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15100 SW 109'x' Avenue
CITY OF T GA R D _ MECHANICAL PERMIT
GEVELOPMENT SERVICES PERMIT#: MEC2001-00469
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/21/01
SITE ADDRESS: ;100 SW 109TH AVE PARCEL: 2S'11ODA-00400
SUBDIVISION: WILLOW BROOK FARM ZONING: R-3.5
BLOCK: LOT: 006 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:
STORIES: —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 UNITS:
GAS PRESSURE: 50 + Hp. WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: OTH;::R UNITS:
> 1000n cfrl: GAS OUTLETS: i
Remarks: Install decoratirr- fireplace and 1 outlet voth piping.
Owner: FEES - ----
MARGt DAVENPORT Type By Date Amount Receipt
15100 SW 109TH
TIGARD, OR 9722.1 PRMT CTR 12/21/01 $72.50 2720010000
5PCT CTR 12/21/01 $5.80 272001000C
Phone:503-639-5637 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE + PATIO
1375 SW BEAVERDAM RC)
BEAVERTON, OR 97005-2129 REQUIRED INSPECTION_S__
Gas Line Insp INSPECTIONS .-----
Phone:646-6409 Mechanical Insp
Reg #: L.IC 51469 Final Inspection
This permit is issued subject to the regLIiations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicabl s 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
Issue By: permittee Signature:
(:all (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
06 22 2001 14- 43 FAX 5036847297 C1t;- of Tigard
C,?j 0 0n
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�A\ Mechanical lPPermhApp
lic�'"
�� Datemceiwed:i, Ii ) Pcrmnna:i
City Of Tigard � --- - - -
Ardtess: 13123SWHalIHly i� Projai:Vappl.no.: Expircdasc.
C ify of TI g, r,t Beard.OR 97223 —
Pt tme: (:503)639-4171 Date issued: BY:. � Kept no.:
F:,ic: (503) 598-1960 � 'VY . II ►Lv G:e ao PaymentrYpe:
11 _
Land use approval: pY�'� Building ptrnirno.:
_4
U 1 &^farrul y dwelling or acccssury ❑Cummeicial/indastrial O Multi fancily O Tenant irupntmmcnt
O New construction ❑Add iuon/altetauon/mplacernent U Other-
41.10 19
Job address: �cr S� �7: Indicate equipment crit uanA les in bo>;e.s below I: -
f3lr' -no. �----_�._._- _- 1 pm 4 rdicatr.the dollar
3 Suite no.: value of all mcchwikal runt^r, s.equipment,labor.ovcrfir-&j.
I . malrhait lot/accountno.• profit-Valuc S
LotTRIS Subdivision: *See checklist for impotent application tnformatinn and
Protect name: ,", —w jurisdiction's fee schedule for rpsidpnital permit fee
Ci /county: / .7
Description and location of work on pmmiscs:
Fst.bate of crm leuoofins —"- !rFe-e(e&) Total
F pectitm: / � )' �, / DexA I" Res.oaly
Tenant improvement or change of use: �vAC:
Is crusting space heated or conditioned"O Yes O No Air handling unit —
IS existing apace insulated')O Yes Cl No AlicoMl—Tt onln(site Dlan -
Alteration0fC1111tinglIVACqUern
oilewcomptessors
Ettsineaa AatAC a State boiler JsertnIt no.:rum
Addtcss:/.,W(,,,'S" ,-c; '
Pit eJsm0 Hampers/ WISn10 dewtors�
Ci r, fi State:n/C ZIP: 9 7c ta(ptr.erp(stre�in-te'qutrr i— --- --
►� Fu• ' E-MAil: tuul tece -ac tuner__
CCB no.: i�/Y/�y "f
` including ductwowven:liner O Yea O No
`fid lnits Iv ey a r>:ocarr aatxx-suype —
Ctty/mUcO BC.00.: s wall;Ap
of flour mounted
Name�pieise ): err app avec n a t to furnarc — -rjtuon units BTU/1fName: i r, rs HP
Addttes: ; c�Ct • rr sora 1{F
rA7 irate: gyp; wre�tal.wtusoncevettt
Pbone: Fa>L F real: e�auat-- ------ - --
s"t yype�rl nToir+e sonar--- --+-
brtari the sapptesston system
I Nagle: 7- i Byht ust toil vtth rngl, duct(bxu.:acn) - --�—
Mailinaddress• -� , ". Inirfiiniu tem m a orA
A""�
1`1111111119 11111111 or too m 4 outletsr
T L.PG � NC - Oil
C�fnail: ve piping each atom,over 4 wt cis�'
rvcasnFWtsc ernanctequtredt
Name: Number of outlets
Addrens: er sM app nor ttnpwe'
------ Decoraurefireplur ",
Ci irate' ZIP: nsert- _
Phone: F Email: to iit0114i-- -
Applicant's Signature- ,%;. pace: i�- �, / —
Name tier):
tots d*Oda m acgrt adt c nb.pi...w Jr.wsv dYmarstl Ptrtmit fee .-------------_..S
0 Vtsa t]MasterCard I Noda:iltis pnemit appiicaar on
Cndlt C"e..W -\�_t �� �I rtrpites tri Minimum fee.. .............f - 7, ,2
—�/ permit;s not obtained
'- witltm 190 days atleT it has beets Plan review(at
-- `T� •• s ,uar{xr t st(I"v U Staste s'mtr hur(8%)....fAmnow
Via-- TOTAL.......................$
--— iaw«rt ttarodoo�q
4�
CITY OF VGARD 2.4-Hour
BUILDING Inspection Line: (593)6394'175
MST
INSPECTION DIVISION Business Line: (503) 639-417,
BUP _--
ReceivedDate Requested � AM__--_ PM _ ___ 13UP —.
Location IS-100 _/0 y P_ Suite_---_-- ------- MEG
(a /L
Contact Person _. ----- Ph( ) q4e 6e �� PLM ..-_-_--_--
Contractor-- __ Ph (--) SWR
BUILDING – Tenant/0& . 9�0�1 4 — 6 3 Ei r.
Footing ELC
Founeation Access: -
Fig Drain ELR
Crawi Drain
Slab Inspection Notes: SIT —_—
Post&Bearn ----- — _—_ -
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 _
Post& Beam
Under Slab
Rough-In
Water Service - -
Sanitary Sewer
Rain Drains ---
Catch Basin/Manhole
Storm Drain ---
Shower Pen
Other: — - -- -- ------ - --
Final _ -..--
PASS PART FAIL ----- ------- ------ -- --------
ECHANICA
Post& Beam
Rough-In --— - -------- -- - �_-. ----- —----
lRe- Dampers ------------..---------- - - -
n,
APART FAIL -- - -- - -- -------.__-_-__ ._
ELECTRICAL
Service – --- -- -- -- ------------------ --.__-- ----
Rough-In - — ---__ _ --- ------- --
UG/Slab
LowVoltage ___-- ----_-_ ._-_T--- -- —.-_--__- __------..-__---
Fire Alarm
Final Re;nspection fee of$ -_.- _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS _PART FAIL
31TE- _ _ [-] Please call for reinspection RE:_.__--__.-.__ ❑ Unable to inspect-ro access
Fire Supply Line -
ADA
Approach/Si iewalk Date-/ _ __. Inspector E�tt -----
Other:
Final — - DO NOT REMOVE this Inspectiofn record from the job site.
L PASS PART FAIL