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12160 SW Ann Place
�ITY OF TIGARD _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2000-00399
13125 SW Hall Blvd.,Tigard, OR 97223 1503) 639-4171 DATE !ARCED: 1
0/6/00 PARCEL: 25103S103B6-11700
SITE ADDRESS: 12160 SW ANN PI-
"UBDIVISION: YE OLDE WINDMILL ZONING: K 4.5
BLOCK: LOT: 036 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: E`JAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W!O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS ORS HOODS:
FU_E_L TYPES Y 0 3 HP: DOMES. INCIW
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: AIR HANDLING UNITSOTHER UNITS:
FURN >=100K BTU: <= 10000 c`m: GAS OUTLET; : 1
> 10000 cfm:
Rnmarks: Installation of new gas insert and associated gas piping.
Owner: _�. _ F_E_ES ---_ �-----
ANITA B. OTT Type By Date J Amount Receipt
6256 SW BURLINGAME AVE PRMT CTR ^^ 10/6/00 $72.50 272000000C
PORTLAND, OR ,47201 5PCT CTR 10/6/00 $5.80 272000000C
�___ Total $78.30
Phone: --- �----
Contractor:
GAS CONNECTION INC. OF PDX
6022 NE 112TH AVE
PORTLAND, OR 97220 _ _ REQUIRED INSPF TIONS
Gas Line Insp
Phone:503-661-4821 Mechanical Insp
Reg#:LIC 00103146 Final Inspection
This permit is issue(] subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty C,.]es
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if worK is
riot 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 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by
calling (503)24r)-9180.
Issue(By: .�� � -- Permittee Signature:
Call (503) 619-4175 by 7:00 P.M. for inspections needed the next business clay
Planec _
CITY`OF= TIGARD Mechanical Permit Application Roti By � —
13125 SW HALL BLVD. Commercial and Resid0t3tIVED Date Recd /o'a o
TIGARD, OR 97223 Dete to P.E.-
(5031 639-4171, x304 (ICT 2 71"p Date to DST r—
Print or TypePermit# Ms;c!b y9
Incomplete or illegible app licatio_nsoWNWo_ u accepted Called
Name of DevelopmenUPro)W DescripG:n
` ) Table 1A Mechanical Code _ Qt Price Am;
� �- � (c; \ � \ A) Permit Fee �
JobStreet Address Suae# _
Address 1) Furnace to 100,000 BTU
includin ducts&vents
Bldg# CRY/State Zip 2) Furnace 1C0,000 BTU+
including ducts&vents _ 12.00
Nano(or name of business) 3) Floor Furnace
Owner r�, including vent 9.65
Mug ddroee 4) Suspended heater,wall heater
or floor mounted heater _ 9.65
l l LO 01 5) Vent not included in a Dpliance ermit 4.75 _
C8X/Stete Zip Phone Check all that apply: 'Boiler Heat Air
_7Z,Z 9l>✓ For Items 6-10,see or Pump Cond Oty Price Amt
name of business) tootnotes 1,2 Como
6)Repair units
_ 8.40
Occupant d Ilny Address 7)<3HP;absorb unit to
100K BTU _ 9.65
cl ylstate zip Phone 8)3-15 HP;absorb unit
100k to 500k BTU 17.65
9)15-30 HP;absorb
Contractor " °r� J ` ( unit.5-1 mil BTU 24.15
(� 10)30-50 HP;absorb
Prior to permit I Mailing A1dress t( unit 1-1.75 mil BTU 36.00
issuance,a r•-ry L- A 11)>50HP;absorb unit>1.75 mil BTU
of all licenses C I'tote ZI Phate� 60.15
are required if Y L�'- 7 2� 12)Air handling unit to 10,000 CFM
expired In COT egon Const Con(.So8fdLk.K Exp Date - 7.00
database / Q' "> Z '� 13)Air handling unit 10,000 CFM+
Atrohltect Name 11.85
14)Non-portable evaporate cooler
�— 7.00
Or Malling Addre-s
15)Vent fan connected to a single duct
4.75 _
Enginee ' CMylSlete zip Pnone 16)Ventilation system not included In
a lience Permit _ 7.00
Descrihe work to be done: 17)Hood served by mechanical exhwist
7.00 _
N,3w Repair(, Replace with like kind: Yes O No O 18)Domestic Incinerators
12.00
Residential f@ Commercial O Modification O
_ 19)Commercial or Industrial type Incinerator
48.25
Additional inf '
information or description of work: A _
20) Other1ir n s,Including14\Xvood stoves ( 700 ill?
