Permit " CITY OF 1 1GARD MECHANICAL PERMIT
Aro
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00714
V �' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/29/2004
PARCEL: 2S111 BC -00500
SITE ADDRESS: 10055 SW INEZ ST
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 01.9 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:
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: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas insert and gas piping.
Owner: FEES
JOHNSON, MELISSA & ED Description Date Amount
10055 SW INEZ ST [MECH] Permit Fee 10/29/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 10/29120( $5.80
Phone: 503 624 - 5003 Total $78.30
Contractor:
NORTH PACIFIC SUPPLY
16256 SW EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg #: LIC 56866 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 -00 9-1-04. ough OAR 952 - 001 -0100. You may obtain copies of these rues or direct ques . ons to OUNC by calling
(5 246 -6699.
Is ed By: � , �� .� / &kid/ Permittee Signature: jitc
Call (50- 639 -4175 by 7:00 P.M. for inspections needed the next business day
O N : OFFICE I1SN U I LI t r s xs
s '
�� Mechanical Permit Application .,q, ,. r .._.., r :.,, t . ..
r .y;
' rf WASHINGTON �YT ®L r 1 ^ -U T Y Date received: /D � Permit no.: �, .
r Address: 15 i E i 3sifl Hillsboro OR 97124 Project/appI. no .'re date: Adirhiii
OREGOe� i1E . ' �
Phone: 50 , ax: 503 -846 -3993 Date issued: i % Receipt no.:
Internet Address: www.c o.w aggtt ton.or.us Case file no.: Payment type:
((C
Land use appro'`v l: 2 �
` Building permit no.:
r - :�
Y.: F PC
1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
N ew construction 0 Addition /alteration/replacement 0 Other:
IO[3 SIT_F IN FOR \lA` -fl�\ +. COI\I I \ 1ERCI\1, - " VAI C0' \TION� SC'H,FDULE; _ • Job address: 1 on 55 . L U i L Sy-, City: I tejakai..Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ • •
Lot: Block: N/A Subdivision: *See checklist for important application information and
Project name: jurisdiction 's fee schedule for residential permit fee.
City/county: ZIP: ' . `l 2 I \I\IIL1'- < 1) \ \ I1L 1 \( - . PI k'vi• IVIT I ` tiC I ll [ )t-pr- ,,, z , -
Description and location of work on premises: AND (O\i \1LRICr_ \ L . :1005 - .1 . R I \L { 16 ..1Pi \4 \ f e; I ll Ul I 1
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM 8.00
Is existing space heated or conditioned? I1 Yes 0 No
Air conditioning (site plan required) 8.00
Is existing space insulated? 0 Yes ❑ Nc Alteration of existing H VAC system 8.00
,• z k ..r ; MI (II \ \:IC? \1( =t) .: I OR �. Y ,;.:r• Boi ler /compressors
Business name: .0 R, �i /�L �C _ State boilerpermitno.:
�P I e ° �, H P Tons BTU/11 N/A
Address: /( /1 ..a k .'e k„.... S/ F ire/ smokedampers /duct smoke detectors N/A
City: C/dc I State: et] ZIP: r(7V 5" Heat pump (site plan required) 8.00
F E l: Install /replacefurnace/burner BTU/H
Phone: S�9 -4) ti YO a x: -r ai
Including ductwork /vent liner 0 Yes 0 N _ 8.00
CCB no.: 5( 9 4 & 0 ° Install/ replace /relocate heaters— s uspend ed, _
City/metro lie. no.: N/A 31'7 6 wall, or floor mounted 8.00
Name (please print): nit.d 4:0.r C. 34; Vent for appliance other than furnace 8.00
, .. s 7 ,r Refrigeration:
(() ~d \ C I i L I \f _ # -` Abso tionunits BTU/H N/A
Name: Me. - IIS$A 421-Ed - ,0ke1SOf . Chillers HP N/A
Address: 1 00 S SW _Itgz Environmental re SF
Compressors [ N/A
ental exhaust and ventilation:
City: -j' State :QR ZIP: 472.24 Appliance vent 8.00
Phone: ..(p2.I 2x 3 Fax: E -mail: Dryer exhaust 8.00
� : : - k . ;: /.: :1 R N I R x ;, , : n , y J = m
Hoods, Type I/ II /res. kitchen/hazat `
" hood fire suppression system R 00
Name: (''?.-5_S a- o'd JOk.fL c.' \- Exhaust fan with single duct (bath fans) 8.00
Mailing address: 1,0(9'S Skit) �t 1 €0 S+, Exhaust system apart from heating or AC _ 8.00
q �� Fuel piping and distribution (up to 4 outlets) 1
City: - G{Q,� 0 ( State: OR ZIP: d dit
Type: LPG_ NG Oil r 8.00
Phone: ` . - j,; S 3 Fax: E - mail: Fuel piping each aional over 4 outlets 1.00
' 4 -1'_�lulNj 1 IL a a ;
=.;r �,,,.: Process piping (schematic required )
Number ofo utlets N/A
x� _�.. ... ,7:;'�F xe � r ,_„ � .. _ rte: -.a-
Name:
Other listed appliance or equipment:
Address: Decorative fireplace 8,00
City: State: 1 ZIP: InsertXtype D i ' - - r / 8.00
Phone: I Fax: I E -mail: Woodstove/pel let stove 8.00
Other: 8.00
Applicant's signature: Date: /0 /,QF /01* Other:
'Name (print): r ,
- s Permit fee $ _7A,.50
ilI Visa O Mas r li„! —-- -� ---� i.- , Notice: This permit application Minimum fee • $ 5-5-6 _57, . 0O
expires if a permit is not obtained
Credit card numb Commercial Plan review
V , 4 V. c. p r� ' - aptr within 180 days after it has been (at 75%) ° $ v
N. e o : rd o der as s own on ere. a car. accepted as complete. $ 5.
f ` 07 - • - State surcharge (8 %)
/ (/' "Cardhol•erssgnature Amowst 44O- 4di7(7iO!COM) TOTAL $ _7S .'7O
05/02/02 TIIU 10:50 [TX /RX NO 55851 Z002
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
a MST
INSPECTION DIVISION Business Lithe: (503) 639 - 4171
BUP
Received Date Requested �� — AD , AM .'S I PM BUP
Location / 6 0 5S 1 Suite — OD g---av 7/9
Contact Person ________10 Ph ( ) 4 - (( -SD PLM
Contractor Ph ( ) SWR ,, (,
`
BUILDING' Tenant/Owner ELC tU , � /-'-
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
h/Sh
Ext Sheath/Shear ,____ .,
Int Sheath/Shear h/Sh a �M
Framing • ° ' ` V\ 4 " —L `' 1 fil
Insulation
Drywall Nailing
Fi rewall • , . ; \ \ 6 ke./6.5 c"?..----
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof (l-�� �/� d 4 (S
Other:
Final V .S S ( /NI"`— () -z j)
PASS PART FAIL `�
PLUMBING;: LL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains •
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: IP
II
Final
PA PART FAIL
CH' ' AL h {
P
C ialiCIL IIV I 4 IIII ill IIIII 9 11111 °.d('4°°.
ost& Beam (.: r , i ,
moK ; / ,�: mpers
Vii
a, PART. FAIL
EL: CTRICAL� °,: ,
Service
Rough -In .
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE" ,' -_, ❑ . Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA , Approach /Sidewalk Date 1 I �� b 0 4 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL