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9570 Sly BRENTWOOD PLACE
i
/^ CITY OF
TIGARD
IGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00266
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/23/01
PARCEL: 2S 111 CD-05500
SITE ADDRESS: 09570 SW BRENTWOOD PI_
SUBDIVISION: SUMMERFIELD NO.9 ZONING: R-7
BLOCK: LOT: 514 JURISDICI rCN: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYNE 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:
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. CLC DRYERS:
FURN < 100K BTU: 1 _ AIR HANDLING UNITS _. O'rHER UNITS:
FURN >=100K BTU: <= 10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace with like Kind
Owner: -- FEES
GRAHAM, JOHN M + LUCILLE H TRS Type By Date Amount Receipt
9570 SW BRENTWOOD PL PRM r CTR 7/23!01 $72
50 272001000C
TIGARD, OR 97224 5PCT CTR 7/23/01 $5.80 :172001000C
—
Phone: Total 378.30
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone:624-2704 Final Inspection
Reg #:LIC 76359
PLM 34-175
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9189 ,
Issue By: I d(t4, l_ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next b tWntt9,d' ay
Mechanitcal Permit Application
IDatereceived: Permit no.:
City of Tigard`J Project/appl.no.: Expire date:
Cm.OfTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 --
Phone: (503) 639-4171 Date issued: By )Zcueipt no.:
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval; Building permit no.:
TYPE OF PERMIY
I &2 family dwelling or accessory 0 Commercial/industrial _1 %Iullr h-10" J]enint impro-ement
J New construction U A(idition/alteration/replacement J c W
JOB NITE 1
IN 1 11
Job address: 1 I Indicate equipment quantities in boxes below.Indicate the dollar
---- • J L�,f.�r rl �
Bldg, no.: Suite no.: I value of all mechanical materials,equipment,labor,overhead.
Tax map/tax lot/account no.: profit.Value$
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: ----� jurisdiction's fee schedule for residential permit fcc.
City/county: ZIP: 7 Z L`a -
Description and loca ion_of work on premises:
t.;k:aL�..�.-� t 1�\,I ,Ni.C_,L_ _ Fee(ea.► Tolal
Lst.date of completioniinspecdon: Destri ttion Qtye Res.only I Res,only
Tenant improvement or change of use: Air handling unit CFM
Is existing spare heated or conditioned?O Yes U No Air conditioning(site an requi l �`
Is existing space insclated?O Yes U No Alteration of exist g ystem �—
1 of er compressors
Business nam L)MVA bi A ���gyp, State boiler permit no.:
t HP --'Ions.—BTU/11
Address: aac)Q S� $ � vs . lr smokednmper�o a etectors
City: _ State: C/;.. Zil': i 1Tcat pur-�' quire
Phone: Fax: F-mail: nsta eplacefurnace urner � BTU/H
r -- Including�Wor vent liner J Yes V No
CCB no.: � - nsta rep ac re ocate eaters-suspen e ,
City/metro imc.no.: C J,7 7 wall,or floor mounted
\time(please pant): m ent for appliance offi-er than furnace
Re gere on:
ONUACIYERSON_ Absorption units________ BTU/H
Name: ' J k,��►l•►t t't4 Chillers HP
Com , Mrs HP
City: f State: i' ZIP: `/ 'J fi
Er nmenta exhaust an ventilation:
Appliance vent
Phone: - I t Fax_: E-mail: Dryerexhaust
Hoods.rype 11 n7res.kitcheiV57miait
hood fire suppression system
Name: S AExhaust fan with single duct(both fans)
Mailing address: (is l r c -1 qct ,I. Exhausts _stem apart from hearing AC'
Cil}: r uei piping adistribution(up to out etsState; LiP: Type: --LPG NG ____ Oil
Phone: Fax; & .mil:
_
ue t In ea-cf amt iitional over outlets
' roeeasp p ng(se ematicreyutreril
`umber of outlets
NaMe: ter tC app once ar equ pment:
Address: _ Decorative ti replace
City:_ State_ ZIl': nsert-type
--`'� on stn�pcllet stove -
Phone: _ tx: Email.
Applicant's signature: Date: —or
er:
Name (print):
Not all Jurirdleaons accept credit cnnla,pletue call Judrdiction for mora loformason. Permit fee.....................
F
O Visa O MosterCard Notice:This permit application Minimum fee................$
expires if a permit is not obtained Plan review
Credit card number, � _.—,_ �._.1 (At _ 96) $
., ��
n
Err;,e within 180 days after it has been State surcharge(8%)....$ T�
m o u u shown on It ear $ accepted as complete. TOTAL •......................$
Amoum W-417(tSr MOM)
CITY OF TIGARO BUILDING INSPECTION DIVISION MST w
24-Hour Inspection L_inu: 639-4175 Business Line: 639-4171 -
��,,pp,��,,,,���� � B U P
__-__Date Requested- AW+ ;7', j AM PM _— BLD
Location �u S w r�," �vvv�`- _ Suite _ _ MEC .2-0-v e-y 2��
Contact Person _ _—, Ph G Z si Z'7 C PLM
Contractor Ph SYR
[BUILDING Tenant/Owner ELC
Retaining Wail — -_—" •~, �—T-- ELR
Footing Access __ __
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ----—r_ -d---
Slab SIT
Post&Beam
Ext Sheath/Shear ` �'t.� �•-�r�
Int Sheath/Shear -
Framing -----
Insulation
Drywall N*linq
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _ _—
Roof
Misc.
