11430 SW 121ST AVENUE 3
11430 SW 121st Avenue
CITYOF TIGARD __ AECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002-00023
13125 SW Hall Blvd., Tigard; OR 97223 (503) 639-4171 DATE ISSUED: 1/14/02
SITE ADDRESS: 1 1430 SW 121ST AVE PARCEL: 1 S134CA-01000
SUBDIVISION: BURLWOOD ZONING: R-4.5
BLOCK: LOT: 003 ,JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: -� EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPAN;Y GRP: VENTS W/O APDL: VENT SYSTEMS:
STOWES: _ BOILERS/COMPRESSORS HOODS:
_
FUEL -TYPES 0 - 3 HP: DOMES. INCIN:
17PG 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 • 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + lip: WOODSTOVES.
FURN < 100K BTU: 1 AIR HANDLING-UNITS---- CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: - OTHER UNITS:
> 10000 cfm. GAS OUTLETS:
Remarks: Replace Furnace Located In Garage
Owner: -----._._ _ --- --- -
_ FEES__ _
COMELLA, MARK R + Type By Date amount Receipt
COM11430 S A, 21 STAVE
E I PRM T CTR 1/14/02 $72.50 272002000C
11430 AN 1, ST AVE 5PCT CTR 1/14/02 $5 80 2720020000
PORTLAND,OR 97223
Phone: Total ` $78.30
Contractor:
FAITH HEATING& AIR COND. INC
15167 NW VANCE DRIVE
PORTLAND, OR 97229 _ REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-356-8686 Mechanical Insp
Reg #:LIC 133911 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to -Tig
Issue By: Permittee Signature: — - / /jt�
Call (503 639-4175 by 7:00 P.M. for Inspections needed the next business day
Mechanical Permit Application
WASHINGTON COUNTY nate received: a Z Permit no. E t:t:
Address:155 N. 1st AV,Suite 350-12,Hillsboro,OR 97124 Project/appl.no.: — Expire date:
OREGO Phone: 503-846-3470 Fax: 503-846-3993 Date issued: 9y: Receipt no.:
Internet Address: www.co.washington.or.us Case file no.: Payment type:
Land use approval: Building permit no.:
all' a
&2 family dwelling or accessory H ('ununerciakndustrutl n Multi family I; 'Tenant improvement
fJ New construction r1 Addition'alteration/replacemert P Othrr
Job adiress: 11 y 3 u , 12—lit A Vt Indicate equipment quantities in boxes 5elow. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materia equipment, labor,overhead,
Tax map/tax lot/account no.: 1 134 CA 01 oa t, profit. Value$ 2-170 -
Lot:
170Lot: Block: N/A I Subdivision: _ 'See checklist for important application information and
Project name: Jurisdiction's fee schedule for residenliul permit fee.
_City/county: .w,� , oP ZIP: 172-23
DeseMDesai tion and location of work on premises: _ r' �I
W
rt
Wlaero,0 - --! Fee(ea.l Total
Est. date of ccmpletion/inspection- / /e/q 2 _ Description - Ott. Res.only Res.onlyl
Tenant improvement or change of use: hila
Airhandlingunit (.FM 7.00
Is existing space heated or conditioned"J'Ycs L) No ircaridiiomng(stte an require ) ___ _ 7.00
Is existing space insulated'?VYes No tcrationo existing system____ 7.00
t er compressors
Business
name: HvA�_ 5tateboilcrpermitno.:
r ►`�., n i HP Tons BTIJ/H N/A
Andress: / / 7 .01 W V&+.C. 1)• treys a atnpers uct"smoke defectors
Cit r a. e1 Sten: '_IP: 472.2 eat ump(steplanrequired) 7.00
Phone: 3s6- 8g Fax: [,l-�_qy� E-mv,,l: Install/replace ma umer
CCB no.: 13 t Including ductwork/vent liner 0 Yes o ( 7.00 7'
Instal ace re ocate enters-suspen ed,
City/metro lic. no.:N/A _ wall,orfloor mounted 7.00
Name(please print): r,"s{ , 4,n„ ftA, ent orappliance o er than furnace 1.00
e gerat on:
Absorptionunits--_ BTU/li N/A
Name: bra Ahn.-h a Com a//4 Chillers IIP N/A
Address: // .S w- /213 f Avr Compressors IIP NIA
nvironmenlal rrhauat and�rnlilation:
City: �,�jrs. -_ State:Q,(� ZIP:eit 223__ Applianccvcni 7.00
Phone: jFax: E-mail: Dryerexhaunt ---
s,TypeT111/re e'n�azmat
hood fire suppression system —�_
Name: J*.►,e 4-3 c,.,.*.,rf eej h )
Exhaust fan with single duct(hath fens 7.00
Mailing address: F-xhausts stems art romealtnn�orAC_��
City: State. ZIP; Fuelpiping and str uton(upto to
�- �Tic I.PG NG Til 7.00
Phone: _ ('rev L'-mail: Fuel i`-tnr�--eacTie�i�itonsoTveraoutets
rocesspiping(sc ematicrequtre )
Name: Numbcrofouticts N/
Address: — �— - Other listed appliance or equipment:
_
_-----�-�--- _ - --_
- ittr
ative ndace
City: S,tc: 7IPInsert
tstove pa ctstove Phone: Fax: E-mail-
Applicant's signature: Date tier: `
--
her:
Name(print)yj.�,s-/,._
---- Permit fee _
0 Visa 0 MasterCard Notice:This et application Minimum fee.................S 50.00
cneu urd number expires ija prndirnJt!s not obtained Minimum
Plan review 's�
--- — -----—-- within 180 days after it has been o
�R"smeTo is l&r 1-1-16wn on epi C-$-rT-- accepted as complete. (at 65%)........................$
s State surcharge(8%).....$
-- ;ad !et 61pli ur -- Amount TOTAL.........................S �(
�, 3c)
CITY OF TIGARD [3llV DING INSPECTION DIVISION
24-Hour Inspectior. Line: 63. 175 Business Line: 639-4 MST
BUP
Date Requested _-L AM PM BLD _
Location / 3C' /oZ ! � v-ems Suite _ MEC �G7I u^7JGZ 3
Contsct Person Ph PLM
Contractor.__ Ph 3_s(ca SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing
Foundation Access:
FPS
Ftg Drain
Crawl Drain Inspection Notes. //aa ' --� SGN
Slab
Post& Beam —�— SIT
Ext Sheath/Shear ,
Int Sheath/Shear ---
Framing
Insulation
Drywall Nailing
Firewall -- — —
Fire Sprinkler
Fire Alarm
Si isp'd Ceiling
Roof — — ---
Misc:
Final -
PASS PAR) FAIL
PLUMBING
Post& Beam - ——
Under Slab J
Top Out
Water Service
Sanitary Sewer _
Rain Drains
Final ---
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In ���\ - - - ----
Gas Line
Smoke Dampers
PASS'' PART FAIL
ELECTRICAL -- --
Service
Rough In
UG/Slab
I.ow 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 Hell, 13128 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE: [ )Unable to inspect no access
ADA
Approach/Sidewalk r
Other Date b r Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.