Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2002 -00404
fill DEVELOPMENT H BMEN9 Tigard, ) 639 -4171 DATE ISSUED: 9/11/02
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 104
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
LPG 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
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Gas piping for oven.
Owner: FEES
TIGARD PROPERTIES INC Type By Date Amount Receipt
2106 SE OCHOCO ST PRMT CTR 9/11/02 $72.50 2720020000
MILWAUKIE, OR 97222 5PCT CTR 9/11/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
COMFORT SYSTEMS, INC.
12300 SW 69TH AVE.
TIGARD, OR 97223 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 598 -4798 Final Inspection
Reg #: LIC 137663
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 OA
952 - 001 -0080. You may obtain copies of these rules or direct quesrji o O C by c Zing
(1�174R -q1 R. — 1 ! `�
(
Issue By: � � 1 / ���(,� Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next bus' s " ay
41.. Mechanical Permit Application
OFFICE USE ONLY
Date received: mg no.:mkC. /i q / 4
r „f i City of Tigard Project/appl. no.: Expire date:
Cr' of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223 ,
City f 8 Phone: (503) 639 -4171 Date issued: ►� Rece no.
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORNIATION COljli9ERCIAL VALUA'T'ION SCHEDULE
Job address: // q L/, 5 („O P4C. H is.) Y /pi/ 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 $ ,''ADO •
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: TO g-T I LI' K/ A S/NN 6AB RJ EL jurisdiction's fee schedule for residential permit fee.
City/county: T i A IL9 I ZIP: 97223 I & 2 FANIII.Y DWELLING 1'I R%1I7' FEE SCHEDULE
t ription and location fwork on premises: AND COMMERICAL /INDUSTRIAL. EQUIPMEN"I'SCIII Dl1LE
q p L 1 An c 6 Fee (ea.) Total
Est. date of co/npleti/in ction: Descripdon Qty. Res. only Res. only
Tenant improvement or change of use: SAC:
Air handling unit CFM
Is existing space heated or conditioned? ❑ Yes 0 No
Is existing space insulated? ❑ Yes 0 No Air conditioning (site plan required)
g p Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: c j,t,�Q(LT S.fs ,r1S ` L�9t_ State boiler permit no.:
HP Tons BTU/H
Address: 12300 St,ti 6:01 ; kl, Fire/smoke dampers/duct smoke detectors
Ci ty: 6krz-D I State: oCZI ZIP:Q'1 ZZ3 _ Heat pump (site plan required)
Phone:5t)3 �'T't17g$ Fax:SC36ZOZ564 E -mail: Instal /replace furnace/bumer BTU/H
CCB no.: t 3 "7 (o G 3 Including ductwork/vent liner ❑ Yes ❑ No
Install/replace /relocate heaters — suspended,
City/metro lic. no.: 4 -t7 3 wall, or floor mounted
Name (please print): asi) /1.) . 2elA16- Vent for a liance other than furnace
Re gera on:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: D er exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG 1C NG Oil I
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: � I E -mail: Other:
Applicant's signature: ( Woodstove /pellet stove
�� I Date: D9- // - O L Other:
Name (print): —A2.∎,ts - 4. ? � t .�0
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7^ —3
Notice: This permit application Minimum fee $
U visa O MasterCard expires if a permit is not obtained o
Credit card number: / / Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ VO
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $ 78, 30
Cardholder signature Amount 440 -4617 (6/00 /COM)
r CITY OF TIGARO 1 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/
BU •41 �
- - .l_
Received Date Requ sted / 0 AM PN. B
Location 1/ 9 4 1C - Suite /0 r � — 1 . U
m C �i_�
Contact Person /l, Ph ( ) s 7? O 3 I co (p it _�_— __ ,�
Contractor Ph ( )
BUILDING Tenant/Owner ELC
Footing ---------_____ ELC
Found n Access: as
Crawl rain —
sl Inspection Notes: SIT
Poe & eam
Sher nchors
Ext heath/Shear
Int S 4ath/Shear
Frami
4
w in
ryw �I Naili
D ng
Fi wIl
Fir prinkler •
. / 9
Fir
Susp'd Ceiling
Roof
O :
%,: .,�•
,ART FAIL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
• - - • . - FAIL
I i ■ : ■ '
Pos • : eam
ii i h wIT
.k. l a Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 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
ADA 2 Approach/Sidewalk Date ' 0 /1
3 Inspector q69/11 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL