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CITYOF T I V A R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: fvicC1999-00420
13125 SW Hall Blvd.,Tigard, OF. 17223 (503) 639-4171 DATE ISSUED: 10/08/1999
PARCEL: 2S1 12CC-1 1600
SITE ADDRESS- 15624 SW 82ND AVE
SUBDIVISION: LANG FREE ESTATES ZONING: R-12
BLOCK: LOT: 048 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STOI•.'IES: BOILERS/COMPRESSORS HOODS:
_ FUEL_TYPES_ _ 0 - 3 HP: DOMES. INCIN:
LPG _ 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP:
FIRE DAMPERS?: 30 -50 HP: REPAIR ES:SOV
GAS PRESSURE: 50+ HP: CLO DRYERS.
FURN < 100K BTU: AIR HANDLING UNITS C
-- OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install gas fir,--place insert end cas piping.
Owner: FEES _
HEIKENS, ROGER F + CINDY L Type By Date Amount Receipt
15624 SW 82ND AVE 5uCT KJP 10/08/19 $4.00 99-318944
TIGARD, OR 97224 PRMT KJP 10/08/19f $50 00 99-318944
Phofie:
Total $54.00
-- --
Contractor:
NW GAS LINES
3607 NE 105TH
PORTLAND, OR 9722.0 REQUIREt7 INSPECTIONS
Gas Line Insp
Phone:503-502.3543 Final Inspection
Reg #:
oRIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
J
Specialty Codes and all other applicable laws. All work will he dont: 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
Utilitv Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain co ' s of these rLIIOs or direst questions to OUNC fey cglling (503)246-9189.
Issue By: Permittee Signature:
Call (503) 639-4175 b� 7:00 P.M. for inspections needed the next bus #s
day /
J
Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd_ o y 1
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type
Permit# A e(- %1`_01q+0
_ Incomplete or illegible applications will not be accepted Called _
Name or Development/Prolert Description
'Fable 1A Mechanical Code Qt Price Amt
Job Street Address Sune11 A) Permit Fee "` 3r(;_ 1600
L c 1) Furnace to 100,000 BTU
Address ��{, ]���/ K- _ including ducts&vents see footnote 1,2 9.65
Bldg* Cd IState Zip2) Furnace 100,000 BTU+
i A 6)p- Cj -12A including ducts&vents _ see footnote 1,2 12.00
Ne(or name of b s`ess) — 3) Floor Furnace
Owner 3 r -► _ including vent see footnote 1,2 _ 9.65
Mailing AlXress 4) Suspended heater,wall heater
or floor mounted heater see footnote 1,2 9.65
y N^e_ 5) Vent not included in ap liance permit 4.75
City/State Zip Phone Check all that apply: 'Boiler Heat Air
For Items 6-10,see or Pump Cond Qty Price Amt
Name(or name or business) - footnotes 1,2 Comp
6)<3HP,absurb unit to
100K BTU 9.65
Occupant Mailing Address 7)3-15 HP;absorb unit
100k to 500k BTU 17.65
Cny/Slate Zip Phone 8)15-30 HP;absorb
unit.5-1 mil BTU _ 24.15
_ 9)30-50 HP;absorb
Contractor Name unit 1-1.75 mil BTU 36.00
61V C� ct` 10)>50HP;absorb unit
Prior to permit Mailing Address >1.75 mil BTU _ _ 60.15
issuance,a copy %v / 11 Air handling unit to 10,000 CFM
of all licenses CnyZip Phone 7.00
State
are required if I y?o�, l 5�'0.-357 -'T-2)A ir handling unit 10,000 C F M+
expired it COT Oregon Const.Cont.Board Uc tY E D to 11.85
database `{,ZI CtGJ 13)Non-portable evaporate cooler
Archite^t Name _ _ 7.00
14)Vent fan connected to a single duct
or Malting Address
15)Ventilation system not included in 4.75
_ appliance permit _ 700
Engineer Cny/State Zip Phone 16)Hood served by mechanical exhaust
7.00
Describe work to be done. 17)Domestic incinerators
12.00
New O Repair O Replace with like kind. Yes O No O 18)Commercial or industrial type incinerator
48.25
Residential Commercial
19)Renoir units
8.40
Additip isl information or description of yvo _7_
,�„ �� J Q 20)Wood stove/gas FP/othe units/clothe dryer/etc l 7.00`
NOTE: For Come mmer/ci�f projects only,Units over 400 lbs require 21)Gas piping one to focr outlets
_ structural gas calcs. See footnote 1 _ 3.75
cr Type of fuel oil 0 natural gas k LPG O electric O 22)More than 4-per outlet(each) 75
Minimt.-n Permit Fee$50.00 SUBTOTAL Q U
I hereby acknowledge that I have read this application,that the information _ 8%SURCHARGE L .
given is correct,that I am the owner or authorized agent of PLAN REV:EW 25%OF SUBTOTAL a
r Required for ALL commercial permits only
the owner,that p .ns submitted are in compliance with Oregon State laws
TOTAL
Sl777
Owner/Agent Date _:A
Other Inspections and Fees
v 1. Inspections outside of normal business hours(mininum charge-two
Contact Person Na ho hours) $50.00 per hour
2. Inspections for which no fee Is specifically Indicated (minimum
charge-half hour) $50.00 per hour
Foonotes for mmerclal projects only:
3. Additional plan review required by changes,additions or revisions to
1 Provide rull schematic of existing and proposed gas line and pressure Plans(minimum charge-one-half hour)$50.00 per hour
2 Provide drawings to scale showing existing and proposed mechanical 'State Contractor Boiler Ce�,tlfication required
units "Re-:Jential A/C requires site plan showing placement of unit
I\mechperm doc rev 7/19/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested —< <f AM _PM BLD _
-_
Location ��G i '=- ?` -'<, Suite MSC �/
Contact Person ��YyL Ph PLM
Contractor ,t Ph SWR _
BUILDING 1-enan wner/ '1LA_ C ►� ELC
Retaining Wall '' ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection NotesSlab SIT'
✓�5� - �1 aJ SIT'
Post& Beam
Ext Sheath/Shear u-1 ��-(7
'-1
Int Sheath/Shear
Framing ------- --- --- -- - --
Insulation
C.ywall Nailing ----
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling --- ------ --- -
Roof
Misc: -
Final
PASS PART FAIL_ - - -
PLUMBING
Post& Beam
Under Slab _—
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PA ART FAIL
CHANICA �)
I'asl Team - ------.. - --- _ -- - ._ ��_--- -- _ ---------- --
aAPART
- - -- --. __---__ - --- ---- -- --- _--
mpars
FAIL
LECTRICA
�- Service
Rough In r
`n UG/Slab -
Low Voltage J
J Fire Alarm _-- - ---..-- -
Final
c�
PASS PART FAIL
LEf
SITE
J Backfill/Grading --- ------ - - -
Sanitary Sewer
Storm Drain I ] Reinspection fee of$—_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspection RIF _ ( ]Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspectors Ext _
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record Irom the job site.