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10350 SW 71sT Place
�\ CITY OF TIGAR® __ _MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: M -00443
13125 SW Hall Blvd.,Tigard, OR 97'223 (503) 639-4171 DATE ISSUED: 1?//6/016/01
PARCEL: 1 S'I 36AA.-00802.
SITE ADDRESS: 10350 SW 71 ST AVE
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
_ FUEL TYPES _ 0 3 HP: DOMES. iNCIN:
LPGI _ 3 15 HP: COMML. INCIN:
MAX INPUT: BT' 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTO`,/ES:
(•�-� PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: v_AIR HANDLING UNITS OTHER UNITS:
TURN >:=100K BTU: — 10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: installation of gas fireplace and gas line
Owner: _ FEES
REPSF ANDERSON Type By Date Amount Receipt
10350 SW 71 ST AVF/ PRMT OTR 12/6/01 $72.50 2720010000
5PCT CTR 12/6101 $5.80 2720010000
Total $78.30
Phooe: 503-222 1110
Contractor,
WESTERN HEATING + A/C
14314 SW ALIEN BLVD
STE 220 '<EQUIRED INSPECTIONS
BEAVERTON, OR 97005 Gas Line Insp
Phone:648-5808 Mechanical Insp
Reg #:LIC 00076973 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All wirk will be dune in accordance with approved
plans. This permit will expire if work Is not started within 180 da;,s of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adapted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling
ren-119a8-Q 1 air'
/ �� Permittee Signature:\
Issue B �� - /(.Ll/��
I (4A k t"t c:_�—
r Call (503) 639-4175 by 7:00 P.M. for inspections n6Aed the next business day
Mechanical Permit Ap
�- <� Date received: �i i) Permitno.� ��
(City of Tigard ` Project/appl.no.: Expire date:
f Tigard Cir o Ti BAddress: 13125 SW Hall Blvd,Tigard,O 4�3'" —
y Phone: (503) 639-4171 Date issued: IRKI Receiptno.:
Fax: (503)598-1960 Case file no.: Payment type:
Land use apprc val: Building permit now:
)_LI &2 family dwelling or accessory U Commercial/industrial O Multi-family U Tenant improvement
U New construction 'UAdditio,.✓alteration/replacement U t)thcr.
0
Job address: Indicata equipment 4uantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,tabor,overhead.
Tax map/tax lot/account no.: sion: profit.Value$ _
Lot: bdiv
Block: Sui *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit lie.
City/county: y
Description and Vocation of work on premises: t ` t 1 1
•U,s
Est.date of completion inspection: Ikswc��ticrrr qty. Res.only Res.only
Tenant improvement or change of use: �'
Is existing space heated or conditioned?U Yes U No Air handling unit _ CIM
Air conditioning(sue plan required) ___•_ __
Is existing space insulated'?U Yes U No Alteration o existing system _
Boiler/compressors
er/compressors
Stale boiler permit no.:
Business name: 7:v e i" He _--Tons BTU/H
Address: y ,V vFire/smoke amper uct smo adetectors -
City: , t . v State:p,i_ 'Ll P o_ eat pump(�stfi ri ieym-re3j v _
Phone: C. y. Sfv Fax:,S�r_ w7 E-mail: nsta replace urnacc urner /
Including ductwork/vent liner U Yes U No
CCB no.: 7�, 1;_ , Instalrep ac relocate eaters•-suspen lc
City/metro lic.no.:GCM (`/ _ wall,or floor mounted
Name(please print): ,J;,, / �• enc or appliance otter than(furnace
e gerat on:
CONTACT P UR SON Absorption units_ BTU/H
Chillers,_ HP
Name: _Jwc' r1 c'/ a�� - — Com.rcssors__ _ HP
Address: n nmenta ex ust an vent at ons
City: State: ZIP: Appliancevent
Phone: - r I aK E-mail: yerex aunt _
y� On s, ypC res. itc en azmat
v-sem hood fire suppression system
Nance: .st- SGU�n.rJ Exhaust fan with single duct(bath fans) _
Mailing Exhaust system a art rom coon i�r
Ar
State��-. ZIP: _v Fuelpiping adistribution,up to out et-c)
City: _ - -�_.._._ Tyne: __-LPC; _X.- NG __Oil
Phone: I nr E-mail: ue _i m1-ncdiuunal over 4 outlets
roues piping(schematic requ re )
Number of outlets _
Name: terst app once or equipment:
Address: Decorativefite lace
City: i State: ZIP__ nsert-type
Phone: Fax. E-mail -vTelstove _
tR rr:
Applicant's signature: _ Date_ ter.
Name(print): _
d dl)udaatcdau sccep cirdtl cards.phase call jUdAdi iM ror mrae infomutlan. Permit fee e ................$
NNotice:This permit application Minimum fee................$
U Vine U MasterCard
expires if a permit is not obtained Plan review(at ___ %) $
Credo card number: � ---- x re. within ISO days after it has been
v State surcharge(896)....$
----NnrM,or catchmidef in d,ownan credit rte„ ---" $
accepted as complete. •'
TOTAL .......................$
Cudholder denature —�lTm-W 4404617(GROMM)
MECHANICAL PERMIT FEES
COMMERCIAL FEES;
CITY OF TIGARD BUILDING INSPECTION DIVISION MST -
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP
-----Date Requested I, / AM-- PM BLD Loca,ion_ t U � � ./.� Yr""�-- Suite MEC f�'��/ GC:.•' ��'t
Contact Person _ -
Contra:for
' Ph SdVH -
_ ELC
BUILDING Tenant/Owner ELR
Retaining Wall
Footing pInspection
- ..�, 4S - rte �-�' FPS
'F 'n r k
'F'i
Drain SGN _
Drawl Drain Notes: SIT
Slab -— - — —
Post&Beam -
Ext Sheath/Shear
Int Sheath/Shear r;) � L7jn��_ r��, 7�g�-- �C� !?S• '"
Framling
Insulation -----
Drywall Nailing
Firewall —
Fire Sprinkler -- — —
Fire Alarm --
Susp'd Ceiling -
Roof ---
Mise: _.-
Final -
PASS PART FAIL. --r
INGleamlabt
ervice ----
Sanitary Sewer
Rain Drains _--------- --------- —
Final
,al g RT FAIL — __—__�---- -- --�
ECHANIC
Pus $ _am
Rou h In
Smoke Dampe,s — --
i
PASS PART FAIL
ELECTRICAL _
Servire -- --- ----� -- —
Rough In _
UG/Slab ----- - -- -�
Low Voltage -
Fire Alarm ---
Final ---_-�-- —
PASS PART FAIL. -.-•-- - ---�
SME _ — ---— —
Backfill/Grading
Sanitary Sewer required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Storm Drain [ J Reinspection fee of •—
Catch Basin Unable to inspect-no access
1 Line ( j Please call for reinspection RE:
Fire Supply
ADA Ext
ApproachlSldewalk l —
Other _
Date �G� ;� inspector_
Final
PASS PART FAIL Do NOT REMOVE this inspection record from the job site.