Permit CITY OF TIGARD MECHAN I CAL
DEVELOPMENT SERVICES PERMIT
!J. J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # 2 / 9 8 —0222
DATE ISSUED: 06/12/98
PARCEL: 2S103CC -02000
SITE ADDRESS...: 12040 SW ROSE VISTA DR
SUBDIVISION • COLONIAL VIEW ZONING: R -4.5
BLOCK • LOT -015 JURISDICTION: URB
CLASS OF WORK..:OTR FLOOR FURN : 0 EVAP COOLERS: 0
TYPE OF USE •SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS ° 0
FUEL TYPES - - -•— 0 -3 HP • 0 DOMES. INCIN: 0
:GAS 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HP ° 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP • 0 CLO DRYERS.. : 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 1
FURN < 100K BTU: 0 (= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =100K BTU: 0 > 10000 cfm: 0
Remarks : Installation of gas fire log in fireplace of residence.
Owner FEES
JOHN HAZARD & DARLINE HAZARD type amount by date recpt
12040 SW ROSE VISTA DRIVE PRMT $ 25.00 DLH 06/12/98 98- 306474
TIGARD OR 97223 5PCT $ 1.25 DLH 06/12/98 98- 306474
Phone #: 639 -9561
Contract or: --
JOHN 0 BRANCH FIREPLACES & MOR
JOHN OSCAR BRANCH - - --
PO BOX 23698 $ 26.25 TOTAL
TIGARD OR 97281
Phone #: 620 -0255
Reg #..: 003958
REQUIRED INSPECTIONS -- - - -- --
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Final Inspection
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 by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 001 -0010 through OAR 952- 001 - 'x':80. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue By: _ 0,/ i • Permittee Signature: OV /_,,
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + + + + ++ + + + + + + + + + + + ++
Plan Check #
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd i z
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 a Date to DST
Print or Type U JC. Li Permit # /1EC9,F - Gaaa
Called
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
M4-.2.4_ A,a D Table 1A Mechanical Code DIY PRICE AMT
Job Street Address Suite# A) Permit Fee -0- -0- 10.00
Address r „Z 6 X10 5 L'U IPOSE V/5 i4
Bldg# City/State zip 1.) Furnace to 100,000 BTU 6.00
1 ( Qe 97. 3 including ducts & vents
Name (or name of business) 2.) Furnace 100,000 BTU+ 7.50
Owner ,J6 f/ N 1 D,¢,L //I/F 1, 0 including ducts & vents
Mailing Address 3.) Floor Furnace 6.00
I G' /l Q 3 Lv ROS E I/ / S TA including vent
City /State Zip I Phone 4.) Suspended heater, wall heater 6.00
T 16-�,C J - , 97,2.... Z 3 or floor mounted heater
Name (or name of business) 5.) Vent not included in appliance permit 3.00
5,�4y/G ,4s ,4 /34 UE
Occupant of cling Address 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorb unit to 100K BUT
City /State Zip I Phone 7.) Boiler or comp, heat pump, air cond. 11.00
3-15 HP; absorb unit to 500K BTU"
Contractor Name 8.) Boiler or comp, heat pump, air cond. 15.00
To 11 /1) Q r e ,Q, firie,71, 15-30 HP; absorb unit.5 -1 mil BTU"
Prior to permit Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50
issuance, a copy /S 7 7$ S u--) 9 F 30-50 HP; absorb unit 1- 1.75mi1 BTU" ,
of all licenses City tats zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
are required if / / 6A--eo e 'g77a/ 42o z'bZ 9� > 50 HP; absorb unit 1.75 mil BTU"
expired in COT Oregon Const. Cont. a uc.# Exp. ate 11.) Air handling unit to 10,000 CFM 4.50
database 395P ` yo .0, 9
Architect Name 12.) Air handling unit 7.50
10,000 CTM+
or Mailing Address 13.) Non - portable evaporate cooler 4.50
Engineer City/State Zip - Phone 14.) Vent fan connected to a single duct 3.00
Describe work New 0 Addition 0 Alteration.' Repair 0 15.) Ventilation system not included 4.50
to be done Residential 0 Non - residential 0 in appliance permit
Additional Description of work: 16.) Hood served by mechanical exhaust 4.50
17.) Domestic incinerators 7.50
6,k ,.o 6- I N s Fe T
Existing use of 18.) Commercial or industrial 30.00
building or property type incinerator
19.) Repair units 4.50
Proposed use of 20.) Wood stove 4.50
building or property
21.) Clothes dryer, etc. 4.50
Type of fuel - oil 0 natural gas, LPG 0 electric 0 22.) Other units ( 4.50 ,
I hereby acknowledge that I have read this application, that the information 23.) Gas piping one to four outlets 2.00
given is correct, that I am the owner or authorized agent of `
the owner, that plans submitted are in compliance with Oregon State laws. 24.) More than 4 -per outlet (each) .50
Signature of Owner /Agent Date 'SUBTOTAL °0 -- t ;€ - - 6 � -;;5-
-7,p_- 91' 5% SURCHARGE ''�?, . / a 5
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL ' -'i Y t' a¢ ' . ', ,; k
// • Required for all commercial permits only _ . ,, l . ,. -,a_v y"1ikf
,f� I'�� / /o .7 g - ?J %/ TOTAL ; _a � - -. Q r!o • A5
'Minimum permit fee is $25 + 5% surcharge
"Residential NC requires site plan showing placement of unit.
1:lmechprmt.doc rev 4/15/98
•
Page No. 1 CASE HISTORY FOR CASE NO.: MEC98 -0222
JOHN HAZARD & DARLINE HAZARD
•
12040 ROSE VISTA DR
10/08/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
•
Code Sent Done Done Date By
MECA007 Application received / / / / 06/12/98 RECD DLH 06/12/98 DLH
MECA008 Create Permit . / / / / 06/12/98 DONE DLH 06/12/98 DLH
MECA060 (F) Issue permit / / / / 06/12/98 DONE DLH 06/12/98 DLH
MECA705 Gas Line Insp 06/12/98 / / 07/02/98 Only 9 psi on gas line FAIL WDJ 07/02/98 WDJ
•
add a support to piping
Replace union with a coupling.
•
MECA705 Gas Line Insp / / / / 07/08/98 Union cannot be in unexposed location. FAIL WDJ 07/08/98 WDJ
MECA705 Gas Line Insp / / / / 07/15/98 Tag 304781 PASS KS 07/21/98 J *H
MECA705 Gas Line Insp / / / / 07/31/98 REMOVE UNION AND VALVE TO GAS LOG, FAIL GS 07/31/98 GES
LOCATION; JUST DOWNSTREAM OF "T" TO GAS
• LOG PIPING. REPLACE W /LFT, RT NIPPLE AND
COUPLINGS
"REINSP FEE OF $30.00 CHARGED AT INSP
DATED 7 -29 -98 IS WAIVED PER GS
MECA715 Mechanical Insp 06/12/98 / / 07/02/98 Gas line failed. Gas log has not been FAIL WDJ 07/02/98 WDJ
installed yet.
•
MECA799 Final Inspection / / . / / 07/06/98 8 lbs psi, needs 10 psi - manf. manual FAIL PDC 07/07/98 J *H
MECA799 Final Inspection / / / / 07/21/98 Approved as noted: PASS KS 07/29/98 J *H
1. Seal around gas piping penetrating
masonry fireplace with hi -heat furnace
cement.
• 2. Damper has been blocked in open
position.
3. Gas piping PT test = 25 psi for 15
minutes (tag) #304781.
4. Installer to check for leaks when
connection is made to supply source.
## #NOTE: Should not have been approved.
Changed status to FAIL. See inspection
report of 072298 & 072998 (per HAP). # ##
MECA799 Final Inspection / / / / 07/29/98 Re- inspection fee assessed $30.00. $ 30 RB 07/29/98 RB
7 -2., 7 -6, 7 -8, 7 -15, 7 -22 and this date
failed inspections w/o re- inspect fee
charged.
Failure to comply with Code req'mts re:
placement of shut -off valve on supply
branch line to furnace.
MECA800 Case Finaled / / / / 07/21/98 PASS KS 07/21/98 J *H
CITY OF TIGARD BUILDING INSPECTION DIVISION
6_,ST
,24 - Hour Inspection Line: 639 - 4175 Q G Business ne 639 - 4171 BUP
24// 3 T Date Requested? olq [ 0 A M — - / PM BLD
Location [2-0 dw Pe) 4 (/ C4 & -Suite 410 r (JCL
Contact Person _ Ph 6 367 -5'p/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
Framing IKY S L.e, /■, S
Insulation /4 e Lou--
'�
Drywall Nailing // 1N
Firewall
Fire Sprinkler / 4.2 / ` 9 ' P ( .1 v \ Q
2 )
Fire Alarm / / g 1 , , F
Susp'd Ceiling Alarm -7/ a W
Miso
Misc:
-7/1C/9 bpi --S Final 7/22 -V q • V.-_S
PASS PART FAIL
PLUMBING y C..R._.-- Ws s � � s��
Post Slab rl t & Beam cO • (— - `` `J,._.v --Q -- C_QA.
Top O
Water S \d1/4.) ■ T � c ' ���
Water Service
Sanitary Sewer
Rain Drains \ _ _ v�
l�C--e_ d O
Final J 1/�J\ -- U vim./( L.).--k_ 4- 1r•-- S
PASS PART FAIL
Pos T B e a CAL X S G S_ 1-.3 AAA
Rough In L :.v‘....12 .sLC ASS N
Gas Line
Dampers 7 6 .12 42
PASS PART FAIL a *" 04..vc `U G
ELECTRICAL I'
Service . U.5 t S a- •
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer tal _ "' Storm Drain [� einspection fee o'f� re_quired before next 'nspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ p Y p
Fire Supply Line Please call for reins ection RE Vu�� 'v t-"r l tenable to inspect - no access
ADA
Approach /Sidewalk � 7
Other Date / Z 7 G
/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
2 Ho1ir Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
?-1// 7 Date Requested 7 , 410 K PM BLD
Location 1 oQ & v (4t Suite MEC ?
Contact Person /_/t aa .__i / ' Ph p PLM
Contractor LW/it (2 BL Ph 63f ! D / SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab , ,,.,,�p/� M SIT
Post & Beam t j7/ �'. ao
G ge o '�1.V v ��L. s �
Ext Sheath /Shear %l'1�(Q Y V
Int Sheath /Shear
Framing
Insulation J
Drywall Nailing Mt 1L•41 Yc- Avir
Firewall
Fire Sprinkler / . set.1 ,4Q-
Fire Alarm
Susp'd Ceiling T ��s �5. I
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
FAIL
ECHANICAL
Post & Beam
Rough In • 6
Gas Line / HI
Smoke Dampers
rna
P SS PART AIL
ELECTRICAL
Service
Rough In
UG /Slab •
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date j Inspector Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION IY MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested a ®' ' AM PM BLD
Location /?L9 1i1 --J �15 04_, . Suite ( � )S '02-2%7--
Contact Person Ph PLM
Ge r i Ph 6,077 O 3 a SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: /�/ 441 Slab l'�.�i
Post & Beam
Ext Sheath/Shear im —� ? t P1 r-
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
P r FAIL
Post & Beam
Ro
S e Dampers
PAS ART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date '� - 2 — le . / /��q E x t
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.