Permit • - CITY OF TIGARD MECHANICAL PERMIT
;2 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00169
�. I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/3/03
PARCEL: 2S 105D D -03800
SITE ADDRESS: 13420 SW SANDRIDGE DR
SUBDIVISION: PACIFIC CREST ZONING: R -7
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 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:
> 10000 cfm: GAS OUTLETS:
Remarks: Install exterior AC unit. Cannot be placed in the required setbacks.
Owner: FEES
D R HORTON Description Date Amount
5125 SW MACADAM #145 [MECH] Permit Fee 4/3/03 $72.50
PORTLAND, OR 97201 [TAX] 8% StateTax 4/3/03 $5.80
Phone: 244 - 5322 Total $78.30
Contractor:
HVAC BY TERRY
6630 SW 207TH AVENUE
ALOHA, OR 97007 • REQUIRED INSPECTIONS
Phone: 503 - 649 - 3458 Cooling Unt Insp
Final Inspection
Reg #: LIC 54970 •
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: ' _ � � � .0 - _ , _ .
Permittee Signature: f t,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
M 'li n1Cal Permit Application Received FOR OFFICE USE ONLY
Q Mechanical
• -- I L, Date/By: ■1 t �3'6 Permit No.: 1Q[- DI9r Ol /b9
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�iamFA�N , � 41i' DateB : Case No.:
Internet: www.ci.tigard.or.us .� �:��� Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 `- "" Name/Method: Supplemental Information.
' TYPE OF WORK ' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST .
W . New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
LII Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
Ultq 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
Accessory Building 111 Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE _ ;'
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: , Heating/Cooling
- - • . . , JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 1 14.00 /ii,
Job site address: / iTjd Sri/ 5 pr • Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: / Duct work 14.00
Project Name: // r M./ tre' Hydronic hot water system 14.00
�/ i� Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: PQ n(j/ (/ a e {- Lot #: /ft Repair units _ 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
_ <:. DESCRIPTION OF WORK . Gas fireplace 10.00
A r / �
i UV 11 in i44-- Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
PROPERTY OWNER • I ❑ TENANT Other: 10.00
Zjrame: D . a G
r/O I /l - � O1/j : - Environmental Exhaust & Ventilation
7 Range hood/other kitchen equipment 10.00
Address: iok (Z4' , /L ,aI wil AvC `ot/D9-- Clothes dryer exhaust 10.00
City /State /Zip: P1'T /V/4 , Q# 1- r Single duct exhaust
Phone: 03-i7)-- /5/ Fax:. - /2y-37/ 7 (bathrooms, toilet compartments,
❑ APPLICANT gCONTACT PERSON . utility rooms) 6.80
Name: NI Gp (f/ 5 1rl Attic /crawl space fans 10.00
Other: 10.00
Address: x(3,24, ;1J- jnGt 49- Fuel Piping '
City /State /Zip: / / /Rkt. d * 177n "($5.40 for first 4, $1.00 each additional)
**
Phone: rj�3 - 772 - *0 I Fax: 673- i a2- /7 Gas heat c **
pump
E -mail: Wall/suspended/unit heater **
CONTRACTOR ' Water heater •*
Business Name: HM �� Range Fireplace **
**
Address: (p LI ( 514) �7�' BBQ ••
City /State /Zip:Mp /eta Q MOO? Clothes dryer (gas) **
Phone: 3 - z/ —3t Fax: Other: ••
CCB Lic. #: 0170 Total:
Mechanical Permit Fees* .
Authorized N Subtotal: $
Signature: l/I ��� Date: �Minimum Permit Fee $72.50 $ . <12
� J I i S Plan Review Fee (25% of Permit Fee) $
V (Please rin name) State Surcharge (8% of Permit Fee) $ 5-K)
TOTAL PERMIT FEE $ 7 '. 30
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after it has been accepted as complete. ••Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 - '
CITY OF TIGARD 24 -Hour L-oz
BUILDING Inspection Line: (503) 639 -4175 M
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received Date Requested 7 — r
' AM PM BUP
Location / 3 y 5-ezAi Suite e 2003 -6e/67
Contact Person Ph ( ) 4 36v ( PLM
Contractor Ph ( ) SWR
LDING Tenant/Owner ELC
AD_ 003-DUl9
Foundation z
Access:
Ftg Drain 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
Oth: :
in
AZ PART FAIL
0 BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P T FAIL
ECHANICAL
ost & t3eam
Rough -In
Gas Line
S moke Dampers
PART FAIL
CTRICAL
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 Date r/W03 Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL