Permit A
•
A CITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2003 -00629
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/03
PARCEL: 2S114BD -01000
SITE ADDRESS: 09920 SW RIVERWOOD LN
SUBDIVISION: PICKS LANDING ZONING: R -4.5
BLOCK: LOT: 071 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF 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:
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: Replace furnace
Owner: FEES
JOHN O'KEEFE Description Date Amount
9920 SW RIVERWOOD LANE
TIGARD, OR 97223 [MECH] Permit Fee 10/28/03 $72.50
[TAX] 8% State Surchart 10/28/03 $5.80
Phone: 503 624 - 2047 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 62196
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 (50 ) 639 -4175 by 7:00 P.M. for inspections needed the next • siness day
Oct 0312:40p climate control 503 968 7224 p.2
1
Mechanical Permit Application I OFFICE USE ONLY
I ®/ ® Date received: Permit no�Q 3,p p
M IJj . City of Tiga V Project/appl. no.: Expire date:
C/rr of Tigard Address: 13125 SW Hall $.1 d, T}$an 97223
Phone: (503) 639 4171UL I 4 / L U U Q 5 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land used rOV�aI�_ OF TIGARD Building permit no.:
PP SUiLDING DiV;SICN -
TYPE OF PERM '
A 1 & 2 family dwelling or accessory ❑ Commercial /industrial O Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration /replacement ❑ Other:
.JOB SITE INFORMATION f COMMERCIAL VALUATION SCHEDULE
Job address: 0 1920 sw pIVQN(j.9OO ' f a /y . 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 $ .
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: $O3.7_, -) — 0' l<. ` 0 ' jurisdiction's fee schedule for residential permit fee.
City /county: 11 40 I ZIP:: U � ° i — I ���. & 2 FAMILY DWELLING PERIYIIT FEE SCHEDULE
Description and Iodation of work on premises: COMMERICALIINDUSTRIALEQUIPMENTSCHEDULE
( Y •5 t 1 Pk., „, e • • • Fee (ea.) Total
Est. date of completion /inspection: to — a.Q, Description Qty. Res. only lies. only
Tenant improvement or change of use: DV 9,C:
Is existing space heated or conditioned? O Yes U No Air handling unit CFM
Air zonditioning (site plan required)
Is existing space insulated? U Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
^� State boiler permit no.:
Business name: C[lvvtG --e. �0,, 0 -"I HP Tons BTU /H
Address: it20 0 SCA-3 . � , V•( Fire'smoke dampers /duct smoke detectors
City: P0 --I-(< a I State: 0/ I ZIP: 7aDl Hea: pump (site plan required) -
Phone i 9 f42 - 7Z tII E-mail: Install /replace furnace /burner BTU /11
Co y Including ductwork/vent liner Yes ❑ No I 1 '-1 • I4
CCB no.: Install /replace /relocate heaters — suspended,
City /metro lie. no.: 1 y i G wall, or floor mounted
Namc (please print): iiii Ada Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON 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: Dryer exhaust
OWNER Hoods, Type I/ II /res. kitchen /hazmat
hood fire suppression system
Name: jOhyx & C . 0 t K Exhaust fan with single duct (bath fans)
Mailing address: e ZL 3 w /A tio...r (,00P(f. En , Exhaust system apart from heating or AC
City: ric I State:O1R I ZIP: C17 Fuel piping and distribution (up to 4 outlets)
� Type: LPG NG Oil
Phone: d at4 - D-(.`7 Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
_City: I State: I ZIP: Inset — type
P hone: Fax: I E - mail: Woodstove /pellet stove
Applicant's signature: �c� Date: f -a- - Other:
PP ue: - S r ^ -v � ` r, � k Other:
Name (print): f'f �1(/ -tI
' Not all jurisdictions accept credit cards. please call jurisdiction for more information` Permit fee $
C Visa ❑ MasterCard Notice: This permit application Minimum fee $ 7 a•5
Credit card number expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been �p
P State surcharge (8 %) .... $
Name of cardholder as shown on credit curd accepted as complete. TOTAL $ ?Ps ' J V
Cardholder signature Amount ,
440-4517 l6N0UCOM 1
CITY OF TIGARD 24 -Hour , • -
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date Requested AM PM BUP
Location qq o R; Ve.✓r.JO°d L- - Suite 40 ° °6
Contact Person s `- Ph ( ) 45 - 3 — PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ` �- ELR
Crawl Drain
Slab Inspec o tes: 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 '
r I i
PASS PART FAIL 111111r,% �■!J
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
Pt. FAIL
ECHANICAL
Rough -In
Gas Line
Si. • - Dampers
4
PART FAIL
E RICA L
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 n Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job Site.
PASS PART FAIL