Permit I .w
CITY TIGARD MECHANICAL PERMIT
rA DEVELOPMENT SERVICES PERMIT #: MEC2003 -00714
..� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/16/03
PARCEL: 1S133DC-14400
SITE ADDRESS: 11607 SW WINTERLAKE DR
SUBDIVISION: ARI GREEN ZONING: R -12
BLOCK: LOT: 035 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: DOMES. INCIN:
OTH 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install wood burning fireplace insert.
Owner: FEES
ASCHENBACH, JON Description Date Amount
11607 SW WINTERLAKE DR.
TIGARD, OR 97223 [MECH] Permit Fee 12/16/03 $72.50
[TAX] 8% State Surcharl 12/16/03 $5.80
Phone: 503 - 521 - 0888 Total $78.30
Contractor:
A CLEAN SWEEP CHIMNEY
2048 CROZER ST. NW
SALEM, OR 97304 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Woodstove Insp
Reg #: LIC 71300 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 -00
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections neede he next business day
,. ••
Mechanical Permit Application OFFICE USE OM.I
Date received: e7 0 BE Permit no.: '(1"1. o03 -CV7/
,, i City of Tigard .4 _11. ,,1 ) `J g Project/appl" no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639-4171 Date issued: CM Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: C
T 1•I'E OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
.10B SI1 E INFORMATION COi1'lll'ILRCLIL VALI ;A LION SCI IEDLLE_
Job address: / /( n '7 S t.J (,J//l/T.E,C C 4-1c4 ) k . 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 S / 7 O 0 , 66 .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: 75 6nie.-b I ZIP: S 7 i Z 3 I & 2 FAiII1,1' D11'1:1,I;I \G PER FEE SCHEDI;I.E
IIDescriptipnandloo4111:--t ccationofl1workonpremises: /h 51 .44 40064 e0a4 A \D COA IM1ERICAL /INDI:S "I RIAI. EQ1•,IP\IF. NTSCHEDI;FE
I.- ze-ft. w- ,O ler cc i 1..S.-#4' r i. in. esc. ff. Wit' Fee(ea.) Total
12 ,1 y-d j date of completion/inspection: n4. 4 So►1 -4 re to r4 ce Description Qty. Res. only Rea only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Yes ❑ No Air conditioning unit CFM
Is existing space insulated? Ayes ❑ No Air conditioning (site plan required)
g p Alteration of existing HVAC system
iN9ECHANICAt CONTRACTOR Boiler/compressors
�� Business namm ( ., 1 t o 4 ,....., ‘ s -
� ,,, G w ' , State boil
Hpermit no.: Tons BTU/H
Address: 0 204i$ CA ti � Fire/smoke dampers/duct smoke detectors
k i City: S 7 I State: 04 I ZIP: 9 ) 3 of Heat pump (site plan required)
J Install/replace furnace/burner BTU/H
Phone: 5 -16 3� I Fax: I E -mail: Install/replace
ductwork/vent liner ❑ Yes ❑ No
CCB no.: 3 e v 3 - 7/300 _ Install/replace/relocate heaters - suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/I-I
Name: V J / Ge /Qf� -� Chillers HP
V ` r/ d Compressors HP
Address:
...p6_67 <43 f �� l.� -�>� Environmental exhaust and ventilation:
City: 1 C l4,le. I State: ZIP: '97 Z L 3 Appliance vent
Phone: S'a 3 -5-2,i '-D ax: E -mail: tr RA 02 4469e/theiSgw .
Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: S ? 41 C i/I/T/tz.7 Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: IZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Na>Yrc: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: I Date: Other:
Name (print):
Not at jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee S
❑ Visa o MasterCard Notice: This permit application Minimum fee S
Credit card number. / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been .. S
Name of cardholder as shown on credit card accepted as complete. State surcharge (8%) ..
s TOTAL S
Cardholder signature Amount
440-4617 (6/00/COM)
CITY OF TIGARD 24 -Hour
BUILDING Insp o 9 -4175 MST
INSPECTI'DN DIVISION Business me: (503) 639 -4171
',I BUP
Received 64'21) W Date Requested /'Z 24 AM PM BUP
Location // �� v � �� � ' Suite MEC 3 O 7 /Y
Contact Person JB Ph (.412) PLM
Contractor Ph ( ) z-/-Dg g $ 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
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
Water he
Water Service
Sanitary Sewer -
Rain Drains ' �_
Catch Basin / Manhole G A /A d ze A ._
Storm Drain f Shower Pan 1M . :
Other: /
Final
PASS PART FAIL
Post & Beam
Rough -In mo
Gas Line
S • .: - mpers 1:14,,
PASS ' ART FAIL
EL - ICAL
ervice
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line �7 -__
ADA
Date — 2 Inspector i Est
Approach/Sidewalk p
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
•