Permit CITY T I GARD MECHANICAL PERMIT
";;!a`f ` DEVELOPMENT SERVICES PERMIT #: MEC1999 -00148
n �' f � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/7/99
PARCEL: 2S 110CC -19100
SITE ADDRESS: 12420 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT: 068 JURISDICTION: KIN
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:
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:
GAS OUTLETS: 1
> 10000 cfm: -
Remarks: Add gas piping.
Owner: FEES
KAY HOFERER Type By Date Amount Receipt
12420 SW KING GEORGE PRMT GEO 4/7/99 $25.00 KING CITY
KING CITY, OR 97224 5PCT GEO 4/7/99 $1.25 KING CITY
Total $26.25
Phone: 639 -3644
Contractor:
re- pox R eomNGrY
SW //S
T/4 ! ?Rx 3 REQUIRED INSPECTIONS
Gas Line Insp
Phone: o? D.Z,L3 Final Inspection •
Reg #:
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 -0080.
You may obtain copi- .f th- :e rules or direct questions to OUNC by calling 3)246 -9189.
Issue By: ,�� % // Permittee Signature:
Call (50 .39 -4175 by 7:00 P.M. for inspections needed the next business day
___,. __.._..,APR- 07 -'99 WED 13:10 ID: FAX NO: 1#110 P01
Plan Check #
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd L1 -q- '
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 • Date to DST, ` - -` 1
Print or Type Permit e/hleAgi9- mem8
Incomplete or illegible applications will not be accepted Called
Name of DevelopmenUprojpet Description
5 a a Table t o Mechanical Code Q Pric Amt
Job Srroes Address Suilv# A) Permit Fee 10,00
1) Furnace to 100,000 BTU
Address including ducts & vents see footnote 1,2 6.00
Bldg#. city/Suite Zip 2) Furnace 100,000 BTU+
including ducts & vents see footnote 1.2 , 7.50
Name (or name of business) 3) Floor Furnace
/� _ Including vent see footnote 1.2 8,00
Owner ,- /�� - 4) Suspended heater, wall heater
Melling •dlees �` or floor mounted heater see footnote 1,2 8,00
./A p < -
lr7 � P 5) Vent not included in appliance permit
City/stale Zip' Phone A 3,00
orPv C / $ 3e. Check all that apply: 'Boiler Heat Air '
ame (or as of burins ) For items 6 -10, see or Pump Cond Qty Price Arra
footnotes 1,2 Comp
- 6) <3HP;absorb unit to
Occupant Melling Address 100K BTU 6.00
7) 3 -15 HP :absorb unit
City /Stale Zip Phone ' 100k to 500k BTU 11.00
8) 15 -30 HP; absorb
unit .5 -1 mil BTU 15.00
contractor Name unit 30-50 5 mil BTU 22.50 HP; absorb
' /des 1E r ..,� -
Prior to permit Melling Address — 10) >50HP: absorb unit
a
issuance, a copy l f;( 5 � / 5 >1.75 mil BTU 37.50
of all licenses C/slate zip Phone 11) Alr handling unit to 10,000 CFM
are required if ( Py/9 -- / a Yr Tj 3 .A6 -pa /J 4,50
expired In COT on toner. Cont. Board Llo# Exp. Date 12) Air handling unit 10,000 CFMr
database 1 7 J 2� - 7.50
Architect nab 4--/-1f 13) Non-portable evaporate cooler
4.50
Melling A ddress 14) Vent fan connected to a single duct
or 3.00
15) Ventilation system not Included in '
Englnoer cay/swte Zip Phone appliance permit 4,50
16) Hood served by mechanical exhaust
4.50
Describe work to be done:
17) Domestic Incinerators
New fik Repair 0 Replace wet, like kind: Yes 0 No 0 7.50
Residential O Commercial 0 18) Commercial or Industrial type incinerator
30.00
.. Additional information or description of work: 19) Repair unite
4.50
20) Wood stove
NOTE_ For Commercial projects only; Units over 400 lbs. require 4.50
structural gas calm. 21) Clothes dryer, etc.
Type of fuel: ell O natural gas' LPG O electric 0 4,50
22) Other units
I hereby acknowledge that I have read this application, that the information , 4.50
given is correct, that I am the owner or authorized agent of 23) Gas piping one to four outlets
the owner, Mat plans submitted are in compliance with Oregon State laws, See footnote 1 / , 2.00
24) More than 4 - per outlet (each)
Signature of lawn®riAgent Date
.50
/ • Minimum Permit Fee 526.00 SUBTOTAL "' '' . - w
Contact Person Name Phone '�- ` '
5% SURCHARGE ` F.'3 "' r " "
(o.__, ,_c 4 PLAN REVIEW 25% OF SUBTOTAL , _y
Foonotes for commercial projects only Required for ALL commercial permits only ';'; :' :;;, :' ° :
1. Provide full schematic of existing and proposed gas line and pressure. TOTAL =i €:71 ;, :i," "-i
_2 _Provlde drwlngs to scale showing elstlng and proposed mechanical ,,d,_,,, "4;,,, „,,,
units. "State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
t :\rnechporm.doc rev 02/4/99
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�i
q4.4e4..P :(50 BUP
Date Requested 4 - 8 9 AM PM BLD �a
Location /V100 (D�> Suite MEC lqq7 / L ig
b
Contact Person �� "� � Ph � -�1 PLM
Contractor 1 1,(x, / 01)01 U'L --PITS (p S -30qtt SWR
BUILDING . _ ELC
�`° Tenant/Owner
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
•
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
n
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING '`$ e `
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post &Bea
0 -11—
Rough I •
• . e Dupers
•
PART FAIL
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 (1'
Other Date � Inspector 9 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •