $40,000.00
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 32
OCCUPANCY GRP: SR1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 3 BOILERS /COMPRESSORS HOODS: 2
FUEL TYPES 0 - 3 HP: 3 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS: 4
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 4
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 13
> 10000 cfm:
Owner: FEES
ELITE CARE Description Date Amount
2300 SW 103RD
PORTLAND, OR 97225 [MECH] Permit Fee 8/1/2007 $636.50
[MECPLN] Plan Rev 8/1/2007 $159.13
[TAX] 8% State Surcha 8/1/2007 $50.92
Phone: 971 -506 -0151 Total $846.55
Contractor:
R & R ENERGY RESOURCES
2401 NE MLK BLVD.
PORTLAND, OR 97212 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 282 -4696
Reg #: LIC 71865
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 or 1.800.332.2344.
Issue y: (\ r -/ /1 , . f Permittee Signature: /// �/ Call 503.639.4175 by 7:00 a.m. for inspections that •,'ness day.
This permit card shall be kept in a conspicuous place on the job site til completion of the project.
Approved plans are required on the job site at the time o each inspection.
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Mechapical Permit Application.. . ' ` ' 4 t "� f
{� t ,:,• 4 FOR OFFICE USE ONLY , t , i 'c /''' � ; t t ' ,
a, 1 Nr hiy A sa l - - • . ' Rec tved 4 r�7 15 V I� City of Tigard kd 1 R; ,� 1 , , ipat /B Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
11
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit
I ' Inspection Line: 503.639.4175 APR 1 7 2007 Date/By: /� Q
T lip A I. D 1 7 Date Ready/By. IMI 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
it ' I ' V Sit 11.li
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: :',1 , : - .; .: ,`.t - ;'' :'•f;r'.'• .;` ' "' -''.. F, '.TYPE OF, O "e r � COMMERCIAL' FEE * =,. USE CHECKLIST
p 1-w-1 11 r 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 materials, equipment, b profit.
Is, eq , labor, over ead and o
r
'E; > ; 'H '' ;'" - : CATEGORY OF CONSTRUCTION - • _' Value: $ go 0 O (J
❑ 1- and 2- family dwelling ❑Commercial /industrial .'` RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / 2 3� Air conditioning or heat pump
S , V1/' (/ 6I Al 1 �v . - (requires site plan showing placement) 3 14.00
City/State /ZIP: y a ro Ore . f '/ Furnace 100,000 BTU (ducts/vents) 14.00
�/ 3 Fumace 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
Subdivision: Flue /vent for any of above 10.00
Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK ' •'• - ' • - Water heater a 1 0.00
Al J'� D Gas fireplace : 10.00
e. I C Q !./ / �W� t°i�� / �6l! �� /✓ Flue vent for water heater or gas
e J h1/ 1 dc 9( fireplace 10.00
L Gt Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
. ": PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00
� ^ � D Other' 10.00
Name: 1 P Care v 8I ' /. = U�
I � l�-U So- _ i �l -p,P Environmental exhaust and ventilation
�
p f ' 3 T f/ Range hood/other kit
Address: e r w, /e 3 equipment a 10.00
City /State /ZIP: For 4 ii it are. 9'7 2 2 ( ^ Clothes dryer exhaust y 10.00
J Single -duct exhaust (bathrooms,
Phone: (77J ) JO ‘ 015/ Fax: ( ) toilet compartments, utility rooms) ,3 2,, 6.80
' .. [APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans /' 10.00
C _go Other: 10.00
Q
Business name: /? Q if C - 4 J g o0 vrce piping
tin
g
Contact name: /�/ fl ee $5.40 for first four; $1.00 for each additional
Address: 9 A/A/4-- ,A ft Ai JYL i e
Gas heat um
City /State /ZIP: P /` ,4 j r Wall/suspended/unit P, pump
suspended/unitheater
Phone: (79 ) .[D4' 0 /I" / Fax: : ( ) Water heater 2.