NOTE: For Commercial projects only;Units over 400 lbs.,located on the 21)Gas piping one to four outlets .�
_roof: ureg Ire structural talcs.prepared by licensed engineer. 35
Type of fuel. oil O natural gas® LPG O electric O 22)More than 4-per outlet(each) 77 5
Minimum Permit Fee$50.00 SUBTOTAL tl
I hereby acknowledge that I have read this application,that the information _ 8%SURCHARGE b
given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL
the owner,that plans submitted are in compliance with Oregon State laws Reaulred for ALL commercial permits only ,.
1,
3lgnatuytrf=r/A Date �-- --'—� TOTAL -
�1 ,l� e
li� other Inspections and Fees
Con Per n Name FFIV119
t. Inspectlons outside of normal busin rs(minimum cherge•two hx rs) $50 00 per hour
0 1 2. Inspections for whit.,no fee Is specifically indicated (minimum charge-half hour)
Foonotes fol,commercial projects only: 3 Additional plan review required by changes,additions or rwlslons to plans(minimum
1. Provide full schematic of existing and proposed gas line and pressure charge-one-haff hour)$50.00 per hoor
2. Provide drawings to scale showing existing and proposed mechanical 'State Contractor Boiler CerUrication required
units. _ "Residential A1C requires site plan showing placement of unit
I tmechpemi doe rev 1111199
f'ITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 539-4171 --
_
_Crate Requested j� AM �UP'
—_ PM — EIL.r)
Location / Z & -Ji✓ �h Suite MEC 2,ewv- Ga3Y 1
Contact Perron _— — _ Ph — U - c } 7 PLM
Contractor_ _v �. --__—___. PFr _ _ _ SW11R
BUILDING Tenant/owner ELC -
Reta'ning Wall ---A -- ELR ----
Footing Accec--s� FPS
Foundation -- _
Ftg Drain SGN
Crawl Drain Inspection Notes: - --
Slab - - --- --- -- SIT
Post& Beam —
Ext Shnalh/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing --------------------�-. ---- — --- ----— -
Firewall
Fire Sprinklf r
Fire Alarm
Susp'd Ceiling -------- - --- -- - _--- -- --- ------- -
Roof
Mise.
Final —
PASS PART F IL _ ..--- -- -__ _ ----- ---- ------ -------_ - ----
PLUMBING
Post 8 Beam _-
Under Slab
Top Out - - -- -._
Water Service
Sanita,v Sewer
Rain Drains
Final - -�
PASS PA FAIL
CHANIC L .7 _----- -
Post$ Bei N _------____ -------------..._-._.----- -_-._----
Rough In
Gas Line f r*P --- ---e_--_- _ ---- ------- ---- --- _ - --
S oke D rnpe.rs
Fir ---- --_---- - —_ ---__._- ----------- -
ASS PART FAIL.
Service. —..----
Rough In
UG/Slab ---..._-- _--
Low Voltage
Fire Alarm ---- -_-------- -- -- —_ ----- ----- ---
Final
PASS PART FAIL ------
SITE
[iackfill/Grading ----
Sanitary Sewer
Storm Drain i ] RPinspectior.fee of$-- _,required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I ]Please call for reinspection R1 T--- i ] Unable to inspect- no access
Fire Supply Line
ADA
Approach!Sidewalk �� � ) �'
Other Date .L-_Z_=4G_-- -- Inspector_-_._L�-- __ __ —_--_Ext -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.