Permit CITY TIGARD MECHANICAL PERMIT
16 '4 , I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00576
x-1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/24/2004
-AA PARCEL: 1S133DC-17400
SITE ADDRESS: 13258 SW LAURMONT DR
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK ZONING: R -12
BLOCK: LOT: 029 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: 1 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of furnace and A/C.
Owner: FEES
PEMENT, JOHN MICHAEL + BERIT Description Date Amount
13258 SW LAURMONT DR [MECH] Permit Fee 8/24/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 8/24/200 $5.80
Phone: 503 579 - 7589 Total $78.30
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 151847 Final Inspection
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: _ .2.1 P , Permittee Signature: ;2 c ,p
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Permit No.: VV -7,, -7,, a Receive. . i 7 // ., V � / ' %v e �y /,
°,
13i 25 S W Hall Blvd., Tigard, OR 97223 ��
Plan Review
phiin 503.639.4171 Fax: 503.598.19 0 a ■ ,at�l,ydi �y��+ Date /By: Date /By: Other Permit:
Inspection Line: 503.639.4175 �' `j) —t-hi ? L Date Ready /By: ME VI See Page 2 for
Internet: www.ci.tigard.or.us AUG L' """ Notified/Method
" Supplemental Information
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New construction wE- Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑Other:
mechanical materials, equipment, labor, overhead, and profit.
s's : :::f:Y „.,. , .> <,:.<,.,::: _,;;: = $
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:,1:1,„,:,:,,,,,4,„0:.,1 S , 4 EQTJ1 ML T S YS T E M S FE , `-
r and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
Multi -family El builder For special information use checklist.
Description ,,ult :: r esc on Qty Ea. Total
y Ot he
ripti
<r , "��_ a >,� - ...2 - _. ���. ..� � . r:t11VD L3QCAT>,`ION., Heatin /coolin
Job site address: \ 3 , O s 1_0.A,- A-- conditioning -or heat pump l Le) (C' l� (requires site plan showing placement) 14.00
City/State /ZIP: .. I ) • Q- Furnace 100,000 BTU (ducts /vents) t 14.00 I ``l
1 Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
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
t 4 l i s 'A ItIPT'Il7 C? ,f� K r� =-: a Water heater 10.00
(n� A n Gas fireplace 10.00
`V\ ' /n� c.( v /1 • -0--rX J � l c_ Flue vent for water heater or gas
A � fireplace _ 10.00
P Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
..: -
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Chimney/liner/flue/vent
- -:- 1'Rt.l'>P4Y' U, - E' , F�s ,. 10.00
_ . , .�:�.... � ",,,�,.;, ,;,.,� � ��:, ,�`� ,r - -�s�. - ..::.: s,� > >� Other: 10.00
Name: LSE f „ ��„ Environmental exhaust and ventilation
Address: p IK �1 Range hood/other kitchen
U S w ��N rylt - , - or ' equipment 10.00
City/State /ZIP: — rt a�, C(-7 d 3 Clothes dryer exhaust 10.00
J Single -duct exhaust (bathrooms,
Phone: ( ) _ ty rooms) q S� � Fax: ) toilet compartments, utili r ins 6.80
«,;, is ;: �,; :, b," ' t t °- `': ° ' `,;;.r,: , ;,, g �O 0 . „ ` ,: Attic /crawls ace fans 10.00
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r ace a 1 vAv t Other: 10.00
Business name: t' Wl/ 1 V t -O�-XJ "t \ l�r Fuel t m
P�P� g
Contact name: $5.40 for first four; $1.00 for each additional
Address: g ( g Ste, L/-14 t'}- lc17) Furnace, etc. 7.___ Gas heat pump
City/State /ZIP: p _n�Ck j
S�(5-63 • q 7 c2 �- Wall/suspended/unit heater •
Phone: () G .� O - /;;
3 `llt� y-�)�i , Fax: ) " ‘:;.71) — ro 67 4/ Water heater
Fireplace
E -mail:
1,.4.; °xi`. ?- :s,'' :.�. .. . :s`.,; s Range
� :t AV &.' 'c®N"C4,40I ,_ r: Barbecue
'' � G� -
Clothes dryer (gas)
Business name:
Other:
Address: L r-- C = .. y :, ; . :, �,, �,. >
� ` ,H � 3t:, � Y� - . : _ F M��T��CAIW ;'F�PF�S *� ����::�,
,
City/State /ZIP: L 012 [ , a13- - -:. 1
i
Phone:( ��) _ Fax: ( o �y Minimum permit ee ('•72.50) - , SD
Plan review (25% o p : :: -e
CCB lic.:
5 ' State surcharge (8% of permit fee) � � 8 U
TOTAL PERMIT FEE `7 '3O _
Authorized signature. 1 -644 �(../ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 3 t;:_ t Date: 2 0(6 -(/ * Fee methodology set by Tri- County Building Industry Service Board
is\ Bu ilding 1 Permits\IvIBC- PermitApp.doc 12/03 440- 4617T(il /02(COM/WEB)
�22.Lb 1O'
. JCI Ms
CITY OF TIGARD 24 -Hour s
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re • ested AM PM BU
1( )
Location 3 � D- g S _�t_��� /� _•.4�t _ Suite X� ' 7
Contact Person Ph ( ) ' 70- 8S' 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC '' 7C) 17°
Footing C - �
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � � _T A,,( _.,- - SIT
Post & Beam
Shear Anchors ( toa—
Ext Sheath /Shear
Int Sheath /Shear ,8(Lick-VWLS\
v� >
Framing
Insulation Y L1----1 U 00
Drywall Nailing
Fi rewall
Fire Sprinkler - U 0 I TO'
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING }�
Post & Beam /� UV Piirk � NN- ( M
Under Slab f /
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
•
Shower Pan
Other: 1
Final PART FAIL a i ' � 0 L) ~ O )10
MECHANICAL
Rough-In
& Beam 5Th �S ��� /- V A �A \L S 1 j `f 7" �1
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL •
SITE Please call for reinspection RE: Unable to inspect - no access
- Fire Supply Line J�
ADproach /Sid Date � ' 7 Inspector IC11/v � Est
pp roach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL