Permit ,
1 �
f ✓ CITY OF T1GARD MECHANICAL PERMIT
twor DEVELOPMENT SERVICES PERMIT #: MEC2003 -00032
c - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 1128/03
PARCEL: 25111 DC -05200
SITE ADDRESS: 15691 SW SUMMERFIELD LN
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 352 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: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install natural gas insert and 1 outlet.
Owner: FEES
JIM THIELKE Description Date Amount
15691 SW SUMMERFIELD LN [MECH] Permit Fee 1/28/03 $72.50
TIGARD, OR 97224 [TAX] 8% StateTax 1/28/03 $5.80
Phone: 503 - 598 - 3939 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 646 - 6409 Gas Line Insp
•
Mechanical lnsp
Reg #: LIC 51469 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
Issued By: 1J�,�bek) Permittee Signature: e) ,, G r Q{ /yyr
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busin, ss day
Ot3%22 /2001 14:43 FAX 50368.17297 City or Tigard 4002
41%. MechanicalPermitApplication
RECEIVED Daiereeeived :/— o Pemutnoo: r4 GC(' Qrvay
. _ . . w ' '. i_� _ City of Tigard Project/app►.no.: Expire date:
City ofTi gani Address: 13125 SW Hall Blvd, Tigard{ O .9'1
Phone (503) 639 -417! INAN / z1UU3 Date issued: By: I Rcccipsno.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: RI III f)ING DIVISION Building permit no.:
TYPE OF PERMIT
Id! & 2 family dwelling or accessory Cl Commercial/industrial 0 Multi- family • Q Tenant improvement
0 New construction tit O Other
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
•
Job address: /5(p 9/ eased Grimm er / c /c& Lid a Indicate equipment quantities in boxes below. Indicate the dollar
Bldg_ na: ] Suite no.: value of all mechanical materials. equipment, labor. overhead,
Tax map/tax lot/account no.: profit Value $ .
Lot: 'Block [Subdivision_ *See checklist for important application information and
Project name: - J-2 i e ie e.. jurisdiction's fee schedule for residential permit fee.
City /county: / _ �,, ZIP: 9 7aa4/ • I & LFA\IIL�' 1)lIEI,I.ING PERMIT FEE SCHEDULE
Description and location of wodc on premises: At ,,J A_ COMMF1ti ' PIT DFS1 IIIAt tt U PMENTStIt
& Zn s er 74" Fee(ea.) Total
Est. date of completion/inspection: )tptloa Qty. R.Oh' R.ealY
Tenant improvement or change of use: HVAC:
Is ousting space heated or conditioned? 0 Yes 0 No Air handling unit CFM
ousting
Air conditlottfag (site plan required)
Is existing space insulated? O Yes O No Altetalon of existing HVAC system
MECH.1NICAL CONTRACTOR Boiler/compressors
State boiler permit no.:
• • • � - HP Tons BT U/11
Address:/ (d 4; . - e , !# 1 . 1. 1 Fireismokedampers /duct smoke detectors -
(� State: 0 - ZIP: - 7 Teat pump (site plan required)
Phone • & � FrmeiI. Instal -. lace ' r ' . caner 1l /H
Including ductwork/vent liner O Yes O No
CCB no.: ,s /yep 9 - a83 PZ install/replace/relocate beaters-suspended,
City /metro lie. no.: wall. or floor mounted
Name (please print): ,. n ,/ • 4 went fora .. Hance other than furnace
RefaigeratImE
CONI'1CC PERSON
Absorption units BTU/Ii
Name: a 01 4G A'eR Chillers HP
Address: / + e:,aastamti.eaolaHP'oa:
City: State: ZIP: Applianccvent
Phone: Fax: E-mail: Dryer exhaust
OWNER ER Hoods Type U Illruct.bOienlhatmat
hood fire suppression system
•
Name: dr . 7 4 ,L/< � Exhaust fan with single duct (bath fans)
Mai - sf.,'.. •� - - ,. , from hcatin • or AC
: ' n me i /� , . Intel , 7,• lied ,,, '., (up to 4 outictsr
City Ci0 Stacey 7
ZIP: 9_
• ' Fax: E T • • Li > TIC / 6: ylJ� . — VO
Fuel piping each additional over 4 outlets
ENGINEER • • - - . pup -. .enquired)
Number of oudets
• ' ' ' -. apps or mpliptue_C
' De corativefireplace
li State: I/LP: nscrt— - ti. / , /ado /aQa
/ dstove et
- . one: Fax: E -mail: woo � stove -
Applicant's signature' I Date: /1,24/4_3 other
Name (ptiny�di.
Nor aD *badman aroma crack orris. please dl iaeddim for ewe ietarmaem‘ Permit fee —_ __. $ 4 5 - ". YO
O Kisa 0 Notice: This permit application Minimum f ___ _ - - ___ $ 7,_2• 50
Credit ewe amnia= ! / s if a permit is rot obtained Plan review (at _ %) $
� .
p within ISO days after it has been State surcharge (8%) .._ $ ..5 8l)
x. a memotae - as as e caw accepted as complete.
. s TOTAL ----- -- $ 7.P. .7
dAteoae amain 4 46i7 (60003M)
0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Busin' ss Line: (503) 639 -4171
BUP
Received Date Requested a 3 AM PM BUP
Location ��� � f� Suite MEC a2Ore3 "-DO 3�
Contact Person a�..:� Ph ( ) �G - (1.0? PLM
Contractor 0 Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing 6-f e- - 3 ,3
Foundation ELC
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
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam '
Rough -In •
Gas Line
Smoke Dampers
Fi
PAS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Anal 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 2 - -43 J
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL