Permit J
C ITY OF TIGARD MECHANICAL PERMIT
� � DEVELOPMENT SERVICES PERMIT #: MEC2003 -00509
��J II 13125 SW Hall Blvd., T i gard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/20/03
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 205
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: •
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: 2 GAS OUTLETS:
Remarks: Replace roof A/C. New unit is the same BTU and 751bs lighter than the old unit
no plan reviewd required
Owner: FEES
GAFFERS Description Date Amount
[MECH] Permit Fee 8/20/03 $102.90
[TAX] 8% StateTax 8/20/03 $8.23
Phone: Total $111.13
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 - 266 - 1249 Mechanical 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 are set forth in OAR 952 -001 -00
Issued By: Permittee Signature
Call (503) 39 -4175 by 7:00 P.M. for inspections nee tt ext business day
a
Mechanical Permit Application OFFICE USE ONLY
Date Permit no. , • a
r I ' 1 '{` City of Tigard /ME ',t_. "� ,
.0 tJ Tigard Project/appl. no.•at� // _1 Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TI'PE OF PERMIT
❑ 1 & 2 family dwelling or accessory WCommercial /industrial ❑ Multi- family El Tenant improvement
❑ New construction • Addition/alteratio.. eplacement ❑ Other:
.106 SITE INFORMATION COMMERCIAL. VALIDATION SCHEDULE
Job address: 1 I i I ' a w .9o.c.: f ` }A..�! Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: j Suite no.: .9.,c5 5 value of all mechan materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ ) c'>o 0 .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: (,.- rc.„ c; 5h N c.. VI', t S jurisdiction's fee schedule for residential permit fee.
City /county: -; a (ZIP: I & 2 FA\IILY DWELLING 1'ER■11T FIT. SC11EOUI.1
Desc iption and lotion of work on premises: AND COMMERICAI.IINDUSTRIAL 1Q1 1PMENTSCNEDIiLE
( - t-QAc■Le vv .4 04 ` V v' I ¥ 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? CI Yes ❑ No Air handling unit CFM
space insulated? ❑ Yes ❑ No Air r ationio f conditioning (site plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: + , 0■Vi nC.,z. State boiler permit no.:
HP Tons BTU/H
Address: (a 0k \0 C, Ai't .4rso' Fire/smoke dampers /duct smoke detectors
I oa– I q) pump plan required)
City: clan tnT� State: ZIP: ' � Heat um (site lan r uired)
Phone: 2_1 (0 — 1 2_14 1 I Fax:2(06_3q E mail: Install/replace furnace/burner BTU/H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: / q 0 v Install/replace/relocate heaters - suspended,
City /metro lic. no.: 2 wall, or floor mounted
Name (please print): S 't IYli rtr t 1 1 Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: ' ve.. 2 ri%t I Chillers HP
Address: Sie,,v� IAs Ora 0.,� Compressors HP
Environmental exhaust and ventilation:
City: I State: ( ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: rn',Wu:ar., mo t/` Exhaust fan with single duct (bath fans)
Mailing address: g 5 US pc C i Exhaust system apart from heating or AC
City: ' VAVtf r,V✓r-ft— I State:(( ZIP: e7 �(
Fuel piping and distribution (up to 4 outlets)
�
Type: LPG NG Oil
Phone: • (jl E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: t/) Number of outlets
/ Other listed appliance or equipment:
Address: Decorative fireplace
• City: ( State: ( ZIP: Insert - type
Phone: 1 a�c: I E - mail: 7 Woodstove/pellet stove
�
Applicant's signature: A fr/ I Date: v /7,,, /4 3 Other: Other:
Name (print): ...--- ✓ L on ,2 1 1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been
State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6/00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
•
Received Date Requested g AM PM BUP
Location L c etti Suite 245 MEC 3 —et) c�4r7
Contact Person Ph ( ) PLM
Contractor Ph ( 5 7 SWR
BUILDING Tenant/Owner Zga ELC
Footing ELC
Foundation Acces /J
Ftg Drain R /9 /,2,� /f/ ; 7j �' 1/Ac i 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. _ — T • T FAIL
Rough -In
Gas Line
Smoke Dampers
PART FAIL
RICAL
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
ADA Ext
Approach/Sidewalk Date Z�/o Inspector
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL