Permit Y
114 . a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00456
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/24/2007
PARCEL: 1S134BC-00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C -N
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PROVIDENCE
Project Description: TI - split system Project Value: $4,000
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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: 0 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
PROVIDENCE HEALTH SYSTEM Description Date Amount
4607 NE GLISAN
PORTLAND, OR 97213 [MECH] Permit Fee 7/24/2007 $118.50
[TAX] 8% State Surcha 7/24/2007 $9.48
[MECPLN] Plan Rev 7/24/2007 $29.63
Phone: 503- 215 -6282 Total $157.61
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 239 -4600
FAX 503- 239 -7038
Reg #: LIC 33135
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 OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B /� �/ ! Permittee Signat /) - Jr ( i ri.P
Call 503.639.4175 by 7:00 a.m. for inspections that day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUL. 1)4007 10:48AM 5032397038 NO. 2551 P. 3/3
FOR OFFICE USE (ONLY Mechalai.cal1er _ , ,.:0 ' i V r ��^ T S=
> ;wd � Ay of �, wT' peTjINo.. w ee
r" Dale/BY
City o£ Tigard =R • 9 _ , � ' -� � plenRet>ie '�+ �.,'• ,_ .
25 5 n Blvd iger& 0 . Page; far
131 SW �,;.;:,.,,, Ae 4i 6d See
Phone: on Line: Fax; 503.598 60 _,. (' Supplemental lalo►rnane
Ins ccti e: 5 igard. r.us �UL ' PP
4 2001 �1 Date Ready ° 65
p oa 1:in 2 [_' ° ..' rloti0ad/MatLo
Internet: www.cl.tiBerd.or.us ae QQ TT c "q�yt py, �,,
r r 1F` 1 AvA� x j 010114: . Nino fo { '�Mrrl �6 !
$41:13, t � t J, J -- u ' :' � '' � r " 'S � Mecha nical permit fees are based on the value of lk work
dollar
' � ��i AddiCionlalterat [o>}Ireplacetnent perfornad. indicate the value (rounded � �e rt� d • re s f all
0 New ccLtstr11ctt0R mechanical materials, c id . ment, labor overhe
[] Dfsmolidon ❑Other _ - V , ,
K 7-( , ii 1- r� -7, - 1 rir ll If lll(L 7J1:J � ,.,� fl +( 120 i'a
use oheciclls +,
0 1- and 2- fatnily dwelling *Cottrrrtercial /industrial C7 Accessory building F or apeefal informor(on sec Totol
[]M aster builder ❑ Other: Description Qty Cill
❑ Multi family S .7.%j rr I -a .. , Lf_r - i -n u3 •. 17 ' 4 Heath : "'an _
I .v A I �`I It I p r� '`, Ff 1G I �Sl II y a'� �
II V�4 JI' 1 r , ♦2,74 lr�7 f ii I l 1 i Y I� 1 , Air conditioning or heat pump 1
�i Job a l l t o a address: F7 1.1 > _ 5 IA/ r�c .:., ,. � 11 s p , : _ sa, .lm ahowin:.kcar men
7obsitcaddcess: � N 1 1N •7G err ^oqd 1400
Furnace 100 000 BTU (dime/vents 1190 UM UM
City /State/ZIP: Ti - Gi r d 0 R r 7223 f Furnace 100,000• BTU dtafslvents) � 14D0
• SuiteibldgJapt no.: 0 Project name: pro Ill CJ e n c e Gas heat . u 1400
// II FC rr M O $ Duet 1400 NNE
Cross street/directions to job site: s G+7o j f S A dronie hot water s stem NM
Residential boiler (radiator or 1400
chronic
Unit heaters (fuel -type, not elecori0), 10,00
in -well. in -duCL cu • coded etc• 1000 IIIII
�� MIN 1000
Subdivision: Lot no' Other
Other fuel a Lianas 1000
'Pax maplpareel no.: Water heat 1000
7 f r P f { 't r l f> r' ai i' I Yg iil W, y � j ; , I ,', : c: 9 u I I i i i Y I1 trll
a,^r� G:17 ,Il V1 � I 1.. � j, ll�,:_�.., di�i., ...__ �.�,_'it.�...,..... ,����..� G_1'i -Y�
fGr i„ Imo.: v11;�w a :u .,. >— rJ C J Flue vent for Water heater or gas 10.00
/n.510 � � �C� 4 V VI wail �� f�! (NM 1 .
• U 2 _ S _' S Ste Fri 5r lace 1000 taco .1.1
� IUD Mill
In
Chimnc /liner/flue/vent
,, : a ' t fr MI {0.
sr i i 7, C � 7 ', (417 y . r r) J i./4',:j',.) l . " I � i f V�,;. l j1 �ii, • Other: ,!` 1 r [ L T �ci h 7 71 '' li r 7 , . 4 i' ice l :Vi lrl, 1:1L:11-1 1 - , 1. 1 .01, L c1.
s•ll
' I ;:LL4 �4�,, W It''''-r- � r, J� $nvlrenmental exhaust and ventilation
Name Range hood/other kitchen 10.00
— --- Range 10.00 all
Address: C10RIem . er exhaust 111111 • Gtty/State/Z>P: Si -duct exhaust (bathrooms, 6,80
Fax: toilet co .artmeete utili rooms ( ) ace Tana IIII
10.00
]?hone ) rl crt 1 1;; 1 I n 1 i Ji/V y fl L - if,� ,',/ 10.00
4 , < I I _1: . �s a-1.- , :As. oth
r l li l: 7 J � 14 �Vb � r \ I Llllc A::: h >; i tIl ` �;� ,Ll' 'E l
Business frame: li 1 ({ 't 85.40 or Cies! four: 51.00 [or dd
convict name: ` � r1 / ' ( G 1‹. f et e EMI
Address: , Walllsu.. endedlunit haater ��
City/State/UP: r � 4 Ike f_ � �r�
Phone: I 1 ) Ot At— r •0 Pax:: ( t mai— r � �
&marl , ' , I 11111111111•11•11111 I � ?P ffILr - � �� I ' ��, . ._7, I�. } f, : . �r_ I +�- - : Clothes d er ��
\' I � P Il 1 „ .(_ _ ) .. ..z. - -
Other , �3 -, .,rs
Btrstnenietrartte: it 1 t` l r d 7 ` pfr �r tirini :�i Ti '. tr1V�1.u=i==.
illimin
e , c11
1 J a • 1 2 0 0 • • % Mirimumpermit fee ($12.90) IMO
Phone:
City/State/ZIP: lP: a Plan review (25% /e of • armit fie)
l e ,
`'(J U 0 ' Fax: ) a fk State revi (5 of permit fee) MON
'TOTAL P1A T PFD
CC:a B •: G " l e mpte is not obtained ed wlmla ts0 A li Thla permit aPPlleadan expires P
�, days after It has been aeee complete. ned Swim it era
Authorized signature: .. . Pee =sociology set by Tri•Co»nty Buildieglndwt7
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: MFC2007 -00456
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/24/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 'I —
INSPECTION WORKSHEET FOR DATE: 10/212007 TIME: 7 :04AM PAGE: 106
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: TI - split system Project Value: $4,000
OWNER: PHONE #:
PROVIDENCE HEALTH SYSTEM, 503.215.6202
CONTRACTOR: AMERICAN HEATING INC PHONE #: 503239.4600
Ins Inspection Request Scheduled For: Date: �j1 Po Ti 4 1µ i
p q 10/2/2007 r \
Code # Inspection Description Confirm # Contact # Me •age 5'" A. j
625 Duct wor 056683.01 503-519 -39G6 Y _
i V1 p
lei
C coons /Comm struct
• ..i t‘ )6 5 -'----1 V / i
-
)(PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 V'
Inspector: Date: . Phone #: (503) 718- 3 V '