Permit CITY TIGARD MECHANICAL PERMIT
I j� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00655
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/14/03
PARCEL: 1S134BD-02000
SITE ADDRESS: 11795 SW SCHOLLWOOD CT
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R -4.5
BLOCK: LOT: 108 JURISDICTION: TIG
CLASS OF WORK: ALT 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: DOMES. INCIN:
LPG 3 - 15 HP: COMM. 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 OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install fuel piping and 1 outlet for fireplace insert.
Owner: FEES
BROWN, KENNETH E JR & KERRY J. Description Date Amount
11795 SW SCHOLLWOOD CT.
TIGARD, OR 97223 [MECH] Permit Fee 11/14/03 $72.50
• [TAX] 8% State 11/14/03 $5.80
Phone: 503 209 - 3881 Total $78.30
Contractor:
•
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 503 692 - 5563 Gas Line Insp
Mechanical Insp
Reg #: LIC 126881 Final Inspection
•
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. �
i
Issued By: . 40 Ai Permittee Signature: 171 €p#,/1 bj->n.
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Nov 13 03 10:39p Shamburg Heating 503- 691 -6955 p.1
Akii
Mechanical Permit Application
Date received: �� // 03 Permit no fit✓ 3- W -5
'`+ ^t.4.' City of RECEIVE ��, . -� I, ty f Ti and g VE Project/app1. no.: Expire date:
Address: 1312.5 SW Hall Blv• . , OR 97223
City of Tigard Date issued: By: ,6 I Receipt no_:
Phone: (503) 639 -417 ' 2003
Fax: (503) 598 -19.: V 13 Case file no.: Payment type:
I i • Building permit no.:
Land use app V :1: a
- I Y PE OF P!T!ZMIT
c & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: //? '5 • tti f /!4 i7/ - ldcc?et' (6 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: jurisdiction's fee schedule for residential permit fec.
City /county: C� /�/, 1Z1P:9' Z 1 S 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and of work on premises: i�S-e— AND COMMERICAL/1NDUSTRIAL EQUIPM ENT SCIIEDULE
G 4.S • ce 94' /th.� ✓e fi /r'73//IGe• Fee(ea.) Total
Est. date of completion/inspection: / /.-/,s -Q 5 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No .
Air conditioning (site plan required)
Is existing space insulated? Cl Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name:, c' j/m`ju�ac y /f3 LLG HP Tons BTU/H
State boile permit no.:
Address: Fa igV R . q J tire /smoke dampers /duct smoke detectors
City: a ,/Q d 1 State: D/Z. I ZIP :• 9(,„ . - `Best pump (site plan required)
Phone: /092 - .5 SG-3I Fax: (9 /- /oz's5I E-mail Install/replace furnace/burner BTU /H
Including ductwork/vent liner D Yes 0 No
CCB no.: /2.40,17,9/ Install /replace/relocate heaters -- suspended,
City /metro lie. no.: ,5 t wall, or floor mounted
Name (please print): L S' ' / i ,i, 6,e4r, Vent for a .pliance other than furnace •
CONTACT PERSON ' egg on:
L Absorption units BTU /H —
Name: • '('07 6_/y7I6LG/ Chillers HP
—
Compressors HP
Address: 6 ),/ Cl S ai9D . ,
Environmental exhaust and ventilation:
City: State: I ZIP: Appliance vent
Phone: C99t f8/ Fax:6,v - 75 E -mail: Dryer exhaust
OWNER Hoods, Type 1 fres. kitchen/hazmat
hood fire suppression system
Name: nj" , l/a.)/t.' Exhaust fan with single duct (bath fans) -
Mailing addre u +C'Cf Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: 77.6f Q Sate: 7 �, I ZIP: • ype: LPG ✓ NG Oil / .5,y0
Phone: C t 5 L ' Fax: E -mail: F e 1 i in each additional over 4 outlets
roctssp p (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorativefireplace 1 /tit t'
City: 1 State: I ZIP: Insert -type
Phone: 1E-mail: Woodstove/pelletstove
Other •
Applicant's signature: I Date: // "i Other:
Name (print): ?co& c __l,Lpei?d!L /� •
Not all jurisdictions accept coedit cords. ple:we can jurisdiction for more information Permit fee $ /5
Cl MasterCard Notice: This permit application Minimum fee $ 7'>2 - 5V
number: )
expires if a permit is not obtained Plan review (at %) $
Credit crud numb _ / /
Expires within 180 days after it has been State surcharge (8%) .... $ .5
Name or cardholder as shown on credit card accepted as complete.
. S TOTATOTAL $ J
Cardholder signature Amount 440.4617 (6001COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5A =-4175
INSPECTION DIVISION Business Line: (-' 7.39 -4171 MST
BUP
Received Received Date Requested AM T v PM BUP
Location / " 7 95 ScG"D I ( /.9.60d C Suite (ID 3 - 00 6.6 "
Contact Person ), cl-04-4 3 '' Ph ( ) (091 — 55 .3 PLM
Contractor aril Ph ( ) q69 — 1 SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear �i 5
Framing 1 v ` _
Insulation ��
Drywall Nailing �^ x:
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 /
CL//15.1
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
ASp PAT FAIL
MECHANICA
Pos eam
ou
Gas L'
S .i . ke Dampers
V 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
ADASupply Line D� ^. J
Approach/Sidewalk Date Ins pector \ `" ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL