Permit ,t
CI TY OF TIGARD MECHANICAL PERMIT
4 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00147
- ..� II E 3/27/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 39 -4171 DATE ISSUED: CELL : 1S135CC-00500
S13 S135CC -00500
SITE ADDRESS: 11700 SW TIEDEMAN AVE
SUBDIVISION: GREENBURG HEIGHTS ADDITION ZONING: R -4.5
BLOCK: LOT: 007 JURISDICTION: TIG
CLASS OF WORK: REP 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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Replace gas line to furnace and water heater.
Owner: FEES
STOVER, LAWRENCE W + SHARON A Description Date Amount
13432 SW 136TH PL
TIGARD, OR 97223 [MECH] Permit Fee 3/27/03 $72.50
[TAX] 8% StateTax 3/27/03 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 624 - 2704 Gas Line 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 -00
Is d By:. _v,�� j�, L l Permittee Signature: �r iii/-
Call (5.3) 639 -4175 by 7:00 P.M. for inspections needed the next' u ess day
M
r Menical•Permit Application e Date received: " Permit no.:1ye(�oildle'0
� '" ` � t4...y..,,,,.:-,1,;:, Cit Tigard � 7
Al City g Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: •
TYPE OF PERMIT
. 0:1 & 2 family dwelling or accessory 0 Commerciallindustria 0 Multi- family 0 Tenant improvement
0 New construction ^Addition/altera ' •n/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / 17 D 0 S lA) T cd rvt a vA 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: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: ma c, I ZIP: 97 a93 I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and Itfcation of work on premises: ND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
re plats . q o c Lvu` - crY)acz 4- Wll3 Fee(ea.) Total
Est. date of comple ' n/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: — HVAC:
Is existing space heated or conditioned? 0 Yes D No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
�• State boiler permit no.:
Business name:
C� Aofe s r /A/G le. Coo/A/10 ZNG HP Tons BTU /H
Address: p O • 0 54 .23 03 1.7 Fire /smokedampers/duct smoke detectors
City: 7 �,q t4.0 I State:0Q I ZIP: 97 /s// Heat pump (site plan required)
Phone: 4 a% ? 7 0'.I I Fax E-mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: 94 3 ...f 9
Install/replace/relocate heaters — suspended,
City /metro lic. no.: /, 7 a wall, or floor mounted
Name (please print): /77, G A a g _ / o /.SG/StfL. Vent for appliance other than furnace
CONTACT PERSON
Refrigeration:
Absorption units BTU /H
Name: PAM &A /b y DAN Oom lleal y Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: • 0 Fax:5 7 , t. E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: Mir . ` - N . - 0\i E_ le- Exhaust fan with single duct (bath fans)
Mailing address: in ^7 O c7 6u T W10-4"- Exhaust system apart from heating or AC
Cit b✓ I � 7 as 3 Fuel piping and distribution (up to 4 outlets)
Y: T�f a rot I Sta ZIP: Type: LPG DL NG Oil I
Phone: i 0 — I p Loy Fax: E -mail: F le i piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or. equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: Fax: I E -mail: Woodstovelpelletstove
Other:
Applicant's signatur —.o I Date 69 7 / Other.
Name (print): ,) bout) n TT
Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ 7� �v
O Visa O MasterCard Notice: This permit applicatio Minimum fee $
ex if a permit is not obtained
Credit card number: / / Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 5. SC)
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ -- lit . 3C)
Cardholder signature Amount
440 -4617 (6r00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION_. q. Business Line: (503) 639 -4171 MST
�1 BUP
J
Received Date Requested -a v AM PM BUP
Location 1 1 760 e Suite MEC 3- 6‘ /ei7
Contact Person _-..-- Ph ( ) 60 01 LE —a ?o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
C �� D
Post & Beam 1 � /a • OC;
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
jib
Sm e+ Dampers
Fi al
S PART FAIL
ECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final L Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA (2 ///7?,
Approach/Sidewalk Date I V Inspector Ext
Other:
Final DO N 1 T REMOVE this inspection record from the job site.
PASS PART FAIL