Permit r ' CITY OF TIGARD MECHANICAL PERMIT
i r I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00638
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/24/2004
PARCEL: 1S133AD-06700
SITE ADDRESS: 10885 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 111 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: . <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace install.
Owner: FEES
PORTOWN, ROBERT Description Date Amount
10885 SW SUMMERLAKE DR [MECH] Permit Fee 9/24/200 $72.50
TIGARD, OR 97223 • [TAX] 8% State Surchart 9/24/200 $5.80
Phone: 503 - 579 - 6211 Total $78.30 •
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS •
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 66578
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: (le Permittee Signature: CidY�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
-„,.. REOEIVED
.;
Mect„,,„.....pnical Permit Appiicauon
FOR OFFICE USE ONLY
Ci0 Of Tig Ard 10°11
A ceiv % l
Plan Revd . nt N°.:11/142Dii—c2r)b.3i
13125 SV/ Hall ;3Ivd., Tigard, OR 97223 sEP 22 DReaI/v Pern
Phone: 503.639 4171 Fax: 503.598.166M OF
TIGARD /144 ' C r'Ari Date/By: Other Penult:
Inspection Line: 503.639.4175
Adis: Et See Page 2 for
BUILDING
Internet: www c:.tigard.or.us DI VISI Date Ready/By:
NotifiecVMethod: •77 Supplemental Information
0,44- -.111.
.
'...... ..
....E ;'; ..,:....'J*.g.'.0-i..;,-.-Y.ktf):&.',.'-',4;ki4.,.:f..7:'=4-..--.41''1:-!.%.: ' 0Artet.Oietkr. EP;i:SCREDI.iLE USECHEcla,IST
constr iction 0 Addition/alteration/replacement
... . . .
Mechanical permit fees" are based on the value of the work
0 New
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other:
mechanical materials, equipment, labor, overhead, and
- .'i i N
roiLiL__
-..:. -..-,..,. -. • M .,,.::...,.:-,17...-::;->...,, Value: S
i. , .., , .. - 4:00FNT4$9VIPIVIENT/ SYSTEMS FEES*
1- and 2-fax lily ing 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-famil / 0 Master builder 0 Other:
Description Qty. I Ea. I Total
pB,.,srilt ..., ,::.,....,..., .....T, _AT_ .4:it.,..:46,...":„.-:,.....,,...' -f: Heating/coollng
Air conditioning or heat pump 1
Job site address: / 0 p-. - s - c- cc .t.l LeaC. -A. I (requires site plan showing placement) 14.00
City/State/ZIP: VA10,^-44 C. / /-?,-2.-3 Furnace 100,000 BTU (ducts/vents) r 14.00
_
Furnace 100,000+ BTU (ducts/vents)
Apt. i.o.: I Project name: 1147.00"
Suite/bldg I
mp
_ Gas heat pu
Cross strest/diro :lions to job site:
Duct work 14.00 I ■
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00 1
Subdivision: I Lot no.:
—
Other: 10.00 1 .
Tax map/parcel r o.:
Other fuel appliances
D..
", - " • ••• - - '. 7 7 7 7 ': - ' ...'. - , . . . ,, - ... • , . .,.... • .. . ....! ..., ;:• .. .,.... ,..., . ; .,...,, . ..--iar4; "P...'nf!! Water heater 1 10.00
•,;'• • .,•:•• . !:;':`•..•.:','' ...••.:---:.:;... :.N. .2.0!W-Cglic :14.1.':',•::::42f•I'•:•••••'.';','!:ig:4•:-..if:'•',
Gas fireplace 10.00
Flue vent for water heater or gas
LU Italt 64.,.... fireplace 10.00
Log lighter (gas)
10.00
Wood:pellet stove 10.00
Wood fireplace/insert 10.00 I
I 1000 I ,
;)i. tIrfook.e*pi,(* : gtgo , .-,.. ; oChthimney/liner/flue/vent . i .
I 10.00 I
Name: N.claptil- Pi 1r-173 LA4A) Environmental exhaust and ventilation
Range hood/other kitchen
Address:
equipment 10.00 I ,
City/State/ZIP:
Clothes dryer exhaust 10.00 I
Single-duct exhaust (bathrooms,
Phone: ( )(::: }..ei .... 6, 2, it Fax; ( ) toilet compartments, utility rooms) , 6.80 1 1
2 •1:1t• 41146AN't ::-'-':, '-'!':•-''' '':'' ' " .. z ..:' Attic.'crawlspace fans i moo
. . Other: I I 10.00
Business nane: f .- c L ,_( .. h.) I t i 1 i 1 5 Fuel piping
Contact nanie: 1 ( 6 1 S c 2- I k k . ‘ - t: .- '-' a ct S5.40 for first four; $1.00 for each additional
Address:
Furnace,
14 rkki. i 4.'"" C 1 .r ( %
■
Gas heat pump
City/State/ZIP: I i '
Hi I i ‘ b ....r`t i.! , ( i 7 /: I L. 3 Wall/suspended/unit heater
•
Phone: (SC ) ( , Ci (3 --- 7 ic 6 4- I Fax: : ( So ? ) (4 4 • / - c ).- '"? I Water heater
Fireplace
E-mail:
1
Range
, .:.;:.;?,:,:ti4::',:-.■:.,.94:Vili :-.1-,..-00,te.F.,.‘,,..%y,"..iw.,27:NA:6,-,L.9.,-:glit Barbecue
,
Business name:
Clothes dryer (gas)
,
Other: 1
Address:
.:: .:;,.. . PER PEES*
City/State/Zal:
Subtotal ,
Minimum permit fee ($72.50)
Phone: ( ) I Fax: ( )
Plan review (25% of permit fee)
CCB lic.: 6. t S 3- -
State surcharge (3% of permit fee)
•
; TOTAL. PERMIT FEE
,
Authorized s ignatu: e: C: t _S_.4›.- /..... • 1 ,- This permit application expires if a permit is not obtained within ISO
f--I • la e
l.. i... C i ( - C .4. • 7
G (
Date: 7 2,/tot days after it has been accepted 30 complete.
Print name:
• Fee methodology set by Tri-County Building Industry Service Board
CaluildinglPerrnits,NCEC-Pc rmitApp.doc 12/03
940•4612T (
2 • d SILO BBS EDS 2 ut4eaH R4IeToaciS d91:20 .00 22 deS
CITY OF TIGARQ 24 -Hour
BUILDING Inspection Line: (503) 634. i73 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 0/5 Date Requeste • r %� PM BUP
•
Location • 0 _ il���,_ = ►�:. ,�! O 3p
Contact Person Ph ( ) PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner /��. _' / ✓. _ ELC /V
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear �� -757S --q
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
PAS - FAIL
Rough -In a
Gas Line
Dampers
4 41 0e
�'�• RT FAIL
ELECTRICAL
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
Approach/Sidewalk Date / ' Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL