Permit A -'-i CITY OF TIGARD
MECHANICAL PERMIT
r A • DEVELOPMENT SERVICES PERMIT #: MEC2002 -00393
" .� II 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/5/02
PARCEL: 1 S136AD -04000
SITE ADDRESS: 11533 SW PACIFIC HWY
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Alteration of duct work for tenant improvement. Project valuation: $4,900.00
Owner: - FEES
SMITH, EDITA M Type By Date Amount Receipt
833 NW 170TH DR PRMT CTR 9/5/02 $72.50 2720020000
BEAVERTON, OR 97006 5PCT CTR 9/5/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 234 -7331 Duct Inspection
Reg #: LIC 1441 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- -0080. • ' u ma obtain copies of these rules or direct questions to OUNC by c. ing
I u e By: 1� !,sRa A _ i. ! ' Permittee Signature: _ - /J _ -
Call (503 .39 -4175 by 7:00 P.M. for inspections needed the next business day
Sep-04-02 03:21P P . 02
Methinical Permit Application . vol,
Received hkehericel
Dat,....... _ -
. No • Nee-PO' -
City of Tigard , r ,
T est Form Plamnni Approva - Wilding
thaniar Permii No.:
13125 SW Ha11 Blvd. Plan !taloa ether ■
Tigard, Oregon 97223 Date4Ity: Permit No.:
Phone; 503-639-4171 Fax: 503-398-1960 Post-Review Land Use
Oa : Cam Pie.: Internet: www.eitisard.or.us ,,A4 . 4 1. 1 C0111,01 /wig.: Mc Amp 2 fur
24-hour Inspection Request: 503-6394175 --- Name/Method: . Supptemental Intermation.
• - WORK ''''',•;.;;' IR ' ' ' . l in ,. coptialtaAUFF.V.:SCUETIL/1.11!usz C.etECKLISIIke; .ii, ..
• New construction • Dornation Mechanical permit fees° Pre based on the total value of the work
lje Addition/alteration/replacement , , J Other petfonned. Indicate the value (rounded to the nearest dollar) of all
,-•- ... • ''.eihatt0010iiottoNstiterfOrt. •. '14. mechanical . , trials, equipment, labor, overhead and profit.
Ii 1 & 2-Fittril dwellin! Ii Cornroercial1Industrial Valutt I at ' - See Page 2 for Fos Schedule
11 Ames - - Buildin: ulti-Famil 1117 . 1 I.Et;SCEEEDULF.1 'Y*
111.1•1111M1M11111111 101111:
1011 11 =131 Total
• Master Builder • I. Other: •!,.• , : : • • •!•" ...:7:.: : red atiOiethae : • •. . :: : : ,,•:
....,• : ,108•:: _till_ IO • a:;.. . o '.7f Ofr.:1:;.M r';` Furnace • add-oa sir ecnuliOssisa I , 14.00
Sob site address: . 33 51 /46 fi 4 HA/ ANNE GIs heat puly 14
_ I _ _ 14.00
... _ _
Suite #: ( 1:17 ,t.#: Duct work _i__ 14.00
H &conic hot water system 14.00 NM
Pro Name: . Residential boiler
Cross strect/Dircetions to job site: f o r radi ..- o r h 4 ; , m a c s stet IIII 14.0n
Unit heaters (fuel, not electric)
l
w. in-duct ,..m:•. • cd etc. Ell 14.00
_
Flue/vat (for anystithoveL NM 10.00
■ Repair units
Subdivision: • • - Lot #: :.... - : • .:OtherdPite1 114' : MOW ' . - ..: i"."i':
Tax a. . awe' ft; . Water hater MOO MOEN
,; . . :. , 1,-. '' t ....tiRfleenVitkilii*CR.Ki:Al : 1 7-: rf a oft -lace EM 10.00
4#4ration 64 ow eis _iv arobsteckir ivy v- water heater/ Ptc . lace) 10.00
Lo • li . host 10.00 IN
iVe0 ratapt ipv.velomeo t is, Spec . ._ .
, W • • • • eller stove ie.00
wood . •... * Nell 10.00
I ft': ,L■ I trifluelvenT =11 10.00
• RO • E • A laM:4 Other. =I I 0.00
i ' _• i. z i .Dieleutekilical.Rattiiall&Tent1Litlite .
. • - , • ,:.:
Namc: Range hood/other kitchen equipment 10.00
' Address:
- othes dryer exhaust .1. 1 0.00 .
City/State/ Cl
Zip. Single duct cnhavet
Phone: Pax: (bertimonu, toilet compartments,
KIR A ' 1. . DI .hf.i:: " 'CO '1' RSON ' t . 1i rooms
Name: Attic/crawl space fens 11111 10.
Other 10.00 :
Address: . p- ' • • .:0 • .-::•'..: . P. • •. Feld ), % ..: • • ' • .:0- •:••• - •:-
Ci /State/Zi • : t - • for trait. 01.00 sash additional **
Phone: . I Fax: Furnace, etc. 111 All
ties heat pump . u
E-rnail: was/swear:a/am beater
Eggamong..74114M/RillIn 1 :.;-.: A.C.i Water h - .. ....
Business Name: ..1 et c i4ESk1it./6 F • lace . M " •
Addr - • • _ i atde..c. • Ve Range • ee
l=
13136 WM..
__.... ... .. .
C /Srate/Zi.: : : • Ci P _ 1 Clothes • , _. 11111.1grin=
Phone: .. _ -I 5 Fax: s' . :I; 9)41_ cow 111111111211111•111111111M1
CCB Lic.#: jillr.: TOO):
.. • Fie oiniti#
w ill11.11
htu- 1111.1111
f
. . $0101111. t
. .
' Minittlt101 remit Pec S72.10 5 7 • 5e
Authorized e e yi/t Flan Review Fee q5 of Permit f ee) , S
Spsturc: "P" , 1...• j 14.- Date: -
$tece Surchorne OM of Permit Fee) S q • 0
4,4 6. ()/h.4 !Lel TOTAL roman act an F s
(Please prim manic) Notice: This permit application eaten if a permi411 cot obta
100 days alter It en hese accepted as cemplere.
*roc aultkOdatogy let by TH•Ceanty Iteilding Industry Service Ileard-
s a
71 •
maw
CITY'd F TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
_MI
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 ?/� 7 AM PM BUP
Location // •s 3- Suite ` M , EEC�
Contact Person /6-41"-- Ph ( ) Q 02 d 0_3 Cj3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P. = FAIL
'Rou•I 1.
. Gas Line
Smoke Dampers
Final
41:227 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 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ?//2/0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL