Permit oCITY O TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00712
' � J II 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/27/2004
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 102
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: 1 <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Gas furnace change out / no heat.
Owner: FEES
TIGARD PROPERTIES INC Description Date Amount
2106 SE OCHOCO ST [MECH] Permit Fee 10/27/20( $72.50
MILWAUKIE, OR 97222 [TAX] 8% State Surcharl 10/27/20( $5.80
Phone: Total $78.30
Contractor:
ROTH HEATING & COOLING -
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 - 266 -1249 Heating Unt Insp
Final Inspection
Reg #: LIC 14008
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 - re set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rul: 9 d ' t questions to OUNC by calling
. (503)246 -6699. 0
Issued By: ��? Permittee Signature: --e
Call (503) 639 -4175 by 7:00 P.M. for inspections nee • - d the next business day
MeclhanicaJ Permit Application FOR OFFICE USE ONLY
!rI
City of Tigard Received _
131 9/19 SW Hall BIM 5 J
Alp, Date/By: - H 13125 I / ,
=' `�' 6 Plan Review
Phone: 503.639.4 T , .. FI' j t y� ' 1 lamwt:. \ Date/By: Other Permit
Inspection Line: 503.639.41 5 / // J
Internet: www.Ci.tigard t� 2 7 2004 i j J. N Supplemental
fed/Method: Information
�
CITY OF TI( OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construcrdWLDIN M ltera ' : Irreplacemen 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. ,
-CATEGORY OF -CONSTRUCTION
Value: $'Z oo —
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '
❑ 1 - and 2 family dwelling ommercial/industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
�l
/ Heating/cooling
Job site address: �� \\ /1 4 t C . r/ " / D Air conditioning or heat pump
/ % �� SW ( (requires site plan showing placement) 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) i 14.00
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
DESCRIPTION OF WORK Water heater 10.00
n e f �. / IV D Y� S6:X
Gas fireplace 10.00
(f Flu n p a c for water heater or gas
VX bu fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
. XTPROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00
Other 10.00
Name: 1 ir-r7 1,_C w K) Environmental exhaust and ventilation
Address: a �2p n l/ c q Range hood/other kitchen
7 ! equipment 10.00
City/ State/ZIP: V C c if Q..42-. W 91? (a s Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (r 6j) 6,11.-3 -5-7 S 7 Fax: ( ) toilet compartments, utility moms) 6.80
APPLICANT ❑ CONTACT PERSON Other ttic/crawlspace fans 10.00
Business name: 10.00
Fuel piping
Contact name: . $5.40 for first four; $1.00 for each additional
Address: • Furnace, etc.
Gas heat pump _
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: RV' v ( /-1,- ,Q(,�Yi �' Clothes dryer (gas)
•
/, Other
n !'
Address: � / / 2L0 MECHANICAL PERMIT FEES*
City/State/ZIP: (/ Cl/t kj,// 9 70/3 . Subtotal -
Phone: (5P3) Z.bio --f 241 Fax: (5) 2hh — 3/74-76P Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: / L 0101 State surcharge (8% of permit fee)
ilY l� TOTAL PERMIT FEE
Authorized signature: This permit application e:plres If a permit Is cot obtained within 180
/ days after It has been accepted as complete.
Print name: f A " O. � Date: ( I / a - r ) (D
• Fee methodology set by Tri County Building Industry Service Board
; la,.: 1, 1i ,am......:r.wrr..Pw...:. AM min d6(l.A MTf' !11 /M /MU/wen
CITY OF TIGARD 24 -Hour
BUdLDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested N AM PM BUP
Location // 9 S - c� Suite /0 MEC , , e) Y" 7/ �
Contact Person Ph ( ) ,57 �7 _ 7 L/aT. PLM
Contractor Ph ( [) SWR
BUILDING Tenant/Owner �S l4) f`iad 1 ELC
Footing
Foundation ELC
Access:
Crawl ELR
Dr ain r &� --42 l » po P
Crl Dr �� [[I�KCC !��
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm Air
Susp'd Ceiling
Roof `..
Other: ■Folor
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
PASS ART FAIL
AL
Post& Beam
Rough -In
Gas Line
II •ke Dampers
ART FAIL -
ICAL
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 0 Please for rei spection RE: —. 0 Unable to inspect – no access
Fire Supply Line _,
ADA Approach/Sidewalk Date 6 / ,/ Ext
Other:
Final DO NOT REMOVE this inspect n record from the Job site.
PASS PART FAIL