Final -------------
PASS PART FAIL -- -
PLUMBING
Post& Beam - - -- - --- --
Under Slab
I op Out ----- —j� _
Water Service
Sanitary Sewer —�—
Rain Drains
Final
PASS PART FAIL �-
Gas Line
Dampers
ASS PART FAIL —
MEMRICAL
Service
Rough In ---- ---�—
UG/Slab _
Low Voltage —
Fire Alarm
Final --- - -- - —_ --
PASS PART FAIL
SITE
Backfill/Grading -- - — -
Sanitary Sewer
Storm Drain [ )Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ [Please call for reinspection RE: Unable to inspect no access
Fire supply Line --_.___ _ [ ) P
ADA _
Approach/Sidewalk -
Other Date Inspector �- Ext
Final -
PASS PART FAIL DO 1404 REMOVE this inspection record from the job site.
CITY OF TIGARD MECHANTCAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., Tigard, OF 97223(503)639-4171 PERMIT #. . . . . . . . MEC913002 I
DATE ISSUED. 01/13/"49
r?rS PARCCL : 2SIII.CD.-05500
TTI. ADD
09570 SW PRr-NJTW. nD PL.
'_)UDD I V I Sj I ON. . . . : SUMMERr I ELD NO. ZONING: R-7
. . . . . . . . . . . LOT. . . . . . . . . . . . . ..514 JURISDICTION: TIG
('I.ASO Or WORK. . :ALT FLOOR rURN. . . . : 0 EVAP COOLERS: 0
`7YPE OF USE. . . . SF UNIT HEATERS. . : 0 V17NT FANS. . . . o
r)'1CLJPnNCY r7-,RP. VENTS W/o VENT SYSTEMS: 0
STORIES. . . . . . . . 0 BOILERS/comr,RESSORS HOODS. . . . . . . :
r,UEL TYPES.. 0 3 lip. . . . : 0 DOMES. INCIN: 0
r GAS 3-IS HP. . . . : 0 COMML. INrTN: 0
MAX INPUT: 0 PTIJJ HP
FTRr DAMr.",ERS?, 0 REPAIR UNITS: 0
30 50 HP. . . . : 0 WOODSTOVES. . : 0
OAS PRESSURE. . . 501 HP. . . . : 0 C10 DRYERS. . .
NO. OF UNITS--- AIR HANDLING UNITS OTHER L)NTTS. -
F(_1RN ( 10OV, Bljj. 0 1.0000 cfm. 0 GAri OUTLETS. : v!
BARN BTU: 0 > 10000 efm : 0
r To a?-k S Graham rpenvp gas 119 and rrplace with gas insert
;-IT I P t': —.1.1.-- _ .._1___-___1.1.._..__-- . __.._.___..__._.__ F
'f')HN GRAHAM typp amol.trit by date r^erpt
'7170 SW BRENTWOOD PL. PRMT $ 00 JSD 01/13/9'9 '?9- ;11-1 0
TOPRD OR 5 PC T $ 1.. P91 Jr r) 01 /131199 M1.3- ;121 SO
ione it: E39.-Glue.
)ntrac-tor-:
TCX T)TTCRA
'IF, S 12,STH CT
)RNELTIJS OR 9711 ,31 26. 25 TOTAL.
one 887--3778
........- REQUIRED INSPEC"TIOrli
permit is issued subject to the regulations contained in the Mechanical Ins
rjard Municipal Code, State of Ore. Specialty Codes and all other FirlR] Inspection
rPliCable laws. All work will be done in accordance with
approved plans. This permit will expiry if work is not started
within 180 days of issuance, or if work it suspended for tore
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 452-901-8010 through OAR r,2-0014080. You may
f3h'ain copies of these rules or direct questions to OX by calling
(503)246-9187.
r
TSite' By SL�_
gnat r_rcrye
++++4 4 4 4-4+4 4-4-1-1-++-+4.+4.4-4.+4-+++4.+-4-++++++4 ++4++++44-+•+++-4-++ -4-+++++-h++4.+4-++++4--1-+4+4
f7a 1 1. 6739 4177 by 7:00 p. m. fcrr 4 n,per-f: i ons needed 'the next bi.ts inptss day
4 +-4 4 4 4 4 4 4- s + ++++++4+-4+++++ +4 4-+++4..++++++4...4-4.++4-4.++4.++ I-+4.