/p ` yf ed Fireplace
E-mail: b f ., e � ,�' t � Oa tl L/del l', Cif /Yl Range 3
CONTRACTOR Barbecue
•
Business name: iI If g'ler / e4 ✓ • Ceti Clothes dryer (gas)
Other:
Address: 2? 0 1 /VI> x /ftY, L9 /y,o(. . ' MECHANICAL PERMIT FEES*
City/State /ZIP: PF r'llif,I#{ 9' 72/ 2 Subtotal
Phone: (5 3 ) .V.2.-- y6'" 96 Fa ( ) Minimum permit fee ($72.50)
/'/74 Plan review (25% of permit fee)
CCB lic.: / /3 0 0 State surcharge (8% of permit fee) /
TOTAL PERMIT FEE G y7
Authorized signature: �P This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /ilea m C RP 1-6( Date: r I '7 /6/, ' Fee methodology set by Tri- County Building Industry Service Board
P 'Building\Permits\MEC- PermitApp doc 04/06/06 440 -4617T (1 I /02/COM/WEB)
,
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valiatinn W Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
t:\Building\Permits\MEC-PermitApp.doc 12/30/05 2
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' BUILDING DIVISION ~'' / pERK�|T#: MEC2007-00209
13125SVV Hall Bhd, Tigard, DRA7223 z DATE ISSUED: EK1/2007
Phone: (503) 839'4171
Inspection Requests (24Hmj:(5O3)G30'4175 ~� 0� - « � I �
INSPECTION WORKSHEET FOR DATE: 912012007 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
: DESCRIPTION: gas line hydronic heat. Value: $40.0O0.00
OWNER: ELITE CARE, PHONE #: 071'506-0151
1 CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: Date: 9120'2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 056033-03 971-506-0161 N
Corrections/Comments/Instructions: a
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Inspector: 4~ ~° --- Date: 9/ / Phone #: (503) 718- , 1
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CITY OF TIGARD , ) ".. , .„:•
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BUILDING DIVISION PERMIT #: 1+1EC2007-00209
13125 SW Hall Blvd., Tigard, OR 97223 ,..-- DATE ISSUED: 8/1/2007
Phone: (503) 639-4171 . agogippiA111 de
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12i11/2007 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 12363 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 046 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: gas line hydronic heat. Value: V0,000.00
OWNER: ELITE CARE, PHONE #: 871.506-0161
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: Date: 12/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Mee \ I
FiVt/Lj 1
610 Gas line 061286-01 971-506-1973
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Corrections/Comments/Instructions:
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FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: t,,,; ( 1.. r.„ - --
Date: Phone #: (503) 718-
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CITY OF TIGARD ' ....
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BUILDING DIVISION PERMIT #: MFC2007-00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/112007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ...4.,„ - -.....
INSPECTION WORKSHEET FOR DATE: '1/4/2008 TIME: 7:01AM PAGE: "6
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 046 TYPE OF USE:
PROJECT NAME: GRANT STREET EUTE CARE
DESCRIPTION: as line hydronic heat. Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971-5064151
CONTRACTOR: p & R ENERGY RESOURCES PHONE #: 503-282-46196
Inspection Request Scheduled For: Date: 1/412008 Pour Time:
Code # Inspection Description ar Confirm # Contact # Message
615 Mechanical rough-in /' 062586-01 971-506-1973 N
Corrections/Comments/Instructions:
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Inspector: - 1,^ - _ Date: V Phone #: (503) 718- 21(2c1
•
CITY OF TIGARD
41 11
BUILDING DIVISION PERMIT #: MEC2007•00209
13125 SW Hall Blvd., Tigard, OR 97223 , DATE ISSUED: 8/112007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 i Ii
INSPECTION WORKSHEET FOR DATE: 118/2008 TIME: 7:01AM PAGE: 10
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: as line hydronic heat Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: - 7 Date: 1/0/2008
„ Pour Time:
Code # 14pection Description fYirm # Contact # Message
615 Mechanical rough-in .0 062776-01 971-%0G-1973 N
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Corrections/Comme ts In tru ctions:
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Inspector: Date: I Na e- Phone #: (503) 718-
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CITY OF TIGARD 0 ,,
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BUILDING DIVISION
A., PERMIT #: MEC2007-00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9i1i2007
Phone: (503) 639-4171 -"191101tili
Inspection Requests (24 Hrs.): (503) 639-4175 Al a 1.1..
INSPECTION WORKSHEET FOR DATE: 118/2008 • TIME: 7:01AM PAGE: 27
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE:
DESCRIPTION: gas line hydronic heat. Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971.506.0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: ate: 1/9/2008 /1 Citir
Pour Time:
Code # Inspection Description _ jTh Confirm # Contact # Mes-.ge
616 Mechanical rough-in c , I 062843-01 971- 506 Y
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Corrections/Co 74ts/Instructi ns.
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Inspector: Date: • Phone #: (503) 718 4 -r-L/
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CITY OF TIGARD
BUILDING DIVISION it T D #: . 8 M I E. 1 ; 2 D 0 20 0 0 7 7002
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13125 SW Hall Blvd., Tigard, OR 97223 :--- DATE ISSUED:
Phone: (503) 639-4171 i k , ,„All i t
Inspection Requests (24 Hrs.): (503) 639-4175 ,.-_,..-_- ....—
INSPECTION WORKSHEET FOR DATE: 1/10/2008 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: as line. hydronic het. Value: $40,000,00
OWNER: ELITE CARE, PHONE #: 971.506-()Th
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: (o r Date: 1/100008 Pour Time:
Code # Inspection Description r 7 onfirm # Contact # Message
6Th Mechanical rough-in <") 062966-02 971-506-1973 N
Corrections/Comments/Instructions: \11 t
PASS El PARTIAL APPROVAL 0 CANCEL 0-NO ACCESS
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Inspector: Date: yt 6 Ds Phone #: (503) 718-
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CITY OF TIGARD ,, A
BUILDING DIVISION PERMIT #: mEc2007..00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/112007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2119/2008 TIME: 701AN1 PAGE: 1 i
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: . gas line hydronic heat. Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: Date: t , Pour Time:
.2/19/2008
Code # Inspection Description 0 e Confirm # Contact # Mes gb
615 Mechanical rough-in 065212-01 971-506.1973 V
Corrections/Comments/Instructions:
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7 FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
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Inspector: 11.76,4-0Z___ / ‘
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Date: 2 / \4 / Phone #: (503) 718- -2_4 ..q•
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CITY OF TIGARD
BUILDING DIVISION
In,Adil
PERMIT #: MEC2007-00209
6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1
Phone: (503) 639-4171 - ,NAVINA
Inspection Requests (24 Hrs.): (503) 639-4175 .. 1.1..
INSPECTION WORKSHEET FOR DATE: 7/9/2008 TIME: 7:00AM PAGE: 1
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION:. Gas line hydronic heat. Value: $40,000,00 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, , PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-2814696
Inspection Request Scheduled For: Date: 7/9/2008 / JO Pour Time
Code # I /
nspection Description Confirm # Contact # Mess/ ge)
899 Mechanical final 072397-01 971-506-1973
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Corrections/CoMments/Instructions:
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Inspector: i 0
. Date:1(1(a r Phone #: (503) 718-2-1
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CI 'Y OF TIGARD
BUILDING DIVISION PERMIT #: M C2007 00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 81 //2007
Phone: (503) 639 -4171 � u b0n��ii� y l i
Inspection Requests (24 Hrs.): (503) 639 -4175 M � :_
INSPECTION WORKSHEET FOR DATE: 7/7/2009 TIME: 7 :00AM PAGE: 14
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXPEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Gas line hydronic heat. Value: $40,000.00 5/7/08: Phase I West, Phase H East
OWNER: ELITE CARE, PHONE #: 971 - 506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503- 282 -4696
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Inspection Request Scheduled For: Date: 7/7/2008 At) Pour Time:'
Code # Inspection Description Confirm # Contact # Mes : -.g=
699 Mechanical final 072252 -01 971 - 506 -1973 V fis,4
Corrections /Comments /Instructions: ° 4 C2/
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Inspector: Date: Phone #: ( 718-
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CITY OF TIGARD
BUILDING DIVISION ., A nd
PERMIT #: MEC2007-00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/1/2007
Phone: (503) 639-4171 Nit U-------------
Inspection Requests (24 Hrs.): (503) 639-4175 ak.1. Ma
INSPECTION WORKSHEET FOR DATE: 5/8/2008 TIME: 7:01AM PAGE: 20
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Gas line hydronic heat. Value: $40,000.00 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: Date: 5/8/2008 Pour Time:
n s r
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 069595-03 971-506.1973 N 9
Corrections/ smments/Instructions:
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____ i2_ 24
Inspector: Date: q'U --' Phone #: (503) 718-
/ ' .,a101L ,•
,' CITY OF TIGARD
BUILDING DIVISION
PERMIT #: MEC2007-00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/112007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/2712008 TIME: 7:03AIVI , PAGE: 7
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXCEND RE LOT #: 0-45 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: gas line hydronic heat. Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 03-282-4696
Inspection Request Scheduled For: Date: 3/27/2008 Pour Time: O
) v r c i.
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough-in 067449-02 971-506-1973 N . •
Corrections/Comments/Instructions:
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Inspector: W,47..
— Date: 3 ) . ..
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Z r Phone #: (503) 718- ZLI LLI
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CITY ��������������� .
--' --- ''------ '
BUILDING DIVISION '
~~~°"~~~~""~~" ~~"°.~~"~~.~ PERMIT #: h4EC2007-00209
| 13125 SW Hall Blvd., Tigar . OR 97223 DATE ISSUED: 8B1/2007
Phone: (503)S39~4171 ~
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Inspection Requoo�C24Hmj: (503) 639-4175 ..4.4 °.~
INSPECTION WORKSHEET FOR DATE: 2/2Ey2008 TIME: 7:08Alvi PAGE: 11
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXFEN[) RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: gas line bydrmnioheat, Value: $140.000.00
OWNER: ELITE CARE, PHONE #: 971-5060151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4096
Inspection Request Scheduled For: P' 2/28/2008 Pour Time:
Code # Inspection Description R Confirm # Contact # Message
015 Mechanical rough-in 055829-00 971'506-1973 N
-
Corrections/Comment ructi
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Inspector: �^�~� u^ L-_--~ '- Date: -^� ^^n / Phone #: (503) 718- ~/
CITY OF TIGARD
BUILDING DIVISION .
PERMIT #: K4E:Q007..00209
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 81112007
Phone: (503) 639-4171 44,440( A
Inspection Requests (24 Hrs.): (503) 639-4175 .--491 fill.
INSPECTION WORKSHEET FOR DATE: 2/2112008 TIME: 7•00AM PAGE: 16
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE Exr END RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: gas line hydronic heat. Value: $40,000.00
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: R & R ENERGY RESOURCES PHONE #: 503-282-4696
Inspection Request Scheduled For: Date: 212112008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
(5Th Mechanical rough-in 065395-02 971-50G-1973 N
Corrections/Comm ts/Instructio :
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I PASS ,'* . AL APPROVAL 0 CANCEL El NO ACCESS
I I FAIL 0 CALL FOR INSPECTION r ADDITIONAL FEES AS / SSED
Inspector: t.' (1.1---------- Date:/bY Phone #: (503) 7182
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