Permit CITY F TIGARD MECHANICAL PERMIT
�rAc DEVELOPMENT SERVICES PERMIT #: MEC2001 -00120
+L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/13/2001
PARCEL: 2S116AD -24900
SITE ADDRESS: 16714 SW JORDAN WY
SUBDIVISION: BEDFORD GLEN ZONING:
BLOCK: LOT: 015 JURISDICTION: KIN
CLASS OF WORK: ADD 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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: INSTALLATION OF GAS LINE TO FIREPLACE.
Owner: FEES
ETTESTAD, LYLE L + LINDA A Type By Date Amount Receipt
16714 SW JORDAN WAY PRMT BFB 04/13/20C $72.50 KING CITY
TIGARD, OR 97224 5PCT BFB 04/13/20C $5.80 KING CITY
Total $78.30
Phone:
Contractor:
MODERN PLUMBING CO
D + DACQUISITIONS INC
11120 SW INDUSTRIAL WAY REQUIRED INSPECTIONS
TUALATIN, OR 97062
Gas Line Insp
Phone: 691 -6166 Final Inspection
Reg #: LIC 00087906
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246 - 9189.
Issue By: j9 /✓ ., /`1 4 „/, Permittee Signature: C G �,/�r - 23/14-4=9
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
04/12/2001 13:09 5036393771 CITY OF KING CITY PAGE 02/02
04/11/2001 15:01 FAX 5036847297 City oT Tigard tg1004/005
•
t,
Mechanical Permit Application ,
Datcreceivcd: , (Z ' O Permit no_ . 1 2001 -Q/
i ` d , 1 Ci T
- � � of � an d
Rojeetlappl. no Expire date:
Cl ry afTtgard Address:) 3125 SW Hall Blvd, Tigard Olt 97223 Deus issued By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598-1960 Casa xllo Co.: Payment typo;
Land use approVal; Building permit no.;
,_Tyrr. li I' lit lvii F • '
Erl & 2 family dwelling or accessory 0 mmercialindustrial 0 Multi - family :I Tenant improvement
CI New construetion 4f. Additlon/sItetndnn/replacet'nent 0 Other:
y ng,i E { )4 ?ii, i j,j Alit `I I I. !NIA lit M 1 II1•\ (':111911F V,11.11a7 ill's ti( IiI•'IHII 1{
Job address: No 1 1 LI ,5 (4) d• Y Indicate equipment quantities in boxes below. Indicate the dollar
1 1d p).: r Suite no.:_ value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: - profit. Value 3
Lot: Block: Subdivision: 'See checklist for important application information and
?Meat nine; Z YL E 4 L I n OA sf✓ TTLSTA f jurisdiction's fee schedule for residential permit fcc.
City /co,inty: ZIP: I +i 2 l'AMIL1 Inv ELLIMi PERMIT FEE SCIIEDUl E
Description aid location of work on premises: AND f.O1\1MERIC AL/INDUST I L E01.1P3 {ItiT Cl1v1)1lE
/ II o. ‘•. s c- Pee(ea.) Total
Est dates a cotxt (etlotl/li►spe.(taon: • / ..„.■ i _ Dutton Qty. Res. only ItAx. only
Tenant improvement or charge of use; IIVAC:
Is existing space heated or conditioned? 0 Yes CI No +'►irhetldlill)unit GEM
:Es existing space insulated'? Cl Yes 0 No Alrconditiofcxi .mitepl system
Boilet /compressors
Business name: p', • ( N Stntehoiler petmletlso.:
• HP Tons ETU/11
Marmot: 1 1 X p Su Tri'.. 5M W r,1 Fire /smokedampers/duct smoke detectors
City: ■ State l L ZIP: , ■ , ' Heil fumy (site , lea -, aired)
• Phone: , q V.. - L a , , . ��il ' E-mail- . , , u .. _ , taste 'replan rant: toner c g
noluding ductwork/vent liner 0 Yee l] No
CCB no.: t # • • . _-,_, : to •p acc/retocate heaters suspended,
City /metro lic. no.; 04 C wall, or floor mounted
Name ( lease rint): r1AA`x R V to cs le, 1 ant fbr appliance other then furnace
Refrigeration:
Absorption units BTU/I-1
Name: Chillers HP
^• - . ^ Com aaoro HP
A r dres;>: u °
' City: � State: � ZIP: �viro ®seta) exhaust and e �lallfon:
A liancevent
Phone: Fax: E-mail: Trycrexfiaust
Hoods, Type U 11/res. kitcben/haztitat
hood fire suppression system
Name: ' Exhaust fan with single duct (bath fans) •
MO N: : address: Kabalist lsyetem apart from heating or AC '
City: Slate; (yH+i Fael piping and Won tup to 4 outlets)
m - Type: LPG , e NG Oil I y Q c fl
Phone: Fast: . E - mail: hue) pfping each addlti'onal over 4 ouches •
Process p p schcmaticroqutrcd)
Name: Other of outlets
Other Ilstedapp owe or eqa pmet
owe Decorative fireplace
City: . . . . . . .I 91xle; I ZIP: Insert -type
,,
Phone: IF= 1 E -mail: ' wocci tovc/ jcllotstove
Other:
Applicant's signature: l Date: , Other:
Name (print): T '
Nut all jouisdicliona accept gedircords, plum call,iurisdicrion tot moot lefournadon:` Permit fee $ r ,
r I VI9a r mnarn� 403
Notice: This permit application Mi nimum for.... T+
expires; it a permit us not obtained
crcdir curd numbic i wit hin I BO days after It has been Plan review (at 90 $
s? slate surcharge (8 %) ..,, $ , - 5, P)
Maas of cardholder as sbown on coedie earl steepled as complete. TOTAL $ /Lab
cm 1Ia der iianawW1 M110110t , 4411••4617 (6itO/C0h1)
',,CITY ( OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
jt Date Requested AM PM BLD
J
Location �t ' ?A 5c4- G Jed Ce-r\- y Suite MEC _o/ - oc /ZO
Contact Person Ph 7 ' D 73 ? PLM
Contractor Ph SWR
BUILDING - - -�� Tenant/Owner p/,G ,, / �/ ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing 4 o6 ���� ��" i r, /IAc� 4•�F
Insulation
Drywall Nailing ' 6/l s
Firewall s �
Fire. Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING ;:' =
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In {ii. 1 4
Gas Line
Sryake.Dampers
S PART FAIL
ELECTRICAL
Service
• Rough In
. UG /Slab
Low Voltage
Fire Alarm
• Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ r Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date L/ 2-) Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.