Permit C ITY OF TIGARD MECHANICAL PERMIT
Aft r DEVELOPMENT SERVICES PERMIT #: MEC2003 -00630
Ail- �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/03
PARCEL: 1S125DC-01600
SITE ADDRESS: 07125 SW VENTURA DR
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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: Replace furnace
Owner: FEES
EBLING Description Date Amount
7125 SW VENTURA DR [MECH] Permit Fee 10/28/03 $72.50
PORTLAND, OR 97223 [TAX] 8% State Surchart 10/28/03 $5.80
Phone: Total $78.30
Contractor:
CLIMATE CONTROL INC -
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Mechanical lnsp
Final Inspection
Reg #: LIC 62196
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
Issued By: l p Permittee Signature: - '2 a4
Call 639 -4175 by 7:00 P.M. for inspections needed the next b day
Oct 27 03132:05p climate control 503 968 7224 p. 1
w
Mechanical Permit Application I OFFICE USE ONLY
.7';'` D ate rece ?„/y) t- Permit nottXt , ,X �3 - Cz, 63
r I . ",
� Crt of Ti Tigard Pro ect/a l no.: Expire date:
City of Tigard Address: 13125 SW Hall Blve *era
_ai' , O 97223
Phone: (503) 639 -4171 T U� Date issued: ' By: Receipt no.:
Fax: (503) 598 -1960 OC 1 � Casc file no.: Payment type:
Land use approval: , c� TIfap D Building permit no.:
CI"
_.1110 N
• TYPE OF PER
*l & 2 family dwelling or accessory 0 Commercial /industrial U Multi - family 0 Tenant improvement
0 New construction 0 Addition /alteration /replacement 0 Other: ,_ _ , _ __ ___.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 I S S _t J¢iv AtA•�, B-R 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.: pro:'it. Value $ •
Lot: 'Block: 'Subdivision: *See checklist for important application information and
Project name: 6 r cs E b � jurisdiction's fee schedule for residential permit fee.
City /county : - y arc), 'ZIP: Q1 S 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descri Lion and location of work on remis s: I COMMERICALIINDUSTRIAL EQUIP ENTSCHEDULE
ti r
t YNCti -•c-Z. i Yl3trA -112tm Fee(ea.) Total
Est. date of completion /inspection: /0 a8 - 0 , Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? l7 Ycs 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boi:er /compressors
/� State boiler permit no.:
Business name: ent yinta Cejvcf e) l HP Tons BTU /H
Address: ( 500 j 7 and Q Fire /smoke dampers /duct smoke detectors
City: - Pp ; .{.v d I State: d' i2I ZIP: (=j y Heat pump (Site plan required)
Phone :56 -_4 Fax: 4'(o48 .7DE -mail install /replace furnace/burner q( 2 BTU /H _
CCB no.: t l ° �P Including ductwork/vent liner Yes 0 No li )4 1
install /replace/relocate heaters — suspended,
City /metro lie. no.: l y 'I 9 wall, or floor mounted
Name (please print): ' �� Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chil lers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hocds, type I/ ll/res. kitchen /hazmat
hood fire suppression system .
Name: John E j n �
/ E I -v\OY l 1A--)h t 1 fo'C c Exhaust fan with single duct (bath fans)
Mailing address: `71 S(Av V fur , p R. Exhaust system apart from heating or AC
City: -- n GoN cA I State: 0 . I ZIP: 9 7,I-a--2, Fuel piping and distribution (up to 4 outlets)
��] Type: LPG NG Oil
Phone: ,(D/ to Fax: E - mail: File:: piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Dec native fireplace
City: State: I ZIP: Insert — type
Phone: Fax: E -mail: Woodstove /pellet stove
Other:
Applicant's signature: , Date: /c/-/C3 other:
Name (print): .' k t,I ��- 1 # fe. Ib i -7
Not all jurisdictions accept credit cards. please call jurisdiction for ore information` Permit fee $ I d- �O
m
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number / / expires if a permit is not obtained Plan review (at %) $ C
Expires within 180 days ;tiler tler it has been State surcharge (8%) .... $ 'a c)
Name of cardholder as shown on credit card accepted as complete.
i TOTAL $ --] `i)
Cardholder signature Amount ,
s.
4411 -4617 (6 /00 /COM1
CITY OF TIGARD 24 -Hour .
BUILDING ' Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
BUP
Received D ate Requ sted /d — a9 AM PM BUP
Location 1 / 9 V r - Or ' Suite MEC 3 — OO 2
Contar, i IV ,d Gf� ? #1 1 Ph (5b 3) , 9t' O/c'9 PLM 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain AC C ss: ELR
Crawl Drain l l 7'C%
Slab I spection Notes: ,Sq /� / /2 / SIT
Post & Beam l r C
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 /� - %• ' -- �/
Post & Beam /
Under Slab
Rough -In
Water Service
Sanitary Sewer ` •••,
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P.
Oh - •
arli - ,
f. PART at,
T im!' ANIC ' •
Post & Beam
Rough In / / 2//er/c)--,--
Gas Line
Smoke Dan : -
PART FAIL /
ECTRICAL
Service a- ,./...„
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 Dat Inspector 12 9 Eat
Other:
Final • DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL