Permit CITY OF T MECHAN I CAL
ih�,i ,� DEVELOPMENT SERVICES PERMIT
Willi PERMIT #— .....: MEC98 -0331
!�- 1 3125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE ISSUED: 08/10/98
PARCEL: 2S11OCA -03200
SITE ADDRESS...: 11960 SW KING GEORGE DR
SUBDIVISION ZONING:
BLOCK LOT JURISDICTION: KIN
CLASS OF WORK.. :ALT FLOOR FURN....: 0 EVAP COOLERS: 0
TYPE OF USE -SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP.. :R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES........: 0 BOILERS /COMPRESSORS HOODS - 0
FUEL TYPES 0 -3 HP....: 1 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.: 0
FURN < 1OOK BTU: 1 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN ) =1O0K BTU: 0 > 10000 cfm: 0
Remarks : Addition of gas line, furnace & A/C unit to residence.
Owner: FEES
VIRGINIA BLADHOLM type amount by date recpt
11960 SW KING GEORGE PRMT $ 25.00 DLH 08/10/98 KING CITY
TIGARD OR 97224 5PCT $ 1.25 DLH 08/10/98 KING CITY
Phone #:
Contract or:
HARDY PLUMBING & HEATING
14689 NE COUNTRYSIDE
26.25 TOTAL
AURORA OR 97002
Phone #: 222 -9654
Reg #..: 000609
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Heating lint Insp
approved plans. This permit will expire if work is not started Cooling Unt Insp
within 180 days of issuance, or if work is suspended for more Final. Inspection
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 -801 -0010 through OAR 952 - 081 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling .
(503)246 -9187.
Issue By: if "ifitamsr .' Permittee Signature: /`�ilL
®A/ /WZ./c
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Call 639 -4175 by 7 :00 p.m. for inspections needed the next business day
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TO : T I GARD DST •
- - AUG -10 - ' 98 MON 11:05 ID: FAX NO: ##027 P02 �`- '
CITY'OF TIGARD Mechanical Permit Application Plan Check #
pp caon Recd By - Lzf
13125 SW HALL BLVD_ Commercial and Residential Date Rec'd rP/
TIGARD, OR 97223 i Date to P.E.
(503) 6394171, x304 I / 1 ' Date to DST
Print or Type / Permit # �Ee 9�P -D_33/
Incomplete or illegible applications will not be accepted Called
Name of DevelopmenvProjea Description
Table 1A Mechanical Code at Price Amt
A) Permit Fee „'`•:'';r ....., 10,00
J 3iraelAddrass K�� 1 �v 3ukedt 1) Furnace to 100,000 BTU
Address • ice, including ducts $vents ! 6,00
eicgtt "Yr me zip 2) Furnace 100,000 BTU+
n1 712,qI including ducts & vents 7,50
Name (or name of busincas) 3) Floor Furnace
Owner / 1 A j 74 L V )�6tNf Including vent • 6.00
Mailing Add / 4) Suspended heater, wall heater
9/z6 / C n or floor mounted heater 6.00
9q
I l 6 .S' (J 4, - ' 5) Vent not included in appliance permit
CttyState Zip Phone 3.00
V 4/9 e /67) z 0 e CHECK ALL 'Boiler Heat Air
(or name business) THAT APPLY: or Pump Corrd City Price Amt
Comp
e> f Nli' 6) <3HP :absortt unit to
Occupant Mailing Address 100K BTU 0.00
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 Nome • g) 30 -50 HP; absorb
telf/ P1_87, ¢- 19- unit 1 -1.75 mil BTU 22.50
Prior to permit Mailing Addraa 10) >.50HP; absorb unit
issuance, a copy ( /.•? 1`J. i<'/ S /69, X1.75 mlI BTU 3 _
of all licenses Ctty /Stoic' Zip • Phon6 11) Air handling unit to 10,000 CFM
are required if . A. f',; A r • el . , �. • 4,50. .
expired in COT Oregon onat. Co 1 Boa . LIcr Exp. Dale X 12) Ai r ha ndling un it 10 ,000 CF M+ ,
database �10 9 r-t 7 F' - c t
" ✓ 7,50 .
Architect Name /1/ y5.19 13) Non - portable evaporate cooler
4,50 •
or
Meiling Address 14) Vent fan connected to a single duct •
3.00
• • 15) Ventilation system.not Included In.
Engineer CItyr5tate Ztp Phone appliance permit , 4.50
16) Hood served by mechanical exhaust
4.50
Describe work to be done: 17) Domestic incinerators
New - Re•air O Replace with like kind: Yes 0 No 0 7.50
Residhnti Commercial 0 18) Commercial or industrial type incinerator
30.00
Additional In • rmatlon or description of work: 19) Repair units
/`J L--- (yam Li - --1 � 4.50
PS ��/C 20) Wood stove •
I 4,50
b/ ( 21) Clothes dryer, etc.
111 4.50
Type of fuel: oil 0 natural gas. LPG 0 electric O 22) Other units
4.50
I hereby acknowledge that I have reed this application, that the information 23) Gas piping one to four outlets j
give ' trees, that I am the owner or authorized agent of ` 2.00
me w e gnat ns sub d a In compliance with Oregon 5 to laws. 24) More than 4 -per outlet (each)
.50
Signature of Owner/Agent a /4 -?1
Dabs :%s.-%rt. ::! _• ;: >" y J '
Minimum Permit Fee $25.00 SUBTOTAL ;4:: r;1Y 1
I 5 % SURCHARGE :g4.0 "t,�ti,;5 , :
%
Contact Person Name / Phone PLAN REVIEW 25 OF SUBTOTAL `' " ,ii..,7
Required for ALL commercial permits only ``•'`n /
' TOTAL jh
*State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
1:lmechperm.doc rev 07/20/98 •
/ - eeee
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
a BUP
24/i Oc L Date Requested / 5< PM BLD
Location 1 / 960 > SW
(� r � i y e} � Suite • �b
Contact Person (J Ph PLM
Contractor Ady, Phr F',- Ph 2 2 2 — q & S SWR
;BU,I,LDING. x ° _ Tenant/Owner ELC
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Framing Sheath/Shear 3 1 4 0
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
;PLUMBING: s •
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
•
Post & Beam
Rough In / C w�_ (
Gas Line 1/ \(0/
S i ce , a Dampers
S PART FAIL
Service
Rough In
UG /Slab -
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITES < .n.
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 ' 1 0 � .
Other Date 4 Inspector Ext (.�
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.