CITY OF TIGARD Mechanical Permit Application Plan Check##
PP Reed ec'd —
13126 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type Permit#/k&74 "vat
Incomplete or illegible applications will not be accepted Called
_ �_ _9 _pp P __
FName of Developmem/F,o1ect --- Description —__--
Table 1A Mechanical Code
G R t..11.�r+� Q Price Amt
Job Street Address sunea --" A) Permit Fee 10.00
Address 1 v—
1) Furnace to 100,000 BTU
oldg# cttyistate Zlp '.icludin ducts&vents — 6.00
2) Furnace 100,1300 BTU+
including ducts&vents 7.50
Name(or name of business) 3) Floor Furnace
Owner U C k N 6"^'e,A.4'4' _including vent 6.00
Melling Address 4) Suspended heater,wall heater
or floor mounted heater _ 600
-9.j 713 .SGS /t�� , 5) Vent not included in appliance permit
CRY/State Zip Phone 3.00
7i 6 r,,QQ c'; I3�i_ ��, CHECK ALL —.Boiler Heat Air
Name(or name of business) THAT APPLY. or Pump Cond Qty Price Amt
Com
U
__ •. _
Occupant Mailing Address 100K BT bsorb unit to
A v1 _ 6.00
��� "t'1 7)3-15 HP,absutL unit -
CnY/State Zip j Phone 100k to 500k BTU _ 11 00- - -
8) 15-30 HP,absorb
— ----- unit.5-1 mil BTU 15 00
Contractor N"n'° 9)30-50 HP,absorb
I, , unit 1-1.75 mil BTU _ 2250
Prior to permit Mailing Address _ �.r 10)>50HP,absorb unit —
issuance,a copy �' S _ >1.75 mil BTU _ 37.50
of all licenses CRY/state Zip Phone— - 11)Air handling unit to 10,000 CFM -
are required H C-oR de/_r k /� V y Y N E (' 4 50
expired in COT Oregon Const.Cont.Board Lie.# Exp.Date 12)Air handling unit 10,000 CFM+
database 't t!p 7.50 _
Architect N°rt1° 13)Non-portable evaporate cooler
4.50
or Mailing Address 14)Vent fan connected to a single duct
3.00
15)Ventilation system not included in
Engineer CRY/State — Zip I Phone-- _ appliance permit 4.50
i 16)Hood served by mechanical exhaust
Describe work to be done _ 450
17)Domestic incinerators
New O Repair O Replace with like kind: YesW No ) _ _ 7_50 -
Residential jx Commercial 0 18)Commercial or industrial type Incinerator
30,00
Additional information orr description of work -- 19)Repair units
e it"o u e o 64--s 4o.yov 4.50
20)Wood stove
7 _
4.50
t PL4-eEA W,-r 4 21)Clothes dryer,etc.
_ 4.50 _
Type of fuel: oil O natural gas LPG O electric O 22)Other units —
__ 450
I hereby acknowledge that I have read this application,ihal the Information 5 Gas piping one to four outlets —
given Is correct,that I am the owner or authorized agent of 2.00
the owner,that plans submitted are in compliance with Oregon State laws 24)More than 4-per outlet(each)
50
Signature of Owner/Agent Date
Minimum Permit Fee$25.00 SUBTOTAL
5%SURCHARGE L '
Contact Person Name Phone PLAN REVIEW 25%OF SUBTOTAL
u Q �r Re ulq red for ALL commercial"rmits onl
K 1 k r /C K rz l C' 16 — ---- TOTAL
'State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
1 lmechperm doc rev 07/20/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -
BLIPDate Requested I I`{~ �j _AM t IPM BLp
Location T _ Suite Ec
l -
Contact Person -�S'� - ph S97 -3
Contractor Ph SWR
BUILDING Tenant/Owner _ _ ELC _
Retaining Wall�r ELR
Footing Access: ^�
Foundation t'PS
Fig Drain _
Crawl Drain Inspection Notes. SGN --
Slab SIT
Post&Beam ---- —
Ext Sheath/Shear
Int Sheath/Shear ---
Framing
Insulation
Drywall Nailing
---------------
Firewall - -- -- -- -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: - - -
Finai
BASS PART FAIL - - -- - - -- -- - -----
PLUMBING
Post&Beam
Under Slab
Top Out -
Water Service
Sanitary Sewer - -
Rain Drains
Final _-
PASS 'ART FAIL
po eam --- -- - - - -
Rough In
Gas Line / --
Smoke Dampers
S' P T' FAIL
ICAL - - - -
Service
Rough In - - - - -
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE-
Backfill/Grading EBackfill/Grading - - --- - ------
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ _ required before next inspection Pay at City Hall 13125 ;W fioll lvrt
Catch Basin
Fire Supply Line I ] Please call for reinspection RF _ _ ( ] Unable to ui,pF cl nr a, r<
ADA -1
Approach/Siuewalk
Other Date , lnspector__ � _ — Ext�
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.