Permit CITY TIGARD MECHANICAL PERMIT
r I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00033
fi 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/04
PARCEL: 1S135DA-03500
SITE ADDRESS: 11481 SW HALL BLVD 100
SUBDIVISION: ZONING: C -P
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:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: 1 OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install new VAV terminal w. elec. heat. Value: $3900.00
Owner: FEES
L N PROPERTIES, LLC Description Date Amount
12725 SW 66TH AVE
PORTLAND, OR 97223 [MECH] Permit Fee 1/27/04 $116.20
[TAX] 8% State Surchart 1/27/04 $9.30
Phone: Total $125.50
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202
Phone: 239 - 4600 Final Inspection
Reg #: LIC 33135
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: 411 / % Permittee Signatur :
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
. ,, . OFFICE USE rONLY "
Mechanical Permit Application
Date received:/ —, 7 -p./ Permit no.:WtC 2OO _006 1 3
� 4 '' �%i r City of Tigard
. '� City b Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By$!3 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ►. ommercial/industrial CI Multi-family 0 Tenant improvement
0 New construction P% • ddition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / Q f S'W - gc-siv, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: / 0 0 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .7 oo .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: 7 S'17or t_t, AND COMIIIERICAL /INDUSTRIAL EQUIPM ENT SCHEDULE
h /e:7 t J V ii1 V T N„ t vmti. (/.../ e...- / _ .. . - Fee (ea.) Total
Est. date of completion/inspection: ( (St . "u 1 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned ?ZCYes CI No Air handling unit CFM
space insulated? es ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business State boiler permit no.:
usiness name:
American Heating, Inc. HP Tons BTU/H
Address: 1339 SE Gideon St. Fire /smoke dampers /duct smoke detectors
City: Portland State: OR ZIP: 97202 -2418 Heat pump (site plan required)
Phone: 239 -4600 Fax: 239 -703: E - mail: Install/rep ace furnace/burner BTU/H
CCB no.: _Including ductwork/vent liner 0 Yes 0 No
X1119 Install/replace /relocate heaters — suspended,
City /metro lic. no.: 6011 wall, or floor mounted
Name (please print): A-t,, *X.✓AA/J Vent for appliance other than furnace
C ONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: jitt<+J b✓/orit, ✓J Chillers HP
Address: / 771 SC clew Sr. Compressors HP
Environmental exhaust and ventilation:
City: . f2oAfrc-dit,,...o I State:a 4._ I ZIP: ' 7 2 u L Appliance vent
Phone: 2 3 S- `! Go u Fax:)-fl- 7 r E -mail: Dryer exhaust
OW Hoods, Type 11 IIlres. kitchen/hazmat
hood fire suppression system
Name: L.. A./ , Exhaust fan with single duct (bath fans)
Mailing address: 3 lit Sc, ,J c ,.t cS r Cr- Exhaust system apart from heating or AC
City: £)I / S ALt'`� I State: OA. I ZIP: 5 -2.30 ' Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone 93 SaY -yi S t Fax: E - mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
� Number of outlets
Name: I� /,e� „, („/psi., Other listed appliance or equipment:
Address: i 7 ? c sc. a t t9 e„v`,+ S- Decorative fireplace
City: J -- m}y,,,g I StateQ& I ZIP: 9 702 Insert — type
Phone: Fax: Email: Woodstove/pellet stove
Other:
Applicant's signatu e � Date: ` /2414 et Other:
Name (print): ,C,2,0A.J WO w,q a
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Permit fee $ //Go • 30
m
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ C +. '- U
Name of cardholder as shown on credit card accepted as complete. TOTAL $ /a
Cardholder signature Amount 440 -4617 (6 /00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING- Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / — AM PM BUP
Location / 6 3 / Suite / / 8 MEC 1-- / - 066 33
Contact Person .t Ph ( ) S 7c- -4s 8 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner -, / tt_L ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
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
Rough -In
Gas Line
Smoke Dampers
P _PART FAIL
E RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date /^ O 7 d 7 Inspector / ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL