Permit CITY � TIGARD
MECHANICAL
'. DEVELOPMENT SERVICES PERMIT
& �� u~u~ nmo u �� x� n�r '
PERMIT #.......: MEC98-0511
13125 SW Hall ��.�o�[�������9��
Blvd., �°-- '' DATE—ISSUED: 11/12/98
PARCEL: 2S111CD-06300
SITE ADDRESS...: 09839 SW KIMBERLY DR
SUBDIVISION ^ VERWOOD ESTATES ZONING: R-4.5
BLOCK..........: LOT '024 JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN. ^ 0 • EVAP COOLERS: 0
TYPE OF USE....:SF UNIT HEATERS..: 0 VENT FANS...: G
OCCUPANCY GRP..:R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES........: 0 BOILERS/COMPRESSORS HOODS • ^ 0
FUEL TYPES 0-3 HP ^ 0 DOMES. INCIN: 0
:GAS 3-15 HP ^ 0 COMML. INCIN: 0
• MAX INPUT: ' 0 BTU 15-30 HP ^ 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30-50 HP • ^ 0 WOODSTOVES..: 0
GAS PRESSURE... 50+ HP ^ 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 1
FURN < 100K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS. :• 1
FURN ) =100K BTU: 0 ) 10000 cfm: 0
Remarks : Installation of gas fireplace insert.
Owner: FEES
WAYNE ISRAEL type amount by date recpt
9839 SW KIMBERLY DR PRMT $ 25.00 DLH 11/12/98.98-310729
TIGARD OR 97224 5PCT $ 1.25 DLH 11/12/98 98-310729
Phone #: 620-3209
Contract or:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
$ 26.25 TOTAL
BEAVERTON OR 97005-2129
Phone #: 646-6409
Reg #..: 51469
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-■q-m10 through OAR 952401-0080 You may _
obtain copies of these rules or direct questions to OUNC by calling
(503)24679187. --'
' ---
Issue By �^" �e��� Permittee Signature
•
++++++++4++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p.m. for inspections needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
~_ _ ~_ was ~~� � _ _
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CITY TIGARD Mechanical Permit Application Recd lication Redd B yck#
By 2:: 4 - -frf
-13125 SW HALL BLVD. Commercial and Residential Date Rec'd /i//z /7eP
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 , - Date to DST
rmit # Mme-' 9,,�- 0 S /
Print or Type 1/ /
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fee 10.00
1) Furnace to 100,000 BTU
Address cis. c,, K164E244 including ducts & vents 6.00
Bldg# City/State Zip 2) Furnace 100,000 BTU+
Tic,p.ie c> orb c' 22.4 including ducts & vents 7.50
..../ Name (or name of business) 3) Floor Furnace
�/ including vent 6.00
Owner / /x`5,41.,,¢ ,_L- -sr.p.�L
` Mailing Address 4) Suspended heater, wall heater
or floor mounted heater 6.00
9 €::3 S■ - 1.01 , -- , 3Et2c_._y 5) Vent not included in appliance permit
City/State Zip Phone 3.00
-i O a 2 cr7224 4.2.0.3 zp1 CHECK ALL *Boiler Heat Air
Name (or name of business) THAT APPLY: or Pump Cond Qty Price Amt
Comp **
is. P+^- -E 6) <3HP;absorb unit to
Occupant Mailing Address 100K BTU 6.00
7) 3 -15 HP;absorb unit
City /State Zip Phone 100k to 500k BTU 11.00
8) 15 -30 HP; absorb .
unit .5 -1 mil BTU 15.00
Contractor Nan' ote49`li r 9) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 22.50
Prior to permit M iijn`' Addres /� 10) >50HP; absorb unit
issuance, a copy / lie, 7 ! C16/j >1.75 mil BTU 37.50
of all licenses /stat z i Phone t/Co� handling unit to 10,000 CFM
11) Air hdling uni 10,00
/}� l
are required if (7ce 2gcq 4.50
expired in COT Oregon nst. 9nt. oard Lic.# Exp. D t , i L 12) Air handling unit 10,000 CFM+
database l (� /e / 7.50
Architect Name /// 13) Non - portable evaporate cooler
4.50 •
or Mailing Address 14) Vent fan connected to a single duct
3.00
15) Ventilation system not included in
Engineer City/State Zip Phone appliance permit 4.50
16) Hood served by mechanical exhaust
Describe work to be done:
4.50
17) Domestic incinerators
New 0 Reair 0 Replace with like kind: Yes 0 No 0 7.50
Residential Commercial 0 18) Commercial or industrial type incinerator
/ 30.00
Additional information or description of work: /� 19) Repair units
p7i4Z/l /l 96 t r-vi G` �C 4.50
20) Wood stove il
q el- //Pe' 4.50 It
2 1) Clothes dryer, etc.
7( 4.50
Type of fuel: oil 0 natural gas LPG 0 electric 0 22) Other units
4.50
I hereby acknowledge that I have read this application, that the information 23) Gas piping one to four outlets ,�
given is correct, that I am the owner or authorized agent of 2.00 (�
the owner, that plans submitted are in compliance with Oregon State laws. 24) More than 4 -per outlet (each)
.50
Signature of Owner /Agent Date -, ; Z�/
Minimum Permit Fee $25.00 SUBTOTAL
5% SURCHARGE ? ' �, I. 37
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL ;
k / ��/�j� / ,{ Required for ALL commercial permits only „`
e. 2 V 7 C% Y / TOTAL ` `' > GI, v�
i% e *State Contractor Boiler Certification required
**Residential A/C requires site plan showing placement of unit
I:\mechperm.doc rev 07/20/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�i
BUP -
W C�h Date Requested t i" / 7 - q AM PM BLD
Location q®39 Yj& /� / ' / Suite MEC cg" DS/ I
Contact Person 1sL .l J 4J _ Ph 26-6.)-167 PLM
Contractor SWR
Contra Ph ��'y
BUILDING' °`s Tenant/Owner ELC
Retaining Wall ELR
Footing Access: cl /` min- ip:10`-,
Foundation P V ���� — C , ,� l 471,C/P64 FPS
Ftg Drain �(�•�• SGN
Claw
Crawl Drain Inspection Notes: u
SIT
Post & Beam ,, �{j- .,D
Ext Sheath /Shear /net . �Q7� tr - v'C
Int Sheath /Shear / _ _ - ,t-/ !
Framing �o — C l�L'7
Insulation
Drywall Nailing L�
Firewall
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
CHANIGAL - ,
Post & Beam
Rough In
(.7:_Z;as Line PT
Smoke Dampers
1 PART FAIL
CTRICAL;,. ^ z 4 e ^,
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] 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 Date / / / Inspector ector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •