Permit , ,L . .
r�, CITY OF TIGARD MECHANICAL PERMIT
1 i) DEVELOPMENT SERVICES PERMIT #: MEC2004 -00276
V 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/13/2004
PARCEL: 1 S 134AD -01600
SITE ADDRESS: 11375 SW LAKEWOOD CT
SUBDIVISION: ENGLEWOOD ZONING: R -4.5
BLOCK: LOT: 056 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:
LPG 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas line to dryer.
Owner: FEES
JIM GIBSON Description Date Amount
11375 SW LAKEWOOD CT [MECH] Permit Fee 5/13/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 5/13/200 $5.80
Phone: 503 - 597 - 2460 Total $78.30
Contractor:
SUBURBAN @HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Final Inspection
Reg #: LIC 143335
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= 9.
Issued y: � ` ;; � / ,I Permittee Signaturg_ ,. A7 - 0 (7, ..
Call (503 .39-4175 by 7:00 P.M. for inspections needed the next business day
10/03/00 TUE 14:59 FAX 503 598 1960 CITY OF TIG.ARD a 002
I , �. .a-
T# ff ,
Mechanical PermitrAp i -e of
A, Date received: • MAIM Permit no.: [ i��, �"
� il l City of Tigard pp
. y g MAY 12 2004 Project/appI.no.: - date:
City of'Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 -4171 CITY OF TIGARO D ate issued: ' By • eceipt no.:
Fax: (503) 598 -1960 PLOININGIEN � �s'e file • no. Payment type:
Land use approval: Building permit no.:
I - TYPE OF PERMIT
iclk & 2 family dwelling or access ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
U New construction ❑ Addition/alteration/replacement U Other:
. JOB SITE INFORMATION I COMMERCIAL VALUATION SCHEDULE
Job address: \ \'3 1 cv..n t ce3 4.) Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ 'caL.) .0. .
Lot: Block: Subdivision: *See checklist for important application information and
Project name: • \ G 5, jurisdiction's fee schedule for residential permit fee.
City/coun . _: L .... ZIP: - Z I. & 2 FAMILY DWELLING PERMIVIIT FEE SCHEDULE
Description and location of work on premises: _ AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
C-.frS l -al a 2.. - -co '.4:1, .t'4sL . Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ Na Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? O Yes ❑ No Alteration of existing HVAC system _
MECHANICAL CONTRACTOR I Boiler /compressors
State boiler permit no.:
Business name: HP Tons BTU/H
Address: l.demlt.l 1,si,_. t \2 " his, Fire/smoke dampers/duct smoke detectors
City: " . �- jQ I State: d .,' ZIP:C112 0 Heat pump (site plan required) -
Phone: -ZS'�, sy3Q, Fax:2'4 tj3 I E -mail: Install /replaceturnace/burner BTU/H ■--
Including ductwork/vent liner O Yes Q No
CCB no.: ILk%S3c - Install/replace/relocate heaters– suspended,
City /metro lie. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON I I Refrigeration: -
Absorption units BTU/H
Name. -- Chillers HP -
Address: � V �L1 m e t , 1 \t,s• ..ey`je` Compressors HP --
Environmental exhaust and ventilation:
City: �� I State{� ZIP: a o t'7z2. Appliance vent
Phone: "Z 5:13% Fax: 2,51- E -mail: Dryer exhaust
• ' OIVNER I Hoods, Type I/ IUres. kitchen/hazmat
hood fire suppression system
Name: -- M G ‘.3S 00 Exhaust fan with single duct (bath fans)
• Mailing address: A >, 3'45 . V�, ,..
Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: , A .. r _ State: DJ_ ZIP: 9 - 7 . _ w„. Type: LPG \ NG Oil 1 SILK)
Phone: G.1- _ Z• , Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER. ■ 1 I Process piping (schematic required)
Name: • Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert – type
Phone: I Fax: • I E -mail: Other. ove/pelletstove ■--
Ocher.
Applicant's signatu - ; _ Date: 1, Other: iii
Name (print): ---..w1 .. � Ai N .14 C.C.)t,-)
Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ 1Z
❑ Visa 0 MasterCard__ Notice: This permit application Minimum fee- $_ 12. •r
Credit card number: / if a p ermit is not obtaine
/ d Plan review (at %) $
Eapinm within 180 days after it has been State surcharge 8%
g ( )....$ – 1 S-
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 1 • 't
Cardholder signature Amount
440-4617 (6!00UCOM)
•
CITY OF TIGARD 24 -Hour
• BUILDING Inspection Line: (503) 4175
INSPECTION DIVISION Business Line: (5 639 -4171 MST
BUP
Received Date Requested — " /Y AM PM BUP
Location _ ite _ MEC0 � )O 27(
Contact Person 1. -(.i/1 S Ph ( ) �- 7 q3, PLM
Contractor Ph ( 5 03) .`5 79 SWR
BUILDING Tenan caner . A■ Atd.'2•.orii ELC
Footing 4
e Foundation Access: �p �.laou� SIe o N w„�
Ftg Drain �j ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear �Q ✓ 0 I fn 4/
Framing ' 1
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
Other:
Final
PASS PART FAIL
PLUMBING
P os t & B eam
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
:MECHANICAL.
Post & Beam
R
mo e Dampers
S PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage.
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at C Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE D Un- - - to inspect – no access
Fire Supply Line /
...._
ADA `f
4/ Approach /Sidewalk Date S ' (.�
/ / Inspector - AA - _
Other:
Final DO. NOT REMOVE this inspection r ord from the job site.
PASS PART FAIL