Permit CITY TIGARD MECHANICAL PERMIT
4A 11 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00265
13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/22/03
PARCEL: 1 S134DC -09200
SITE ADDRESS: 11498 SW TWIN PARK PL
SUBDIVISION: TIGARD PARK ZONING: R -4.5
BLOCK: LOT: 008 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: 1 DOMES. INCIN:
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: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Installation of a/c unit.
Owner: FEES
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JUSTIN KRISNODI Description Date Amount
11498 SW TWIN PARK PL [MECH] Permit Fee 5/22/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 5/22/03 $5.80
Phone: 503 443 - 1583 Total $78.30
Contractor:
OREGON HEATING +A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
hone: 538 - 2953
Final Inspection
Reg #: LIC 125815
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
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Issu • By: ee�� i!1LL:4 Permittee Signature:
Call (503) 6.9 -4175 by 7:00 P.M. for inspections need d the next bust ss day
Mechanical Permit Application OFFICE USE ONLY
Date received: 6 03 Permit no.: f ek06" DO j{(p5
„ City of T Project /appl no.: Expire date:
City of ri
Address 13125 SW Hall Blvd, Tigard, OR. 97233 Date issued: (By Receipt no.:
Phone: (503) 639 -4171 , —
Fax (503) 59S -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT .
U l & 2 family dwelling or accessory U Commercial/industrial U Multi - family U Tenant Improvement
0 New construction U Addition/alteration /replacement ❑ Other:
JOB SITE INFORMATION . COi MERCLAL VALUATION SCHEDULE
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Job address: 11416 SW will 'i P Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: I Block• J Subdivision: '`See checklist for important application information and
Project name: ja ThA Kfjff( ( jurisdiction's fee schedule for residential permit fee.
City /county: '�' ZIP: T7ZZ3 I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE ,
Description and loation o f oik, on premiises: ,j� AND COMMERICAL /INDUSTRIAL EQI!IPMENTSCIIEDULE
i tISTaL l Q� w716(M MIL Fee (ea.) Total
Est. date ofcompletlon/inspection: Description Qty. Res. onty Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? U Yes 0 No handling unit CFM
Is existing space insulated? ❑Yes ❑ N o Air conditioning (site plan required) (
g P Alteration of existing HVAC system
MECIIYNMCAL CON'T'RACTOR Boiler /compressors
Business name: State boiler permit no.:
OREGON HEATING HP Tons BTU/H
Address: & AIR CONDITIt7NINO INS - Fire /smoke dampers duct smoke detectors
City: P.O. Box 397, Dundee. OR' 1, I Z IP: Heat pump (site plan required)
Phone: (503)`' 8 -2953 E -mail: Instal /replace furnace /burner BTIJ/H
Including ductwork/vent liner U Yes U No
CCB no.:
25-0/. ' Install/replace /relocate heaters - suspended,
City/metro lie. no.: 4'l wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chillers TIP
Address: Compressors HP
Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
Hoods, Type I/ II/res. kitchen/hazmat
L • hood fire suppression system
Name: j( . 2 st"j/l k ( /SMOd,I Exhaust fan with single duct (bath fans)
Mailing address: ( I4 � 1 5( -r PE- P1 Exhaust system apart froth heating or AC
Fuel piping and distribution to 4 outlets)
City: n � I State:px' LIP: 9� Type: LPG NG Oil ,
Phone: 445- 513 Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert - type_ _ __ - __ -_
Phone: Far: F�,rrf:, IL• Woodstove /pellet stove
i Other:
Applicant's signahlre. Date: S/Z Other:
Name (print): / 477-erofeyl 1 pe
`Nor ill pinadtction:: accept erdtr cards, pkn.o call prztsdicaon rnr more mtilrmauon, Permit fee ................... _
Cl viv CI �fettitet{:arrl Notice: This permit application ivlinirnum he $
Crzdu and number.
/ expires if a permit is not obtained Platt review (at %) $
- - -- ---- - - -- -- - - -- - - _- within ISO days after it has been - - - -- - - - -- --
Iaptrx y State surcharge (8 %t) .... $
Norte of rardfinfdcr as ahown on cralit c.tnf - - _ . accepted as complete.
- - __ -__ -__ _ _ .
------- - - - - -- u-d -- - - --------- - - - - -- -- ---- ---- --
[OTAL s - 78.. 3v
l.'.holde r .ignaua_ Amount I-1(1 -1617 ((,,00 /t'Oi\I1
JOB (�ST�v KV-LS NO St ft xy-to
OREGON HEATING & AIR CONDITIONING, INC. SHEET NO OF
CCB #125815
P.O. BOX 397 CALCULATED BY DATE S11 10-N �
DUNDEE, OREGON 97115 CHECKED BY DATE
(503) 538 -2953 Fax (503) 537 - 2172
SCALE N o w G •
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received .?1' Date Requested 4' r / 3 AM PM BUP
Location I t 'l / " s40 orlio lad Note Suite MEC 3 --0
Contact Person c D Ph ( ? 7) �� �a � 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 7 � 1� P.? ELC
Footing �' ELC
Foundation Access:
/6 (
Ftg Drain ELC
Crawl Drain
Slab Inspect' otes: � �� 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
IPCRAWAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
d ig = PART FAIL
ECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 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 'sr _ , , / Inspector Ext
Other:
Final DO OT REMOVE this inspection record from the Job site.
PASS PART FAIL