12765 SW KATHERINE STREET r
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12765 SW KATHERINE STREET
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/ (VITY OF TIGAR® _—_MECHA.T�ICAI PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00230
1J125 6W Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/6/03
PARCEL: 2S 104AA-0730('
SITE. ADDRESS: 12765 SW KATHERINE ST
S"BDIVIS:ON: BELLWOOD NO. 2 70NING: R-4.5
BLOCK: LOT: 112 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR F JRN: EVAP COOLERS:
TYPE OF USE: SF UNII HEATERS- VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS_/C_OMPRESSORt- _ HOODS:
FUEL TYPES 0 - 3 HP_�T DOMES. INCIN.
LPG _ 3 15 HP: COMML. INCIN:
MAX 'NPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: .30 • 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FU RN < 100K BTU: 1 _ AIR 111_ANDLING UNITS OTHER UNITS:
FI IRN >=100K BTU: <= 10000 I,fm -�-_.
> 10000 cfm
GAS OUTLETS:
Remarks: Ilg)lacc gas I".unace.
Owner. _ _ _ FEES
KARL GUSTAFSON Description Date Amount
12765 SW KATHERII JE ST ITA X H"!
MaH 05 03 01 : 54p Spee: a l r.y IIc ar,t n� 503 598 071V p ,
Mechanical Permit A►pp icatilon
Date received:
cwt or Tigard Project/appl.n�o• �e EPextptir_ie
.. -
date: _
Cfryof?igard Address: 13125 SW Hall Blvd,Tigard,OR 07223 pate issued: 13y:0. Receipt ,o..
Phonet. (503) 639-4171 _ -
Fax: (503)598-1960 Case file no.: payment type;
Land use a rOVal: Building permit no.:
(�1&2 family dwelling or accessory U Coam etc iAhadustrial U Mulu.-J'uttily U Tf:nant imrrovarnent
0 New construction )d*Addition/sitemUon/replacement 0 OtheL.. __ .
j=L1;&W_0NF011MAT10N
Job address_ 'I 1kS- Indicate equipment quantities in boxes below.Indus te.the dollar
Bldg.no.: Suite no.: vah.e of all r echanical materials,equipment,labor. )veoiead,
Tax mai,/tax lotiaccount r.o. profit.Value$
Lot: 0luck:i Subdivision: _ *See checklist for important application information and
Pro)eet name: -dipIrfL1A Cy_✓t/ - _ Ju-4sdiction's fee schedule for n: i l n!iol srnt fee
—----•-�/county--�'f�r-- ----ZIP- �--• • . _ 7hatidling
D>-sc-ption and Iotatiost of worn.on peemises: e2j: LFtti(re) ToldEst.date of completion/inspection: .� 0.3 11en7i on ly. Ra.only Res.only
"icnant impmvenient or change of use: nit _ CFM
Is existing space heated or cenditioned`�.a`1 Yrs l]No condition n(situp ancequ e )
Is existing space Insulated'r Yea ❑No W
A—lreration otexts ng HVAL s
CAL 1 1 ut u/contpteasors
Business nartm,— State boiler permit nu.:
` Of �� �' N Hl' runs BTU/H
Addttiss:f_ fqjy0 f9Q rt�0 Direlsruoke ampery act smoke detectors
City: State; ZIP_ Z/.13 eatpum stie plan aro - — -
Phone: �^3GD Fax: if Email: ns rcp.sc s ac urner iT I
Includi
CCb no.: —- rg d actwork/vNo
cnt line Yes d
�+♦PS7 naf��ep^Tocelin n�•rte rarere W werrcn e .
09/metro lic.nu.: ��� wall,or flora mounted
Name(please print): U/"/11 o9 %.�f1>Tp..! �- - ent for a fT�ncc ober an tLrnacc
/ 1011 M101 j 110
I e t gPrntlon:
P.bsotptiuu units
Name: !y �k'//y/l��P/ Chillers_-- — HP
Address: AO,, U_ex,—# C7I¢-D __ Cou tessnrs ,�=--_ HP
vtmnmrnta a ttsl tW� talons
City: //j_ StaGe ZIP: ' ?- i Ap li�anecvent
Thune:&,q&3(0) Fax:(r�/-07Q3 Email: _Uryerc&ttaur- —
oo s y e I/ sea. to en/hazmat
hood fire supprr.snlvu system _
Name: +�(/ Exhaust fan with single duct(bath fans)
_
Mall(rig dress:, ids sT,� �� lair,:system apartlronrTie t it or AC
City__ -.__. _ State: LIP; fire hRnp;an`3 JE1,r 6uaon up to outlets)
Type__,_LPG NO Oil _
Phan(--5._U <L F lx: J', mail. fuel i ing eachaaaition ova outlets
ergs piping schematic requ )
Nantc`_._ 01berste outlets
erpceoregidp
Addttiae: Decotativefire laic:
Cd • `'Ztc: ZIP: nseri•-type
Phone: E-mail. -- W10- vtov• e s ov -
Apptican's signature. Datev 03 OfFiF
Na WI judedicdom srecgg mcdir cards.rdeue call iwildclion fa►Maid k4bnastioa. Notice: This permit application Permit fee
O Visa 0 mutcrCard Knimum fee................$ __
Credit ca!numnm __ ._ _ expires if a permit is not obtained Plnn review teat _ %) $ _
within 180 days after it has been
State surcharge(8%)....$ ,
a,eannlhaldet u abown on credit tax— accepted nes complete. —
s TOTAL. ... ...................$
,.�nl-hn
- 4aaA617(609COM)
CITY OF TIG ARD 24-Hour
BUILDING Inspection Line: (503)639-4115 I
MST -------------__.._-....- _.
IN`'PECTION DIVISION Business Line: (503)639-41:'1
BUP _
Received __Date Requested �_ AM—_ PM_ ___ ___ BLIP
r y _
Location quite— _ ____ MEC �5
Contact Person —__ Ph 3(o C� ._ PLM
Contractor _ _—_—____ __ Ph(—) __ SWR
BUILDING TenanVOwnel - ELC
Footing ELC
Foundation Access'
Fig Drain ( � L ELR
Crawl DrainSlab Inspection Inspection Notes: SIT
'I Post&Beam
Shear Anchors I
Ext Sheath/Shear _
Int Sheath/Shear
ramin
Insulation
Drywall Nailing - ---- ---
Firewall
Fire Sprinkler
Ore Alarm
Susp'd Ceil;ng - -
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
MECH INICAL �!
Post&Beam —.—. --------------- -__._ —
Rough-In
Gas Line
Smoke Dampers
i
AS PART i=AIL --.-- --—------ - - - -
CTRICAL
Service --
Rough-In --
UG/Slab
Low Voltage
Fire Alarm -
Final Reinspection fee of$—____ required before next inspection. pay at City Hall, 13125 SW Fall Blvd.
PASS PART FAIL
SITE [] Please cull for reinspection RE: .. _ Unable to inspect-no access
Fire Supply Line At) jADA Deto y 3
Inspector f —-- — ut--
Appraach/Sidewalk -
Other-
Final DO NOT REMOVE this Ir:dpectlon record from the job site.
PASS PART FAIL