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—' 11380 SW GREENBURG ROAD
CITY OF TIGARD MECHANICAL
DEVELOPMENT SERVICESPERMIT MEC96-0426
13125 SW Hall Blvd., Tigard,OP 97223 (503)639-4171 PERMIT #. . . . . . . :
DATE ISSUED: 12/10/96
PARCEL: IS135CA-01'.200
SITE ADDRESS. . . : 11,38qi SW GREENSURG RD
SUBDIVISION. . . . : ZONING: R-12
BLOCK. . . . . . . . . . : I.-OT. . . . . . . . . . . . . ..
-------------------------------------------------
CI-ASS OF WORK. . :ALT* FLOOR t"'URN. . . . : 0 EYAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY ORP. . :R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . . 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL 0-3 HP. . . . 0 DOMES. INCIN: 0
: /GAS/ 3-15 HP. . . . 0 COMML. INCIN: 0
MAX INPUT 0 BTU 15--30 HP. . . . 0 REP;)IR UNITSt 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : 0
F URN i 11710K BTU: I (= 10000 cfm : 0 GAS OUTLETS.
FURN ) =IIAOK BTU: 0 > 10000 cfhl: rA
Hemav,l.(s : Installing fl.-lir-nace to 100, 000 BTU' s and gas piping
Owner-
F[7 ES
RAYMON MACY type amount by date v-ecpt
11380 SW GREENBURG RD PRMT $ 25. 00 B 12/10/96 96-287507
5PCT $ 1. 25 B 12/ 10/96 96-287507
T'IGARD OR 97�23
11hone #i 968•• 1 '114
oilt t,act nir-:
OWNER
-------------------------------------
Phone $ 26. 25 TOTAL
r7pq #. . : 13125 REQUIRED INSPECTIONr,
This nervit is issued subject to the regulations contained in the Gas Line Insp -------
Tigard Municipal Code, State of are. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This persit will expire if work is not started
within IA days of issuance, or if work is suspended far sort
than IN o3YS.
Psi-mittee S, n&t1JT`e ."( 1,k
Issued By .
Call for inspection 639-4175
Plan Chacktn
CITY OF TIGARD Mechanical Permit Application F .c'd By;� � . ��
13125 SW HALL BLVD. Commercial and Residential Cate Recd % � 'f
TIGARD, OR 97223 Oate to P E.
(1503) ' 39-4171, x304 Date to DGT
Print or Type PE'
Called
_ Incomplete or illegible_ applications will not be accepted _
Name of DevelupmenvPmiect ,tet Description
A-i-1:Lit c , Table 1A Mechanical Code OTv PNCE ANIT
Jot) street Aaaress sunea �A) Permit Fee —` ---III
Address =+ � c' 1 �` � �j4ic' '� .0- -0- 10 00
1 k 7�t E,J
Bid M ''—c tylslate fZip B) Supplemental Permit 300
Name,or name of businessi 1 1 Furnace to 100 000 9TU F)00
Owner I-11i MAIM A) 144 cit-/ i,lcl ducts&vents
nfa ng a tlrosa 1n y1 21 Furnace 100,000 BTU+ 7:7 07
(I lC1 k'tc' rl' K r{ ocl ucts&vents
Gry State Zip Phone 3) Floor Furnace _
.-- 6 OQ
�' incl vent
Name nems of til nese) 4) „1.ispended heater,wall heater 600
or floor mounted heater
Mamng n resp7� S.) Vent not incl.in 3.00
Occupant
1 _ appliance permit
Crtystule zip Phone' 6.) Boiler or comp,heat pump,air tend. 6.00
to 3 HP,absorp unit to 100K BTU
I / 7) Boiler or comp,heat pump.air Gond. 11 00
L Y1 p )L) l c r-t 3-15 HP,absorp unit to 500K BTU
Contractor Mating address 8.) Boder or comp,heat pump,air Gond 15.00
15.30 HP,absorp unit 5-1 and BTU
(Prior toC tyrslme zip Phone 9) Boiler or comp,heat pump.air Gond. 22.50
issuance a copy 30-50 HP;absorp unit 1-1.75 r .I BTU
M all licenses are Orogen Const C0411 Board Lc r Exp.Date^ 10.1 !oiler or comp,litzt pump,air wnd 3750
required if >50 HP,absorp unit 1.75 and BTU
expired in C O T CCT Business i ano�Mew a Exp Dne 1; ) Air handling unit to i 4 50
data base) _ 10,000 CFM_
Architect Name --- 12 1 Air handling unit 7 50
10,000 CTM+
Or Mating ndtlress 13.) Non portable �Y 450
evaporate cc�!dr
Engineer Cnytstale _ rip Phone 14) Veit fan connected _ 3,00
to_a single duct
Descnbe work New O AdIrtion 6 Alteration O Repair O 15) Ventiiabon systemnot 4 50
to be done _Resx,ential O Non-residential O included in appliance permit
Additional Description of work 16) Hood served by mechanical exhaust 450
l T A1 "I/Ill /�._ "N/Al'*1. 17) Domestic incinerators _ 750
Existing use of 18) Commercial or ndustnaltype 3000
bwlding or property
19) Repair units _ 430
Proposed ise of 20) V.00dstove 450
hu,'dfng or property
____ 21) Clothes dryer,etc. _ 4 50 _
Type of fuel-utl O natural gas LPG 7 efectnc O 22) Other units �^ _ 450
I hereby acknowledge that I have read this application,that the 231 Gas piping one to four outlets 200
information givens correct that I am the owner or authenzed agent of
the uwn1r,that plans submitted ark in compliance with O gon 'tate 24) More than 4-per outlet (each) 50
/laws 1
_L Z t. 1 C l 2/t v
Signature o er/Agent ate OTY.SUBTOTAL
//
4
Contact erson Narniii Phone 5%SURCHARGE
PLAN REVIEW 25%OF SUB TOTAL
TOTAL -
i`dst\mechpmt aoc tri.v 7/96) Minimum permit fee is S25+5%surcharge
CITY OF TIGARD BUILDING INSPECTION NOT199
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service N
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing Mech
Plbg.Und/Fir/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: ���.- ----
Date: _ ` L_L��.___ A.M. P.M Entry:_
Address: ---
Tenant: -- - -- Ste:----_ Sl: - — - —
_-
BU P.
Con/Own: __ —___ .-- —._ ML
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector - --- ------ mate:
—APPROVED __—DISAPPROVED/CALL FOR REINS P. CF CO
CITY OF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: P 17/03 00090
DATE i3SUED: 311703
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1 S 135CA-01200
SITE ADDRESS: 11380 SW GREENBURG RD ZONING: R-12
SUBDIVISION:
BLOCK: LOT: — JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME" SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
1 UBISHOWEP.S: SEWER !_INE: ft
WATER CLOSETS: WATER LINE: 200 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair 200'of water service. — ----
FEES
Owner: _ ---- Description Date Amount
MACY, RAYMON 111LUM131 i'Cimil I cr 3/17/03 $101.4C
11380 SW GREENBURG RD rn�1 ti°„ , I., 3/17/03 $8.12
TIGARD, OR 97223 — � ---
Total _ $109.52
Phone
Contractor: _
PREMIER PLUMBING
20 SW 131 ST AVE
BEAVERTON OR 97005 REQUIRED INSPECTIONS
Water Service Insp
Phone : 503-469-4631 Final Inspection
Reg #: 11(' 124547
III %1 34-3 181`13
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
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
fcr more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: t/ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bus ss day
Building Fixtures FOR
Phumhing Permit .� r. lication Received '
I'wmbing
Date/By
Cl.'r Permit No.: CHAI- F Aly L�
1 ;:11 dPlanning A prova Sewer
City Uf
Date/By:: Permit No.:
13125 SW I I ill Blvd Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-41'11 Fax: 503-598-1960 Post-Review Land Use
Datc/13 : Case No.:
Internet: www.ci.tigard.or.us Convect Juris.: see Page 2 for
24-hour Inspection Request: 503-639-4175 Nam./Method. su Iemental Information.
TYPE OF WORK FEE*SCHEDULE(for special information use checklist
New construction _y e_molition Description Qty. Fectca.l rr�tal
Addition/alteration/re lacementOther: New 1-&2-family dwellings
CATEGORY OF CONSTR CT10N Includes 100 ft.for each utIII(Z connection
I &2-Familydwellin Commercial/Industrial
SFR I bath 249.20
__�_ _- SFR 2 bath 350.00
Accessory Building Multi-Family SFR 3 bath _ 399.00
Master Builder M Other: Each additional bath/kitchen _ 45.00
JOB SITE INFORMATION and LOCATION Fires rinklci -sq. fl.: Pae 2
Job site address: Grr Site Utilities
Suite#: Bldg./Apt.#: Catch 11/lea h line/trench
drain 16.60
Dr ell/leach line/trench drain _ 16.60
Project Name: _-- Footing drain no.linear R. _ Pae 2 _
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60 _
Rain drain connector 16.60
Sanitary sewer no. linear R. Pae 2
Subdivision: Lot r.. _ _ Storm sewer no.linear fl. Pge2
Water service(no.linear RZ l" i Page 2
Tax ma / arcel#: Fixture or Item
DESCRIP'T'ION QF WORK Absorption valve 16.60
Backflow prevcnter _ Pae 2
Backwater valve 16.60
-- Clothes washer 16.60
- -- - Dishw..sher 16.60
Drinking fountain 1660
ROPER'1'Y OWNERTEN NNT •- Ejectors/sump 16.60
Name: ; ^- , 5�Q Expansion tank 16.60
Address: )( ?,r� /tc�lwX � ' Fixture/sewer ca 16.60
C /State/Zt�- Q `� Floor drain/floor sink/hub 16.60
lt
Y P'_FkQ -2�------- Garbage disposal _ 16.60
Phone: r' Hose bib 16.60
APPLICA14T ON CT PERSON L Ice maker 16.60
Name: tr ( rr' #V%_ lnterce tor/ rease trap16.60
Address: edical as-value: 5 Page 2
rimer 16.60
City/state/z, Roof drain commercial 16.60 _
Phone Fax /5 Sink/basin/luvato 16.60
E-mail: Tub/shower/shower an 16.60
CONTRACTOR Urinal 16.60
Business Name: Y Water closet 16.60
1 Water heater 16.60 _
Address: Inj Other:
Cit /State/Zi Y
Other:
Phon00V
-� Plumbic Permit Fees*
' 3 Q -
CCB L1C. L Fl nib. Lic.#: Subtotal 5
Minimum Permit Fee$72.50 $
Authrriz �I Residential Backflow Minimum Fee$36.25
Signatu 1� ate:._ l Q 3 Plan Review 25%of Permit Fee 5
h1_LY"l State Surcharge 8%of Permit Fee) 5 i
IT
(Please Illnae) TOTAL PERMIT FEE 5 r
im
Notice: This permit application expi s if a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
11110 days after It has been accepted a%complete. riser diagram for plan review.
*Fee methodology set by 7A.County Building hdusnl,Service Board.
is\Dsts\Permit Forms0mectmitApp.doc 01103
Plumbine Permit Application - City of Tigard
Page 2 - Supplemental Information '
Fee Schedule: Residential Fire Suppressio Sy terns.
Site Utilities Qty. Fee(ea) Total Square Foota e: Permit Fee:
Footing drain-1"100' 55.00 0 to 2,000 _ $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 _ $160.00 _
3,601 to 7,200 $220.00
Sewer- Ist 100' 55.00 7,201 and greater $309.00
Sewer-cacti additional 100' 46.40
Water Service-Ist 100' 55.00 Medical Gas S stCmS'
Water Service-each additional 100' 46.40 Valuation: Permit Fee: f
Storm&Rain train-Ist 100' 55.00 $1.00 to$5 000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Total additional$100.00 or fraction thereof,to and
Fixture or Item Qty. Fee(ea) including$10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 and including$25,000-00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$10 .00 or fraction thereof,to
Inspection of existing plumbing or and includins$50,000.00.
specially requested ins ctions•per hour 72.50 $50,001.00 end up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: r each additional$100.00 or fraction thereof.
r
i
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurate) 'report fixtures could result in increased sewer fees*.
Quantity b FixVuc Work Performed I Comments regarding fixture work:
Fixture Type: Replace
_ New Moved Existing Capped --
Ita tisal I unt _ 9
►.lath -Tub/Shower
Jacuzzi/Whirlpool _
Car Wash -Each Stall - ---- -
-Drive Thru
Cus idor/Watcr Aspirator
Dishwasher •'.'ommerci:d _ __ -• --
-Domestic _
Drinking Fountain
Eye Wash
Floor Drain/sink 2"
.4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage -Domestic - increase of sewer EDI Js,a sewer permit wil' .re issued and
Disposal -Commercial
-industrial fees assessed for the sewer increase mutt be paid before the
Ice Mach./Reffig [rains plumbing permit can be issued.
Oil Separator (las Station
Rec•Vehicle Dump Station -
Shower -Gang
-stall _
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service
Swimming Pool Filter
Washer•Clothes
Water Extractor
Water Closet-Tcilet _
Urinal
Other Fixtures:
i:tDlstsU'ermit FotmslPlmPerrmtAppPg2.doc 01103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST —
BUP
Received Date Re uested___-.3 _ AM_. PM BUP __—
Location _--� � ____ Suite MEC _
Contact Person Ph(_--._) "_ _ PLM
aoo 9D
Contractor Ph(__—_—) oZ� p�� SWR
BUILDING_ Tenant/Owner _ ELC
Footing a 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 "' 'Z�_,� -----«��i'" �/r •'
Post&Beam
Under Slab - --
Rough-In
ervi —
arntary Sewer
Rain Drains -
Cetch Basin/Manhole
Storm Drain
Shower Pan
Oth
Final —
PASSi T FAIL -- - —
*A�-C1`I
Post&Be
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL_
ELECTRICAL
Service - --- --
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 PAPT FAIL
SITE Please call for reinspection RE:_ -- Unet•,e to inspect-no access
Fire Supply Line
ADA r%
Approach/Sidewalk Data. _ EX-1_—
Other:
Final DO NOT REMOVE this Inspetatlo record from the fob she.
PASS PART FAIL