Permit CITY TIGARD MECHANICAL PERMIT
,4 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00030
- � f l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/19/2005
PARCEL: 2S 103BB -03400
SITE ADDRESS: 12505 SW KAREN ST
SUBDIVISION: BROOKWAY ZONING: R -4.5
BLOCK: LOT: 034 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:
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:
Remarks: Run gas line to range.
Owner: FEES
HARSH FIELD, RUTH A Description Date Amount
12505 SW KAREN ST [MECH] Permit Fee 1/19/200. $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 1/19/200: $5.80
Phone: Total $78.30
Contractor:
MP PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015 -0393 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Misc. Inspection
Reg #: LIC 5002 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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
- (503)246 -6699. - - - -- —
Issued By: r Permittee Signature:. ; c gyp
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next � usiness day
JAN - 05 15:28 FROM - MP Plumbing 5036551726 T -804 P.004/004 F -697
ivitem.anical Permit ,A. lie ion . , • R OFFICE USE ONLY
i•- R eeetved Mechanical
DateB :� / Permit N o.: , L' �.Q .. o 3C
City of Tigard G C oo l
Planning Approval Building
13125 SW Hall Blvd. V ` Plate/13y- _ Permit No.:
QQ'J Plan Review Other
Tigard, Oregon 97223 . � DateB _
Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -5 �j Post Review • ' Land Use
Internet: www.ci.tigard.or.us 6 Z C' ",' y'i�'� Copt Case No.:
0 .....4r... - ti - el Contact et J El $ce Page 2 for,
24 - hour Inspection Request: 503 G,' Name/Method: ` r
I if Supplemental Information.
• lw: •, :. • 7.T.YPE OF..M012Xel z` Gl? : " '. krsz;.161. ; ti`. i s :.i:a;" k !,;.'4 4 COMIVIER t
GZAIrP'E)tJ., 5 C> lEDULE ;'- • USE;7C)3ECKI:I9T; , :.v
❑ New construction ❑ Demolition Mechanical permit fees' arc based bra the total value of the work
IV Addition/alteration/re 6 lacement • Other: performed. Indicate the value (rounded to the nearest dollar) of all
-•: ,: ,' _ ` '• 'CkaigGORVOr.! - % ; •rr., mechanical
^����"� -� • •,;1 .r-, COI�STRUGTXON'P;rir;�,s; `eS�,�.k"`i� materials, equipment, labor, overhead and profit.
•Y4 1 & 2 - Famil dwellin rU Commercial/Industrial Value. $ • See Page 2 for Fee Schedule
r Accesso Buildill: • '44, i/E, SIpEN T, iAz;EQil)PMENVSY.SO:EIVisik1':k;*
El Master Builder Description
■ Other: Qty Fee(ea) T otal
F;:: r.. • ^.,.14 ;, OBsSE EFINFORlifit"TION:,aiiidLO •`C,.A° ''TiOlal'a :r t -i � J inni Coolie .
�'"'� Furnace - add - on air conditioning** • 14.00
Job site address: i-2_ ..c' - w -_ - Gas heat pump - 14.00 •
Suite #: Bld /A.t. #: • Duct work . . 14.00
Project Name. ..�...:`--.S1- 'ronic hot water system 14.00 1
Cross street/Directions to job site: Residential boiler
(for radiator or hydronic system) 14.00
Unit heaters (fuel; not electric)*
jwall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: Lot #: Re air uni 12.15
Tax ma.. /.arcel #: Other )Betel •App liances ° "r,.:4r.:
Water heater
:,i,<�;....:.;., SCPTION 1 , ,' >,„ r .., Gas ls 10.
::'r,::0. e.F: , . 1;liE . •U .1IORK�9'�t � 4:? `a1641.3iu' ,
; 10.00
r ^rMa fireplace
. in
• z.. we-- Flue vent (water heater /has fireplace} 10.00
Log lighter (gas) :10.00
Wood/Pcllet stove • 10.00
Wood fireplace/insert 10.00 •
;r� a Chimney/liner /flue/vent 0 "
1 . a'�20PERTY.OWNER'!:� d,: ' -' gt;I'ENA 'Ta•�`a ? #'y,;C :;iiE)'_:: Other: .. 10.00 •
Name: _ Environmental Exhaust & •Vcntilativn; : .--.' • -
Range hood/other kitchen equipment - 10.00 •
Address: - T,�T�� _
Clothes dryer exhaust 10.00
• +, ' ' Single duct exhaust
Phone: Fax: •(bathrooms, toilet compartments, .
IMMEEKEignammal.f SA 'C eai' 0' utii' rooms) 6.80
•
Name: i s w • ... Attic/Crawl space fans
10.00
Address: _ ■ Other: - 10.00
' Fuel
Ci /State/Zi.: ,- : 4.. Cc. • r � 01 - * - e :
(SS•40 for first 4, $1.00 cach
Phone: La a 1 Furnace, etc. .s
E -mail: Gas heat pump .« •
CON7° < . Wall /suspended/unit heater . + +. •
.::, ;:.: .•;_ RWCTOM. ;i95A • 'i. :''� .': I`r i:; ; i :.:r_• Water
Business Name: w heater «s .
.. :ab t C Fireplace «*
Address: ` Rangy -
.s S y o
Ci /State /Zi. • 1313Q +►
Clothes dryer (gas) - s«
Phone: C.�.ss Cl�l Fax: Other: **
CCB Lie_ #: 4..c,
_ Total:
Authorized ------- Mechanlcal Permit Fees
Signature: � _ ' Date' `- ( G - 05— Subtotal; S
� ` Minimum Pct Fee 572,50 $ — tZ 5�
AM" a, - N • rt ■ Plan Review Fee (25% of Permit Fee) $
_ (Pieasc_print e) _ _ _ — _ State Surchar a 8 %.of Permit -Fee - -$- - -°) -
TOTAL PERMIT FEE $ -1 $ %IS)
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after It has been accepted as complete. Site plan required for exterior A/C units.
i:'.Dsts\Pcrmit Forms\MccpermitApp,doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST igiov_a„
Received Date Requested ; — °7 AM ,"D3a PM
Location AP-505 /< Ovsr e 1 Sir. Suite MEC
Contact Person Ku+• Wer✓gin eid Ph ( ) 59 a — ,3a & Ofai). P0 ,5 - - ODQ23
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: V ((I - _ - p vt SIT
Post & Beam (J/ C��
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall a
Fire Sprinkler
Fire Alarm rn eZ ?l9 O s — 003 C)
Susp'd Ceiling // // /�
Roof d ,e6R�i') � ( _S G 'J— a7_7l`
Other: b /-
Final pcc p �4-1 ' 7(s V ® J7 — a
RT FAIL
eam -
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains i k.
Catch Basin / Manhole
Storm Drain_ , al „
Shower Pan • _ _
.
PART FAIL
`
ANICAL
P
•
ost & Beam
Rough -In
Gas Line
Smoke Dampers " r
n
' PART FAIL
ELECTRICAL a `
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 •. >, 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
7 & CF
Approach /Sidewalk Date 777° inspector �� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL