Permit A: CITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2002 -00022
VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/03
PARCEL: 1S135DA-01400
SITE ADDRESS: 11505 SW HALL BLVD
SUBDIVISION: ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 1 VENT FANS: 0
OCCUPANCY GRP: A2.1 VENTS W/O APPL: VENT SYSTEMS: 3
STORIES: 2 BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 360,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP:
WOODSTOVES:
GAS PRESSURE: M 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 2 <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 3
Remarks: TEMPLE: Mechanical systems for new temple. Valuation of project: $5,995.
Owner: FEES
BRAHMAPREMANANDA ASHRAM /TEMPLE Description Date Amount
11515 SW HALL BLVD
TIGARD, OR 97223 [MECH] Permit Fee 9/18/02 $87.62
[MECPLN] Plan Rev 9/18/02 $21.90
[TAX] 8% StateTax 9/18/02 $7.00
Phone: Total $116.52
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 453 Gas Line Insp
Mechanical Insp
Reg #: LIC 62196 Hood Inspection
Fire Alarm Insp
Final Inspection
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
iss d By: • N >;1 • / Permittee Signat T�
Call (503) •39 -4175 by 7:00 P.M. for inspections ne-ded the next business day
446 oz) O ?,
Z i G . o i ,. , a'k FPM ,, Q r ? , bT y 4 p- A ..�. 5+ f ^
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' Mechanical Permit Applica , c,. .-xi.,,,, . ,.>.. i V ht ,: ,. , . #. >It { = ,•I'e, c
Date received: / 7 0 Permit no.. ` - • ,,_,
t'� i ii e %. City of Tigard Project/appl.no.: Expire date: •
Ciry ofTigard Address: 13125 SW Hall Blvd Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
�� Building permit no.:
Land use approval
j p+.6 v x E( w PJ r �,;y a;
; e .= w ' ,' TYPE�OF , IIT �� r.', it -
, '. " , t. ' _ •••;':' s
W'"� r x a . 'f•': t , . y , � �i �t < �a �;��:e t " M 3 � 4'� % , ..'�' : y° "'„0..,":': t . , .. -�l : ,, :, . r � .
0 1 & 2 family dwelling or accessory r Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other:
" x m h z �Ra • - " * a x ' �P xr " 4 ' 'J 4: t• I U 1/ ■ ; ' I . + 1 f
= ��x -•'.� ..��.�,.�.,;�,�J,OB:SI+1'E INFORMATION- ;s�'�,,rs�:�: �, �` ;" .. � ''\
Job address: I i Gj 1 5`60 ' t1A-1- L pi—V0 • Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: 1 1 -pA • 110 15 3
•profit. Value $
Lot: (Block: Subdivision: *See checklist for important application information and
Project name: • di • , — '_ .J7s As q nsdiction s fee schedule for residential permit fee
�'� »` ti ettFAMIL�Y "D1VELLING :PERMITIFFI SCIiEDULE
City/county: ANDtCOMMERICA
/count ` �"`
Y Y' J ;�� ZIP: � � _ Z ��� � aK. • s .
UIND JSTRIA Y.QUIPMENTSCHEDULE''
Description and location of work on premises: �ar,r < �. �•
Fee(ea.) Total
Description Qty. Res. only Res. only
Est. date of completion inspection: HVAC:
Tenant improvement or change of use: Air handling unit • CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
s r 7"t : i MECHANICAL CONTRACTOR `'' "' ` , " `pro : 'A'`=: Boiler /compressors
' State boile permit no.: •
Business name: ' . .t *i � / A ' ` *L., HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Fax: I E-mail: Install/replacefurnace/burner BTU /H
Phone: Including ductwork/vent liner 0 Yes ❑ No
CCB no.: Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Vent for appliance other than furnace
Name (p lease print): Refrigeration:
r t o ",, :'.- CONTACT<IPERSON '' Absorption units BTU/H
Chillers HP
Name: • Compressors. HP
Address: Environmental exhaust and ventilation: '
City: I State: I ZIP: Appliance vent
Phone: Fax: E-mail: Dryer exhaust
7 ��� n ; ' - : ' Hoods, Type U I I/res. kitchen/hazmat
et err 1t•'?yy "k.'' ' O„T1:1\ r .«.'"
- - ,,tp„ .� s + . - r , , - +r+,: � :: " `• pp''` hood fire suppression system
Name: f l�. y M A � 4/ fJ 1cMp4 > " 1 I� ' Exhaust fan with single duct (bath fans)
Mailing address:1 j 1 ej � . W. Ar LL_ 0. 1__■IP - Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets) '
City: • `G - ' I. I StateU�. ZIP: 2_
7 23 - Type: LPG NG Oil
Phone: A l 41. -" A Fax: E -mail: 7 Fuel piping each additional over 4 outlets
*i = =.fi•. '' ki 42' . t _ Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorativefireplace .
City: I State: I ZIP: Insert -type
Woodstove/pelletstove
Phone: I Fax: mail:
Other:
Applicant's signature:: 4 ate: Other. T
Name (print): � g � �° A47i { u I Permit fee $ T .-- •
'Not all jurisdictions accept credit cards, please jurisdiction for more information. Notice: This m
erit application P pP Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (a[ _ %) $
Credit card number: / s 180 d
within days after it has been
Expires y State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature $ Amount i 440-4617 (6100 /COM)
CITY OF TIGARD • 24 -Hour
BUILDING : Inspection Line: (51 • .39-4175
INSPECTION DIVISION Business Line: • -4171 MST
BUP
Received Date Requested / AM PM BUP
Location / (s D . bkitif Suite MEC
a0 6
Contact Person Ph ( ) .j s3 ' ¥12 2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access: •
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear 1 44 67t - U —
Framing
Insulation
Drywall Nailing
Firewall 0 1
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
PART FAIL
TRICAL
' ervice
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date , \ / Inspector Ext
Other:
.Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL