Permit CITY OF TIGARD
MECHANICAL PERMIT
rA DEVELOPMENT SERVICES PERMIT #: MEC2004 -00203
�� I-II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/20/2004
PARCEL: 1 S 125DD -02200
SITE ADDRESS: 06965 SW VENTURA DR
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R -4.5
BLOCK: LOT: 013 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace and AC.
Owner: FEES
BAIRD, TOM Description Date Amount
6965 SW VENTURA DR [MECH] Permit Fee 4/20/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 4/20/2002 $5.80
Phone: Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 - 640 - 3607 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 66578 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 - 0010 through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: G[ Permittee Signature: f'/
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
i
Altanical Permit Al FOR OFFICE USE ONLY
•
i n Received /
1� Date/6 : ' ow 0I, Mechani
Permit Nu.. .. ..• ;I. , Cii: y o :: T Permit •1 Building
Datc/B : rmit No.:
i . ;1 >_5 SVr Hall Blvd. 51 Other
NPR 19 P lan Review
Tigard, () regon 97223 Date/13 . Permit No,:
Phone: 5')3 -639 -4171 Fax: 503 - 593 -1$ IG' 'i� Post- Review Land Use _
�( r:7 y1 rr D ate/B :
IIntel ,vww,ci.tigard.or.uS GO ` l �' : ` ` � Case No.:
24 - hour G tspecuon Request: 5 03. 11aQ G D - "� :III 1 I Contact Juris.: tP4 See Page 2 for
Name /Method: Su • • lemetltal Information.
TYPE OP WO RK OIV'IMERCIA.L FEE* 50 UULE- USE CHECKLIST
Th4ew , :onstruction (l Demolition Mechanical permit fees" are based on•thc total value of the work
• Addit ion/alteration/replaeement ❑Other performed. Indicate the value (rounded to the nearest dollar) of all
i CATEGORY OF CONSTRUCTION : - :.• mechanical materials, equipment, I¢bor, ovenc�all uncl profit.
Li 1 & 2 'Family dwelling 0 Commercial/Industrial value: S See Page 2 for Fee Schedule
• f�cce sary Building (Mxlti- Famil RESIDENTIAL.EQUIPMENT /SYSTEMS FEE* SCHEDULE
• Mastcr Builder - Q Other: Description Qty Fee(ea.) rota)
JOB SITE IIlN'I� ORMA'i ION and' LOCATION •• ' • - • _ �ffeatt g/Loolle�
• C d -on hir conditions W L 14,00
Job ;site a idres • C w! v - ".. `� 0; , • mo
Suitt: ?/: 14 0p
( , q( 1 Bl /,a # : D uct work 14.00
Pro fret N lme: Hydronic hot water system 14.00
Cross street/Directions to jab site: Residential boiler
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: I Lot #: ' Repair units - 1 12.15
Tax tnap/� farce) #: Other Fuel Appliances .
DESCRIPTION O C WORK ( Water heater 10.00
ll II Gas fireplace 10.00
,l��a• 7,-'t x t t _ Flue vent (water heater /gas fireplace) 10.00 •
I 1 l - Log lighter (gas) 10.00
• wood/Pellet stove I 10.00
Wood fcreplace/insert 10.00
Chimney /liner /fluc /vent I 10.00
❑ LROPE] tTY OWNER .. [ J TENANT ...• . .. . Other:
— 1 - 77,00
Name: L -t a / � G � t .[ Environmental Exhaust Sc Ventilation
h
Address: Range hood /other kitchen equipment I 10.00
� I{
Clothes dryer exhaust
Ci /3 /Zp: 10,00
Single duct exhaust •
Phone:
-( LI o 4-6 F ax:
(bathrooms, toilet compartments,
It A.PPLIC LNT ' • . .. [''CONTACT PERSON'S ; . 7.7r utility rooms) 6.50
Name.: Attic/crawl space fans 10.00
Address: Other: 1 10.00
City/State /Zip: Fuel Pipi ft
* *(SS.40 for tirst 4, 51.00 each additional)
Phone: Fax: Furnace, etc. ..
E -mail: --- Gas heat pump •*
walVsuspended/urtil heater •.
CONTRACTOR •;:; • Water heater •.
Bus iness ]fame: S VI c•-4. -L C—' - 1 r\) Fireplace ..
Address: i Lc C., 1 S P v - r- 4-.4. Range
Am
Ci /;;tate,'Zip: fi 6 1 S 69 •-►� c' >3BQ ••
y - Q , G l */ 1 7 Clothes d cr gas) *'
Phone: k -i o _5 L c — • I Fax: e ' i - e -- I t -3 Other: ..
CCB Lic. /: (rj t t - S �.S Total: _
Authorized ' r ` Mechanical Permit Fees
Signature: 'L . -Z- L . Dater / q /nth Subtotal: S
L },`,{ •� `•` `1 I �� -� L Minimum Permit Fec $72.50 5 . 4 Z. , SI'
( � Plan Review Fee (25% of Permit Fee) S
(Please print name) _ State Surcharge (8% of Permit Fee) S • Y
TOTAL PERMIT FEE 1 5 • ?o
Notice: this p :rmit application expires if a permit is not obtained within "Fee methodology set by Tri -County Building Industry Service Board.
ISO days after t has been accepted as complete. * *Site plan required for exterior A/C units.
i :\Dstc\Purmit F)rms\MecPermitApp.doa 01/03
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SITE PLAN
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STREET
Specially Heating & Cooling, Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793
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CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
/fir 4
Received 7 / Date Requeste. " a 41 AM PM BUP
Location uite E
Contact Person G' 6Z. Ph ( ) PLM
Contractor od . 4(R Ph ( ) SWR
BUILDING Tenant/Owner 00 — O 40
Footing
Foundation ELC
Access:
Ftg Drain • ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall Fire Sprinkler - / !• �1 �' —
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 IL
MECHANICAL �� 1
Post & Beam
Rough -In .
Gas Line
Smo, ; Dampers. •
RT FAIL
- - 'TT' AL
Service
Rough -In
UG/Slab
Low Voltage .
Fir- -rm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
44.V.I ART FAIL
SIT — ❑ Please call for einspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspect • � � .1 . , , Ext
Other:
• Final DO NOT • EMOVE this inspection record f m the jo site.
PASS PART FAIL