Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00740
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/12/2004
PARCEL: 25111 CD -09300
SITE ADDRESS: 09900 SW KIMBERLY DR
SUBDIVISION: KERWOOD ESTATES ZONING: R -4.5
BLOCK: LOT: 033 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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
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: Reconnect furnace.
Owner: FEES
RUZICKA, DIANE L Description Date Amount
9900 SW KIMBERLY DR [MECH] Permit Fee 11/12/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 11/12/20( $5.80
Phone: 503 620 - 8679 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 66578
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: Permittee Signature: 1-1_ G-J%L6
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
1V1 ;
ica� Permit�`Alp ti ® FOR OFFICE USE ONLY
Ci II ti�� --- Received ,
Dew It l PertnitNo.O
,
13125 SW Hall Blvd_, Tigard, OR 97223 �} Q ' I % -
Phone: 503.639,4171 Fax: 503.59B.19b0 1 U 20° " Plan Review
Other Permit;
/^+
Inspection Line: 503,639,4175 I�� RD 4`PRP Daccigy;
Internet; www.ci.rigard.or.us GcTY OF TIGA -11. Date Ready/By: Soo Page 2 for
LL Supplemental o ISI O1� Notifjed/Medrod: Swl l nfor matlon
t2t IIt t ING V
�).' 1 1/41m:.70a + F;;, " " 1,.,,ll,M''' ail' CO111MCki4hL FEE°' 'SC EDrJLE - 'TJSE'. , CfCKUST •
Mechanical permit fees' are based on the value of the work
❑ New con C] Addition/alteration/replacement
❑ Demolition performed, Indicate the value (rounded to the nearest dollar) of all
❑ Other;
mechanical materials, d d
overh
equipment, labor, ea, an pr
"':I :,l' ,,*' ` . n; Ca'TE0OR, I � . OF F ' C ON " SFRL,TCTIOIV ..,r „ �rv.I �'I ,, - u profit. -
r� � ,,,, . '• r' � .' ^ „�d�� �:;,; slue: $
I�t-1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory RES 'I:,.EQIIJTPMEp[T
ry building
❑ Multi - family ❑ Master builder ❑ Other: For spec[p! Wormy/on use checklist,
' } ; n �Y L „I,i,,, _ Description 1 t I La- i Total -
. rin+ 1, 1' {si: ;.TO)3: s ,�,,'��' c,, Qty'
a; �1!F, DErDT lY, LOCATI N, , A!''' ms r,'„ .'' ri;rI ' ' '' Heating/coollnQ
Job site address: r�� / + ' l./ / �r Air conditioning or hear pump
+'Y! ! 1 (requires site plan showing plaeomend 14.00
Ciry /State/Z1P: 4 fi r z il Furnace 100,000 BTU (ducts/vents) 4 14.00
Suite/bldg. /apt. no.: Project name:
Furnace 100.000+ BTU (duets/ventsl 17,90
Gas heat pump _ 14,00
Cross street/directions to job Sire: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
ydronic) 14,00
Unit heaters (fuel -type, not dectnc),
in -wall. in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.; _
,. Other fuel appliances
- '
rd9i „ ;;i'I�i , ;, 'DESCRIP'ThO' h1;, Og i1 4'' S `t'' ‘ I''; Water heater 10.00
Gas fireplace 10,00
Flue vent for water heater or gas
fireplace 10.00
V Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
��:�� .i'w, �P?IiT7C' , 11 ^1g R1 "'
' ri ti,; R'.iP {� ,I m �� n
----µ�m' `�L� �,,. Chimney /liner /nue/vent 10.0
i , t ,' . ;> a • ., 1X ' ' ' i '• Qs •. � s' ;, a;f ; ' . _ �s:' C.:Pc` ' kY N r LY ' 51. I . ' a i:d':, 10.00
Name, +�u�l,N b Other: 10.00 .
Lit �1. _ Environmental exhaust and ventilation
Address: Range hood /ether kitchen
equipment 10,00
City/State/ZIP; Clothes dryer exhaust 10 00
Phone; ( /� /� Single -duct exhaust (bathrooms,
Phone:
I ! ) 2-a- e tp l Fax: ( ) toilet compartments. utility rooms) 6.80
.I ij ,, r� ,_, la ace [an
•r,'t, .,1J„ ",. , AIVri?; ; :. .', °, a; ; ' ®6 01, , �. .I .a Attic /craw _
/ ' I�. �. :�50i?1; 'Vii;' "' P 3 _ _ 10.00
Business name: _. I -f, L 4 f - � 1'-� (' ! . i' 7 i I. 1 r Other: 10.00 `
Contact name: C
Fuel piping _
V G I 7 L e, i f�' e - a 55.40 for first Four; $1.00 for each additional
Address: / - j---1 i Furnace, etc,
L 1 _.CC' -L\
•
Ciry /State /ZTP; Gas heat pump
i I: s h rv,-• - C'Y'C , 9- / L .. Wall /suspended /unit hearer
Phone: (S' S ) Ir ( .1 0 . - 7 (r t : l P a x : ; ( ' ) to : .r 1 - p i- 7 f Water heater
E • Fireplace
is �' �q I' �a ?I .{ „ i ' w dn z _ Range
�' Fk � ' '. :_y,y , l mil, p f "' "' , ,_ �N ,C 4 �' "s' 1.' rh.^ I�;nte,'r' :' y i
��.a ' :P. {i !�,- 1' _ ' Lo .I-, "� ���i� _ .lh� �r `l+, 'e�l i° dyiP °.
.{ •� u ;_;:_ - •. „, , °;j, _barbecue
Business name: Cloches dryerisay)
Address: Other:
City/State/ZIP: loll ,':1 ' , �k1 1„ l' . : 6/7AIY•TCAI{,",i0.1VIIT PEES'
Subtotal
Phone: ( ) I F ax: ( ) .. Minimum permit fee ($72.50)
CCS lie.: 6 L' S 7- k' Plan review (259 of permit fee)
State surcharge (8% of permit Fee) S
TOTAL PERMIT FEE t 3 D
Authorized signature; C +'�' 1 • TM permit o Ilcadon eat Irea lr a permit Is not obtained within 190
L ��- P pP P D
Print name: days after it has been Accepted an wmpiete.
r-i ,- 6 _ r. e..._ c ' / S ( "_, , Date: C '1 o f a I • Fee methodology sat by Tri- County Building industry Service Board
oituildiegwerreimeu' sc•Permliapp. doe 17107
are - (i I /OZ /COM/ViED)
Z00/300 2 XVd ZZ Zl 000Z/06/LO
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503)- 639 -4171 MST
BUP
Received
geLizes ed / /0 PM BUP
Location 9 '46 ��� / Suite MEC CRI u 6
Contact Person / J4" - 2 Ph ( 3) i0 e - 6 7 / ( R4LM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner A 9 ELC
Footing
ELC
Foundation Access Ftg Drain ELR
Crawl Drain - .
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear.
Int Sheath /Shear
Framing
Insulation _
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
•
Other:
Final
P ASS 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
Post & Beam
Rough -In
Gas Line
Smoke Dampers
' na
=PAS ART FAIL
CTRICA
Se ce
Rough -In 5•Ai -c. 172 A /6l
UG /Slab •
Low Voltage
Fire Alarm
� 1 Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
as.. �C PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA �/
Approach /Sidewalk Date / ` J D Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from he Job site.
PASS PART FAIL