Permit . - - J w
C ITY OF TIGARD MECHANICAL PERMIT
I,� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00732
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/9/2004
PARCEL: 2S114BB -02000
SITE ADDRESS: 16375 SW SYLVAN CT
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT: 034 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: DOMES. INCIN:
LPG 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: 1 AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace.
Owner: FEES
WORSLEY, ROBERT L AND Description Date Amount
DONALEE I [MECH] Permit Fee 11/9/200 $72.50
16375 SW SYLVAN CT [TAX] 8% State Surchart 11/9/200 $5.80
TIGARD, OR 97223
Phone: 503 620 - 1603 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
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 thrau • h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6 9. `
Issued B , / � /� r/ % Permittee Signatur �/ / ;���� , LA
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next • usiness day
Nov 08 04 12:12p PAM DALBY
_ - -•-- -- 503-598-0270 P.2
•1
Mechanical Permit Applica.tigneD FOR OFIFICE1USE ONLY •
cit of Tigard
111PleCtIM Received i
Da il g Oct 44y( Permit N°.qee...,94:VICb•stne)73 D'.1
13125 SW Hall Blvd., Tigard, OR ,2. Flan Review I
Phone: 503 639.4171 Fax: 503.598.1960 '/,:'1 1 0°4 4.wjl l'il (4 Date/By: . Other Permit:
Inspection Line: 503.639.4175 V‘,, ' rs - P"i•-••••1 Date Rcady/By: ...ty„,s.. (6 / RI See Page 2 for
Internet. www.ci.tigard.orus NotifiecVMethod: , Supplemental Information
)
( 11G".
n )5100
4,1i4Virp0-0-1*43,-,it-glmgci,10.4, .ivoisavoikEitii - .1...1gri CHECKL 1ST
. "":".:‘,..:: - .',..,. ; %.474se f ,::,:.' Ku; -e2fitp.1*•• s'...N. .,i'..i. :' r: ....' , . -.... ...x.'....., . !'..,k ., ;', • i' .•-•,• ,•-.): • • ' ' '-r** • •••I t e •' • • • •"-•• r':, •• , • • .•-• • , •. i • • ' . . -
Mechanical permit fees are based on the value of the work
0 New construction t5rAddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) cf al,
n Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
FEES
..-!;-1•14:41-14PfA"AgerlIttiagratt-VMONttOltaill•.417;rfiI:i47:1•:.;•4:4■^Mf.74M. , „ , _ ,, , , , , . „, , . „
ii ij.-;,V1 I., .., , ...:... !......:„ ,..*.-,.. . -- •
C C1 - and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description 1 Qty l i Ea, Total
•',t,'LV-....;,•,":11:*:•=,"7.1.4.0111....0,:tittaOrgigkalgi.g_inAlt.-.46.1.$1.',I'X:.'-;IOI77A: ReatinWcooling
Air conditioning or heat pump I
lob site address: /4 3 7 c 5 k i . 5 i ,, 6-&- (requires site Oan showing placement) 4 \ 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 1 / I 14.00
Furnace 100.000+ BTU (ducts/vests) '1 1 17.90 ,
Suite/bldg./apt. no.. I Project name: Gas heat pump 1 14.00
Cross street/directions to job site: Duct work
1 14_00
- 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
.1 .
Flue/vent for any of above i_ 10.00 .
Subdivision: 1 Lot no.:
Other: _L 10.00
Tax map/parcel no.: Other fuel appliances
-;:- ;•••'•..rz•`•••1•I:;?;,•'474-iiltiltriti,l,r4i7VU''''40:47',Igket;,-4)P,.,,,iir..k.:LWVitriltil:,40.1,!••■•■:,,,..554 Water heater I 10 00
•-•' •••, .."- .41 - e. 0410X-9. I
Gas fireplace 10.00
7 t 9?4 < -zii,,,,yiek-f.,. Flue vent for water heater or gas •
fireplace 10 00
Log lighter (gas) 1 10.00
•
Wood/pellet stove 10.00 i
Wood fireplace/insert -
e•
• 'f.: .1,1:4!..zttiikftblikVON'cr-grOtq-V-WW;;I:11*1-intt;oif- .4140;;;IP,f10 Chimney/liner/flue/vent
10.00' . •
-- ..-.. e.■.k. 7,.. , - .., -,, c.....• .• .?A• 0' .....- , r• A,.: .. r• .ritli ": - :'*..., .. • Other: 10 00
Name: 13. 6 uii 4 5 c ie y Environmental exhaust and ventilation , •
•
Range hood/other kitchen
Address: /( 3 '7 5 . 5 44.i . _Cy /v.i,t) cd , equipment I 003 ;
City/State/ZIP: Clothes dryer exhaust 10.00 i
779 &A to/ Single-duct exhaust (bathrooms,
Phone: ( D• ) ,,, 0 4) Fax: ( ) toilet compartments, utility rooms) 6.80
tr %-.,,:.,,„..,,,,, „•:',:'"„k i +. ...- C
'• Attic/crawlspace fans 10 00 1
, r., ' ,,..:. ' 9 •, . : 4146' -., - . . ... ),. - .,.. ,. • . .......
Other: 10.00 1
Business name:
Fuel piping • I
Contact name: A9/ 0/9-/by $5.40 for first four; 51,00 for each additional
' Furnace, etc. •
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone: ( ) 0 ,2,./ ,7,70t7 , Fax: : (y ) .57( 42,7 .,
1
Fireplace l
E-mail: Range
IA VIC.TCX4.k51. bifilaieWIN"-grgi.Cktfon.M14.A.tV,16.510,B0-115,2S
Barbecue
Clothes dryer (gas) i !
Business name: C / . ,, 61 6 / a., /_./..e.. A; .... r a ( .4- C e . 1 , I
Other: I
Address : D ao Y. ( ROe ' .3T Mrtqaatliii''aitaidk.i4iR_ ''
. t41. .-_ ..,00 •-•"*.."•• - - !-.,• • ••• ' • 1,- • - - ' . ,
City/State/ZIP: Sbtotal 1 I
Minimum permit fee (572.50) 1 72..50 .
Phone: L 4, 4 ,2 LI 0 71 e , 47,e I Fax: 0,3 ) ,5-1 e 6 el '7e. Plan review (25% of permit fee) I
i
I
CCB lie: . State surcharge (8% of permit fee)
I 7 6 -2,5 9 TOTAL PERNIIT FEE 1 71%56 ,
Authorized signature: a.-2--7z--"..--e---../ This permit application expires if a permit is not obtained within ISC.
days after it has been accepted as complete.
I Print name: ... . / . Date: .4( 0 4 • Fee methodology set by Tr'.-Couaty Building Indusa Ser,ice 603 rd
03uilding\PcfmuWX.C-PermitApp.doe 12/23 440 (1 t/OVCOM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ► Date Requested / 1 — 3 6 AM PM BUP
Location - Suite MEC 0 % - 7
Contact Person F-4 Ph ( ) ti,2'- -" a70 y PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC .
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear , _ v
Int Sheath/Shear rA vl. `1 11 _ 5 Z `EL- �s
Framing 1-j � vu (� v
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL \\ ,
PLUMBING , ! i rr;` — :
Post & Beam k
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
' S_ • -mpers
6 9 , PART FAIL
ICAL
Se ice
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 El Please call or reinsp- tion RE: ❑ Unable to inspect — no access
Fire Supply Line i
ADA
Approach/Sidewalk - Date Inspector 1 Ext
Other:
Final - DO NOT REMOVE this Inspection record from the Job site. •
PASS PART FAIL