Permit CITY TIGARD MECHANICAL PERMIT
41
DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00177
� DATE ISSUED: 4/8/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 CA -08700
SITE ADDRESS: 09950 SW KABLE ST
SUBDIVISION: GULF SIDE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 031 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Replace gas furnace.
Owner: FEES
TREES H, BRADLEY & LEILANI Description Date Amount
9950 SW KABLE ST [MECH] Permit Fee 4/8/04 $72.50
TIGARD, OR 97224
[TAX] 8% State Surchar€ 4/8/04 $5.80
Phone: Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503- 284 -2173 Final Inspection
Reg #: LIC 222
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 -669%.
Issued By: -t __ Permittee Signature: Di /JGi e.¢ -77,0
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application ,
- FOR OFFICE USE ONLY
■1■1•103% Received r Mechanical ,
Date/By: 7/0 y Permit No.:rig Y " 77
City of Tigard Planning Approval Building
13125 SW Hall Blvd. / .*\'‘': IVED p Date/By: Permit No.:
Plan Review
Other
Tigard, Oregon 97223 - - - Permit No.:
Phone: 503-639-4171 Fax 503-598-1960 /,, , e ., ,\ Post Land Use
Date/By: Case No.:
_4 :Ai t Internet: www.ci.tigard.or.us , 'L.:NMI'? nn',
. ! t0 Contact Juris.: El See Page 2 for
24-hour Inspection Request: 503-639-4175 4 - " "' Name/Method: Supplemental Information.
CITY OF TIGARD
BUILDING DIVISION
TYPE OF WORIC -':;::. : 1 :. . USE CHECKLISTY '..e..`.L
0 New construction 0 Demolition Mechanical permit fees* are based on the total value of the work
RAddition/alterationfreplacement 0 Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead and profit.
: ' ' : ''CATEGORY40EICONSTHMTION , , ':..;
R1 & 2-Family dwelling 0 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
El Accessory Building 0 Multi-Family ::RESIDENTIAVEQUfPlifENT/SYSTEMSTEEtSCHEDUDEa;.
Description I Qty I Fee(ea.) 1 Total
D Master Builder El Other: Heating/Cooling
JOB : - :. Furnace - add-on air conditioning** ,( 14.00 i 14 lib
Job site address: 1 95-0 ,....T. ) g 4 r ,bit 51-. , Gas heat pump 14.00 _
Suite #: I Bldg./Apt.#: Duct work - 14.00
Project Name: ---- rit 00_51,, Hydronic hot water system 14.00 .
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances
Tax map/parcel #: Water heater 10.00
DESCRIPTION OF-WORK : : .,!-,', Gas fireplace 10.00
C2i4A- 5 ht. // 6724 6tizai aa, Flue vent (water heater/gas fireplace) 10.00
t CLIA4 '/P e4 /It/ Log lighter (gas)
Wood/Pellet stove . 10.00
10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
. VOROPE14TYLOWNElt:'; , ;:. --, - 1121:TEWANT-t-dii A. Other: 10.00
Name: kAiee -7 77e . 0, LE/ 1.,9-iv/ ,
7 Range hood/othe 10.
Vr & Ventilation
00
Address: .1 5 57) ( 5u) ie si
Clothes Myer exhaust 10.00
City/State/Zip: -i ar _ e31 2.24
Single duct exhaust
Phone: 57 S - 14'14 :,: (bathroom, toilet compartments,
1:1)LP1Ltaisinn:"Lite.''i : t,.010 utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Other: 10.00
Address:
Fuel Piping 1
City/State/Zip: **($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
Gas heat pump **
E-mail: Wall/suspended/unit heater **
::CONTRACTOR:- -: I „, - " ' . Water heater **
Business Name: AAA kia-#, featatq , Fireplace .
**
Address: 2, 1 i 5" ,vi E vr) I 4 16/Pof Range **
BBQ , **
Cit4ate/Zip: p e d ene- 117e / Clothes dryer (gas) , **
Phate. Zell-- 7-i.-7 5 Flog- zbi( _15-5 -.7. Other: **
CCB Lic. #: 2...2..-z_- Total: \ -
Mechanical Permit Fees* ---
Authorized
Signature: 41 ._,,,_ _ _AA.. - . 1 .. , , o_ r.' . te:___/LJ5 09 Subtotal: $ i 4. ab
Minimum Permit Fee $72.50 $ 1 2. 5 C)
ir i m i n n W 'A A A 4 Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ 5: 60
TOTAL PERMIT FEE $ .
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri Building Industry Service Board.
180 days after it has been accepted as complete. **Sit plan required for exterior A/C units.
1:113sts\Permit Forms\MecPermitApp.doc 01/03
CITY OF TIGARQ ., 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ' AM PM BUP
Location (77,57) K X.L-ep Suite MEC V-00( 7 7
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ ne 64121. `i 9 3 / 4-/ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post &Beam.` •;
Shear Anchors
Ext Sheath/Shear „4027s..y1L
Int Sheath/Shear
Framing ^ p
Insulation %/ 6, s. r
-L 1tiGt '' -� L f 3 Q / 0 i
Drywall Nailing
Firewall e
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
ECTRICAL
Service
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date 5 Inspector ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL