Permit CITY TIGARD • MECHANICAL PERMIT
6In DEVELOPMENT SERVICES PERMIT #: MEC2003 -00084
r�l �! 13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171 DATE ISSUED: 3/4/03
PARCEL: 1S133DD-03100
SITE ADDRESS: 12852 SW WINTERLAKE DR
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 ZONING: R -4.5
BLOCK: LOT: 070 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:
LPG 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install gas furnace and 1 gas outlet
Owner: FEES
NAGANUMA, KATE 'P +TRAVIS J Description ' Date Amount •
12852 SW WINTERLAKE DR [MECH] Permit Fee 3/4/03 $72.50
TIGARD, OR 97223' [TAX] 8% StateTax 3/4/03 $5.80
Phone: Total $78.30
Contractor:
SUNSET FUEL CO
PO BOX 42287
2944 SE POWELL BLVD REQUIRED INSPECTIONS
PORTLAND, OR 97242
Phone: - 503- 234 -0611 , - Gas Line Insp
Heating Unt Insp
Reg #: LIC 2374
•
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: ji� Permittee Signature: __ / p/ Yy
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
w
1
A Mechanical Per ,. ,a _4,
. Date eived: 3 _. y_ `i. Permit no.:/e)Ce3 gi
.. ,� 11 ',, :li 1 City of Tigard Project/app l. no.: Expire data:
CiryafTigard Address: 13125 SW Hall Blvd, TigarB DNG DI d, 9I�?� 2003 Date issued: By j I Receipt
Phone: (503) 639 -4171 Pax: ax: (503) 598 -1960 C OF TIGARD V ISI Case issued:
uilding Payment type:
ON
Land use approval: _
•i 1 l'L or I'I•Iti i I•I
01 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction . Addition/alteration/replacement 0 Other.
JOB SI I E INFORMATION CO1111LRCIAL VAl.l 1'l('/N SCHEDULE
Job address: ;1 . ►" _ 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; Block: Subdivision: ' checklist for important application information and
Project name: f, ( G 11U.L_. jurisdiction's fee schedule for residential permit fee.
City/county: y d Emovamiiii I S: 2 TAMMY Dw:LLIN(: I'rItmi i' I CE SCHEDULE
Des 'ption and 1• ation of work on premises: 71 v . • AND (•Ui•1ML•;Itl('ALIINUtiti i I11AL EQUIPMENTSCIIl
V V\0. C.Q . RI Fee(ea.) Total
Est: date of completion/inspection: Desai. lion s Res.onl Res. old
Tenant improvement or change of use: Air handling unit CPM il
Is existing space heated or conditioned? ❑ Yes ❑ No •1 conditioning Mc p an req ed) =
Is existing space insulated? ❑ Yes ❑ No •1 teration o existing .1. • system I♦
11lISl'IIANICAL CONTRA(' 1(Ilt S ttuoompre ,■ .
State boiler permit rmit no.:
Business name: 5tAY1 C F ► . HP Tons BTU/H
Address: 21 U N 5 'owe! I " v a . ; , ,z , • c . II .. • . tectars 1.111
City: 'or r S ZIP: I:1 2 ' eat pump (site plan rcqult • 0 —
Fax 4 .6,134 E -m ail: nsta ►rep ace urnace/burner 11:: • ' 1 11-1D6
Phone: 2.31.1.0(.4,1/ Including ductwork/vent liner ►: Yes ❑ No
CCB no.: as L/ nsta l rrep ace/relocate , eaters - suspen • ed,
City /metro lie. no -: 2'-152, wall, or floor mounted
Name (please print):
eat fora' ' lance o • er than furnace .
CON I A(" I PLRSLIN' b ��' : t iaiu n i ■ --
Absorption units BTU /H
Name: Chillers HP MI EN
Address: Coy •ressols ■ �-
amen eltlmust as a
n ven .1 a on:
City: - State: ZIP: Appliance vent
Phone: Fax: E °•.� e Type - f • free z tc • e I azmat ■ ��
hood fire suppression system
EMMICSIIIIMMIIIMIN
.. Mann: fan with single duct (bath fans) = - �
Mailing address: - . aust s stern apart from Mann: or •
p,. , : au. ri , , on up to • on ets •
City: State: ZIP: T : LPG NG Oil
Phone: Ti I - ;f.' 3 Fax: E -mail: uc . . : each a• • itton: over • outlets I♦ _�
:N(.IN'I•:L:R roceesp ,mg sc ematicrequire•
Number of outlets 1 �r
Name: I 1, er 1: . ap . i saes or egmpmentt II
Decorative fireplace
City: State: ZIP: r +
"' .' -tov: pc etstove —�—
Phone: Pax: E -mail: � -
Applicant's signature: 4 i:�� Date: alai 0 t'l , ill
Name (print): L
Permit fee $ 17g 5E1 Not )urisdiclleas accept credit cards. Please can jurisdiction for more i Minim
all
Notice: This permit appl Minimum fee $
t4viss t expires if a permit is not obtained
credit cats namber: Z (y.t -i 10/ / oc Plan review (at _ %) $
i 180 days after it has been State surcharge 8%
r3err�t M r st r, Expires within � ( ) .... $ . 5 • �
Nsme of eardholeer w etiown on credit trod S , 8.30 a ces .
n accepted as complete.
p TOTAL $ 7 . 3O
- Csrdnotder si Amount 44041617 (6Io COM)
TO /T0 3Etid VV VVVVVV :adgd 0000000 Zb :TT E00Z /8Z /Z0
CITY OF TIGARD , 24 -Hour
BUILDING '— Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 3 _0 '? AM PM BUP
s
Location / g a "v S u i te MEC 3 -o'?
Contact Person Ph ( ) 01-3 `f —O(' ( I PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
•
Ext Sheath/Shear
Int Sheath/Shear
Framing . . Offi .L .. n-1 , t Cc.: i f
Insulation
Drywall Nailing ¢ � 0 10 ./ 4 - / .5"72
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
Gas Line
Smoke Dampers
d eafX
•
• PART FAIL
LECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal 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 J ,
Approach/Sidewalk Date -7 -- Z or 2 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL