11455 SW 115TH AVENUE-1 Ln
cn
J
a
cn
D
ro
11455 SW 115"' Ave
CITYO F T i GA R® _ MECHANICAL PERMIT
{ PERMIT#: MEC201-00230
DEVELOPMENT SERVICES
DATE ISSUED: 06/22/22001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S134DC-00100
SII E ADDRESS: 11455 SW 115TH 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 W/O APPL. VENT SYSTEMS:
STORIES: _ BOILERSIC_OMPRESS_ORS HOODS:
FUELTYPES _ 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 • 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FLI'RN < 100K BTU: AIR HANDLING UNITSOTHER UNITS:
FURN >=100K BTU: — 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of wood stove
Owner: FEES
GARY,TANJ BOURQUE Type By Date Amount Receipt
11455 SW 115TH PRMT CTR 06/22/20( $72.50 272001000C
TIGARD, OR 97223 5PCT CTR 06/22/20( $5.80 27�001000C
Total $78.30
Phone:
Contractor:
LUDENAN'S FIREPLACE + PATIO
12675 SW BEAVERDAM RD
BEAVErRTON, OR 97005-2129 REQUIRED INSPECTIONS
Woodstove Insp
Phone:646-6409 Final Inspection
Reg #:LIC 51469
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION. Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9140. -?
Issue BY: :�- Permittee Signature:
C,._
Call (503) 639-4175 by 7:00 P.M. for Inspections needed the next business day
Mechanical Permit Application
DatereceivedOz v �Permitno: � ,tJ -pJr�3C,-
City of Tigard Project/appl.no.: I Expire date:
Address: 1311_i SW Hall Blvd,Tigard •o 7223_, �'.
Cuy n/Ti/{arr( ,� Date.issued: Bye t Receipt no.:
Phone: (503) 639-4171 --
Fax: (503) 51181900 I ��' gFVF•iUY� Case file 110.: — Payment type: -
IV
� Iluildingpermitno.:
Land use approval: a —
)<1 &2 fancily dwrlling or accessary ❑,Commercialfindustrlal ❑Multi-family 0 Tenant improvement
U New construction A Addition/alteration/replacement ❑other:__._.1011*Sl FE INFORMATION cclaml:lwfu_
VALVATIOWSCIIEDIUki
Job address: 3,%�) / �ti u Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials.,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
l,ot: Block Subdivision: 'See checklist for important application information and
:'inject mune -- Jurisdiction's tee schedule for residential permit fee.
City/county: i' LLZIP:
,�fL� '
Description and location of work on premises: 44 J-5774r
A, Fm(ee.) t'utal
Est.date of completion/inspection: y Deaalpdoa Res.only Res.oely
Tenant improvement or change of use:
Air h,;,,,di,i�g unit _ CFM
Is existing space heated or conditioned?0 Yes 0 No --•----
tr,:ondmrnung
Is existing space insulated?0 Yes 0 No teriuon existingAC system —_
0111111 ON � 1 ei/compressors
Business name: t_MAN A P., ptAcF wo P�4 no State Wiler permit no.
t D - HP Tons
Address: d,:ut,,Vrcia,,me) rrc._ ^eam�-s/ urtsmo ede ixtorit
City: Q u1 -) fly,
State: . ZIP:Q7C05 T{eatiwmp, <"Tenrcga
Phon%.S,3(o`/(o Fax:N%y6 E-mail: nclud�ngdu%.�vork;entunu= o
CCB no.: � Including du.;!+�rk,'•:ent i°net ❑Yes❑No _ --
_ U J CI = ns
replacr7rcTcicatehestcrs-sus�erT
Cify/metro lie.no.: — _ _ w
all, r floor moun,ed
Name(please priori )I l �_ /( 1�(✓1 1 f} �(.-1 r aIlan_cc other than furnace_-_ BTU/11
Name: X144ZK_ L._t,eOe M/1 of (Millers Hp - - --
Addrrss: j lc}Yy1� �' ti -_ --
_ —� a• omssors HP
enta err rata! ten on:
City: date: ZIP: Appliance vent _
Phone: Fax: .-mail. erex iaust
ITorn,s-,7yjW7 res. tc a air.tat —
hood fire suppression system _—
Name: j Tian t,`, �, c� --___ Exhaust fan with single duct(bath fans)
� _
�. 'x alsl s stem a art From ItCaun
Mailing address' � l~�''0 —tel--�
City: �1 State. LIP n a trots top to outlets)
Trryp.- _LP(
; NG : O—
amc:
il
Phone_'_ Fax: E-mail: 7Uel Piping cac a monal`ve�tVi 'O
1oess p p r. rmw )
Number of outlets
ter listed oegolpment �1
0
_
ss' _ _ Decorative fireplace (�IP
_ State: ZIP: nsett -�y — l .C)!2
_
ion Fax; E-mail: -�t've7peTtetstovi--_—_ C
1�5tTi
App ' sIBt1.�7t.
e Tint)
Permit fee... .................$
V tit IubNctiam weep"cr"l alda,oteaw.rail hairactim fr nwm inf Notice:lois permit application
U MaxtrlC,ud, t"' pP Minimum fee................$
expires if a permit is not obtained plan review(at
Ordit cod nam _ , D�._
g, within ISO days after it tins beef; c
accepted as comp!!re-
rate surcharge(8%) S
-- " -
30 Mm Insa+s4nMnitm: TOTAL .......................$ '
C'rdholdra Ilpiaiure awm —
$77 50 ori v�d rmw d: ran In..num w.p�+.e none 4434617(60"M)
-� 1 "Velm-hf~no IN M.pMjlkYV tiY0~(161W9W#W N"1
97:50 err'r
1 4ldhpnM d/n nr.,w•rp,rw,mY[}rn('M�mmram V TwK.n M',pri�nMRrrlltr
r,wp�drnN ndr I a�7 SO rr npu
'tl�u f.onrnstd adw CMNkatl�in.M,Nrvl M units�)om�PTU
7
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
c/ BUP
Date Requested _—AM PM _ BLD
Location �� �;�- j /S �th /-�'t/'' -_ Suite MlE%.; ���;_ ,_ r ,-
Contact Person � J� `�- '17 5-/ PLM
Contractor Ph SWR
BUILDING -' Tenant/OWnar ELC —
Retaining Wall ELR - -
Footing Access:
Foundation FPS _
Ftg Drain SGN
Crawl Drain Inspection Notes: --
Slab -__- -- __-- - SST _
Post&Beam -�
Ext Sheath/Shear —_
Int Sheath Shear
Framing `.-
Insulation
Drywall Nailing - -__-- -__--- -._ _--, -- -- —
Firewall
Fire Sprinkler ________._-_._..__._.__.
Fire Alarm
Susp'dCeilingRoof
Misc:Misc: ----------
Fins) ~ - -
PASS PART FAIL ------ _.- -. - - - --- --- - .._ ---------- -
PLUMBING
Post 8 BeamUndei Slab
Slab
Top Out
Water Service
Sanitary, Sewer
Rain Drains
Final - _ --
PASS PART FAIL ------ -- - -- ------------ - — -_- ----
MECHAINICAL
Post& Beam - ----_--- ------ - -- -----
Rough In
Gas Line --
S Dampers
nal - - - --. -- - - - -—
�A6;>! PART FAIL
ELECTRICAL - - --- •-- ---•— - —
Service - ----_- --- ----- -- --
Rough In
UG/Slab
Low Voltage
Fire Alarm — ---
Final
PASS PART FAIL
SITE
Backfill/Grading -"'---
Sanitary Sewer
Storm Drain ( J Reinspection fee of$�—required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( J Please call for reinspection RE:- _ -_, _-__ ( J Unable to inspect no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date _ _Inspector Ext _
Final
PASS PART FAIL DO NOT R MOVE this inspection record from the job site.