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12355 SW ALBERTA AVE
CITY ^C TIGARD _ MECHANICAL PERMIT
DEVELOPMTENT- SERVICES PERMIT#: MEC2004-00084
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6.,39-417'1 DATE ISSUED: 2/27/04
PARCEL.: 2S103BC-02500
SITE ADDRESS: 12355 SW ALBERTA AVE
SUBDI✓ISION: CANOGA PARK ZONING: R-4.5
BLOCK: LOT: 009 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BG,JRS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
I.PG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + lip: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS _ Ol HER UNITS:
r
FURN >=100K BTU: = 10000 cfm. 4 GAS OUTLETS: 1
> 10000 ;f m:
Remarks: ( i i%rn oil furnace to gas and gas piping.
Owner: —------- FEES
FENNELL, DELBERT c, Description Date Amount
12355 SW ALBERTA ST !v IA 111 Permit I-ce 2/27/04 ',)72 '>()
TIGARD, OR 97223
1 fA!iI tt°s,State Surchart 2/27/04 S5 N()
Total $78.30 _ _J
Phone: -
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS___
Gos Line Insp
Phone: 692-1565 Harting Unt Insp
Reg #: LIC 5193 Final !nspection
This permit is issued subject to the regulations contained in the Tigard Munic,,)al 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: r_ l ,` _ Permittee Signature: - ---- �>
Call (503) 6394175 by 7:00 P.M.for inspections needed the next business day
0,/27/2004 11:25 503691.1879 01
Mechanical Permit Applications Recetived , , / Mechanical
- f Date/By- _ Pamil No.:
1 E I r Planning Appy va Building
City of Tigard � �! gato/BY. PermitNo.:
13125 SW Hall Blvd Plan Review Ot a
Tigard,Oicgon 97223 FEB O"� ' Lamle sc `-
ti � Post•Rcvicw � Land Vac
Plione: 503-639-4171 Fax: 503-? ,960
Date/By Case
Internet: www.ci.tigatd.or.us 11� OF I Contact .r See Page 2 for
24-hour Inspection Request: 503-604WNG C11J Name/Method: _ Su lemental Information.
t'Z'PTL�b1�WORA 1VI14IERQI►La'2tEfrrP SCLaLc,a!W r.•�'tiFY1SL CIICIilS
ew construction I3ettiolition� Mcchanical permit fees*are based on the total value of the work
JA!ldditiords-IteratimVreplaccmen'I ❑Other:
1' performed. Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead and profit.
C:'tTEGCf�Y OF' C3�iSTRUC1T10N'..{: I' `'' Value: S See Page 2 for Fee Schedule
fA!cCccssory
2-homily dwelling Cemmercial/Industrial IDE A7t,E Building Multi-Famiily De�cri tiro gtyeeea. Toeal
ster Builder Other: iii t#ng/Coolin
rOIRR SWiTME NGtitM,AT,[Cf�i„and CSA__ .-N Furnacz add-on air condition' 14.00 .�
Joh site address: 1 2.3 SS Gas heat purrip 14.00
Suite 4: _ 1 Bld ./A t.#: Duct work 14.00
Hydtonic hot water system 14.00
e: Residential toiler
irtosstreet ircetions to job site: for radiator or hydronic_pjjem 14.00
Z ST --iv Al-f3 - j� Unit heaters(fuel,not c1cch4c)
in will,in-duct suspended,etc. 14.00
Flue/vent for any of above) 10.00
Repair units 12.15
Subdivision: Lot#: other ,et.� llanica
Tax ma / arcCl# Water heater 10,00
NdF WORK IT.,miry; Gas fireplace 10.00 _
Flue vent water heats/ tf lace 10.00
Alp,JALo lighter as 10.00 -
Wood/Pcllct stove 10.00
I� NSWood fits laceltnacrt 10.00
C,'hiimney/liner/flue/vent - 10.00
M�o
l<t';'•�:;, : TS 11k1VICa �7 Y''.",r" „ �� 1l' Other: 10.00
EnvleonmentalEthoust de Veekilidbu.Name: a,�{L.'r'- �.#-M 6 LL- Range hood/other kitchen equipment 10.00
Address: Clothes dryer exhaust 10.00
city/state/zip: j[ ]�2 Single duct exhaust
Ph0t1e T ax: (bathrooms,toilet compartments,
?Lt'1ptlICY1NT Cd :lt >1' Cf "'
utility rooms) 6.R•�-.-
Natnc: Anic/crawl ace fans 10.00
!►'1'R-il.�--------- other: lasso11
Address: Fu Ila
CRL/State/Zip: _ •• IO for first 4,S1.0a each additional)-------
Phone Furnac!,eic *' d
Fax: Gas heat u `•
E-mail: Woll/sus cndcd/unit heater "
C,' ttkG'
'Ott'! Water heater
Business Name, � � � Fero lace ••
Range
Address: t.� l4_ DB ----- .«
Cit /SY tate/Z_ip: -TIAA,L n&Z - Clothes dryer(gas)" -
Phon . - � Fax: other «.
CCB Lie. #: !- -- _ Total:
M baAterl Permit Fm—
Authorized / Subtotal: $
Signature ' _ 1�atc' ."`-I Minimum Permit Fee$72.50 S
Plan Review Fee 25%of Permit Fee S
--- --- — — State Surcharge(B%of Permit I'cc) $- -
- (Please print natne) —
TOTAL PEP-MIT FEE S -7$
NoU,e: i hit permit application eapirri Ito permit to not ohtrin�d within •Fee methodology act by Tri-County Building Industry Service rd.
180 days after it has been steepled■%cnmptete. "Site plan required for e:tterior AJC units.
\tttte�Permil Fonna`MccPermitApp doe fit ip1
■
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4,175 MST
INSPECTION DIVISION Business Line: (503) 639-4171 -
��// BLIP _
Receivecryll Ill-r�SPDate Requested.. -_�� AM PM BLIP
Location ---- 12 3�S l t^ �1 _ _Suite-------,- �Q
Contact Person �Q,P., Py -1 Y _ Ph(_, _ P `pi.M
Contractor --_��.caa�, � 1_. _ Ph( _�) __. _ 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 r
Susp'd Ceiling — --- - _--
Roof
--yr -
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
Rou ---
as Line
e Dampers — -
it
PART FAILV*K — — —
rRICAL —
Service
Rough-In _
UG/Slab
Low Voltage
Fire Alarm
Final
nalPARI FAIL F-1 Reinspection fee of$— ranidred before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASSSITE [] Please call for r Inspection RE: — Unable to inspect-no access
Fire Supply Line •� J` �j'%i��
ADA //
rpproach/Sidewalk Date— Inspector
Other:
Final DO NOT REMOVE this Inspection record fronn the jabs 41o.
PASS PART FAIL