Permit CITY TIGARD MECHANICAL PERMIT
l l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00088
Adj
' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/04
PARCEL: 2S104AA -07900
SITE ADDRESS: 12685 SW KATHERINE ST
SUBDIVISION: BELLWOOD NO. 2 ZONING: R -4.5
BLOCK: LOT: 106 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: Furnace replacement.
Owner: FEES
RYAN, PAULA Description Date Amount
12685 SW KATHERINE ST
TIGARD, OR 97223 [MECH] Permit Fee 3/2/04 $72.50
[TAX] 8% State 3/2/04 $5.80
Phone: 503 -590 -1779 Total $78.30
Contractor:
JACOBS HEATING + NC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503-234-7331 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -669
Issued By: / Permittee Signature: ,;
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
•
Mar -01 --- :" - -4.=4 09 - 00A P _ 02
4. FOR OFFICE LJSE ONLY
Mechanical Permit A lication Received Mechanical U�i
H ED D Date/By:$ //l)q 6 Permit No.: M� D'
e Planning Approval Building
City of Tigard Date /By: Perot No.: •
13125 SW Hall Blvd. f. Plan Rev ether
MAR 2 04 Date/By: Permit Nu,:
Tigard, Oregon 97223 Post- Review Land Use
Phone: 503-639-4171 TY0 9 p CAM,A;m: Date/8y.
Cacc Nu.: • Internet: www.ci.tigard-I DING DIVISIO , 1,I,,, e' 1 contact luris } : ® See Page 2 for
Nam/method: 1G S
24 -hour inspection Request: SQ3 -639 175 � - --
' :TYPE-OF:WORK : COMMERCIAL *-SCHEDULE = •i1SE CHECKLIST ,
New e°nstruction
❑ - Demolition Mechanic& permit
fees` are based on the total value of the work
❑ Addition /alteration /replacement n Other: perfonncd. Indicate the value (rounded to the nearest dollar) of all
-• mechanical materials, equipment. labor, overhead and profit,
m L CA'1`EGORY OF CONSTRUCTION . 2- Family dwellin , El Commercial /Industrial
Value: S - _ Sec Page 2 for Fee Schedule
. 'RESIDENTIAL F.QUIPM1?NT /SYS EMS FEE* SCREDULE _ Accessor Buildin r i Multi-Family _ Descripti Qty Fee(e.a -) J Total
171 Master Builder ❑ O t her: tlenti„('oelir, _ ._......
I
; JJOB SITE�LN1`'ORMAT'lON and •LU 'A'lii .'N : . _ -- Furnace - add-on air conditiatin�__ 14.00
i
Job site address: 1 �
. (� Q I CJ Gas heat pump 14.00
J < - —
Bl /A it. #: Ductwork -_ • Suite t 1 i4.U0
Hydronic hot water system _ 14.00
Project Name: -
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
_ Repair units 12.15
Subdivision: Lot th O ther Fuel Applianc
Tax map/parcel ; Water heater - 10.00
'' tA ?Gl° E 4 1PTIOT OF'WOREC' `t ; °;fin; =`uM c, 4: Gas fireplace 10.00
Flue vent (water heater/gas tireplue) 10.00
-. Log lighter (gas) _ 10.00
1 1 . ' .A• ' ' , _ - - -- Wood/Pellet stove 10.00
1
_Wood fireplace/insert _ 10.00 _
Chintney/lincr /tlue/vent - 10.00 _
: i :;;:, f, .:,,:.J ; ENA'NT: :'•i °i^i ? R° t�: ;{'ili Other: 10,0
- -
ORE ': ;tO.VVIVI: T .. 0
'' Environmental Exhaust & Ventilation
5line: -. . .._ Range hood /other kitchen equipment 10.00
Address: ,•, �l -�n1, > l�t /1
. f t ,r1L! Clothes dryer exhaust 10.00
City /State/Zip: r , . 0 6 _ C7 1 - 1, Single duct exhaust
P • 2e: Q - • Fax: (bathrooms, toilet compartments, •
... -• 'r ,'' utility rooms
OF P)'L1 T • � ■ CONTACT PERSON __ _ Y ) _... _.- .__ -
-- 11 Attic/cr space fans _ _ 10.00
Name: / „( , : -) > - of -_,....A. , .^F Other:..- 10.(10 ._ .
Address: 4 L l - -- Fuel Piping -, - - - - -.
City / Skate /Zip:
- i *•(SS-40 for first 4, $1.00 each ad ditional)
1 . _
- --- -
Furnace, etc. "`
Fax: — ,
Phone: .
_.. Gas h eat pump - - -- " •• •-
L- n3ail: Wall /suspended /unit heater -
< ••.- rhea - --
Business Name: , C;(`C-) - - l -� �� �, , ^.1 - _ Fir place _ -
c Range
Address: H1 b - • - 1 r 1 ,.3 ..A. VI 4 _ - :: .
t 1313 _
City/State/Zip: ��1 \�_ i _ C�,– . .. t i 1 1 Cy .- Clothes • dryer (ga-s) ��
Phone: �. ? - )`I 3, 3 1 _I Fax 1 7?c7:.1 3. % Other: -- 1 ,
ota ;
CCB Lie. #: 1 ` Me chanical Permit Fees
Authorized (.721j11 Subtotal: $ -
Signature: ;, Minimum Permit f fee. $72.50 $ .
L P lan Review Fec (25% of Permit Fee) $ T . 1
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE S 1� .
Notice: This permit application expires if a permit is nut obtained within *Fee methodology set by Tri-County Building Industry Service Board.
Igo days after it has been accepted as complete, ••Sete plan required for exterior A/(' units.
1:1Dats\Permit Forms MecPermitApp•doe 01/03
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
• ■ GL 'Li2 Suite MEC - bC)G g&
. Contact Person . Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ CO r " / ' a _ - 6= 9 • - - - j _ - - - _ , - - ( 4 : 1 - 62C
Footing !� -- I , ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain —
Slab - Inspection Nofes -. .- - . - - _ -SIT:
Post & Beam / - - r -- - _
Shear Anchors --
Ext Sheath /Shear ` ��� O -� m
4 -- �� %.1 il 4k— / ,- -A g- /1L a
Int Sheath/Shear , / .
Framing ( _r _ `� � F R . ~-
Insulation \ " - -
Drywall Nailing —. . _- -r
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof 1 /
--- Ti. t G • .
Final (Z- : 4 ' V 6- ) N -- ) C `C) L1 ) 3` ", 3.‘ M .
PASS PART FAIL J \ 1 �
PLUMBING :.'. ' u
Post & Beam C /
Under Slab
Rough-In ' .
Water Service •
Sanitary Sewer
Rain Drains
Catch Basin / Manhole Q / tiMirr■ob j 1. E ^ L Li
Storm Drain - r , - -
Shower Pan
Other:
Final V� ti \ hs
S PART FAIL_- - -
ECH i
'f Post & Beam
Rough -In
Gas Line -
Smoke Dampers -
AS PART FAIL .
ELECTRICAL ,
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: al Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date /7 a Ilnspe / .„/ / 1 pct
Other:
Final DO NOT REMOVE this inspection record from the job si : e.
PASS PART FAIL