11165 SW 123RD PLACE 11165 SW 123RD PLACE
CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003-00342
DATE ISSUED: 6123/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S134CB-09000
SITE ADDRESS: 11165 SW 12 3RC PL ZONING: R-7
SUBDIVISION: ANTON PARK JURISDICTION: TIG
BLOCK: LOT: 052 4
CLASS OF WORK: — FLOOR FURN- EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WiO APPL: VENT SYSTEMS:
t DRIES: BOILERS/COMPRES`,ORS __ HOODS:
FUEL TYPES 0 3 HP: 1� DOMES. INCIN:
��— 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 50 HP: WOODSTOVES:
GAS PRESSURE. 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS____ OTHER UNITS:
FURN -100K BTU: <= 10000 cfrn: GAS OUTLET`'
> 10000 cfm:
Remarks: Replace A/C unit —i
Owner: — —_. — FEES ^_ —
MISTY MCVICKEK Description Date Amount
11165 SW 123RD �MECIII Permit Fee 6/23/03 $72.50
TIGARD, OR 97223 (TAX]8%StateTax 6/23/03 $5.80
Total $78.30
Phone: --
Contractor:
ROBBE14 = SONS HEATING
2214 SE 8TH AVE
PORTLAND, OR 97214 _ _ REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 233-5841 Final Inspertion
Reg #: LIC 1884
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow ruleb adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699. /
j
,& L Permittee Signature: / 2 Croct"� �
Issued By: _�: ,(<C0[.r �'c c _. ---
Cad (503) 539-4175 by 7:00 P.M. for inspections needed the next business day
Jun 9 03 10: 09a ROBBEN and SONS HF_riTING 503 23E 8849 P a
Mechanical Permit Application
-- - r Datereceived: _ Permitno. �C�p;•002
City Of Tigard ProjecUappl.ne.: Expuedate:
C'iryofTigard Address: 13125 SW Hall B;vd,Tigard,OR 97223 Date issued: By: Receiptno..
Phone: (503) 6394171 —-- -
Fax: (503) 598-1960 Case file no.: 1 Payment type:
La-ad usu appioval: _ - --,_-- Building permit no.:
1
U I &2 family du elling or accessory 11 Contmerciallindustrial U Mulli-fatnily U Tenant improvement
❑New construction iJ Addition/alterntionlre.placemenl LI(Rhee __-_-
IIt1a 11IN11) 1 i 1 10c
]oh address: /, 3 /�� Indicate equipment quantities in boxes Wow. Indicate the dollar
Bldg.no.: Suite no.: — value of all mechanical materials,equipment.labor,overhead.
Tax map/tax lot/account no.: profit.Value$
WL I Block: Subdivision: 'Sec checklist for important application information and
project name: jurisdiction's fee schedule for residential permit fee
City/county %II': 7�d 3 _ I &2 FAMILY 1 t
ULE
Description and local4cincif work/o�n�r�emises: t 1 1 s
�i°e�—a!EL Ct Fee(ra.) Total
Est.r tiocompletion/inspect ion: e _- Description fM . Res.only Res.only
Tenant improvement or change of use: h
Is existing space heated or condit]an gid?O Yes U Nr Air handiiionin ire CFM_�-
A rcon iuontng(site plan reyu re )� /
Is existing space insulated?O Yes D No A.tcration r:exis-gC system
1 1 of er Corr.pmssors
State buiier permit no.:
$ __ v _ --_�
Tons BTU/H
Address: IV 5 _rrJsmokc aNe-detectors
City: - 5tate' ZiD.�1/�! Y eai pump site pian rrgn r )
BTUfH
Phone:SQ - - Fax:Sd3- '� E-mail: nsurhrcplacc urnac wrner_�
Including ductwork/vent liner U Yes O No
CCB no.: / try-le / nits rep ace/felocate. carers-suspen
City/metro lic.no.: _ _ wall,or floor mounted
Name(please print): -'J�- / -- -` Vent ora ance.of er t tan furnace
e eration:
CONTACT PERSON Absnrptinntin its .____ BTU/11
Chillers-_-___�---- HI'
Name: 1_ _ �S�G _ _ -
Address: Com ressnrs—�.__ HP
n ronmenta cTuuat an vents alion:
State: Z[P: — Ap Iiance vent
phone Fax E-mail: ryerex h aust _ _
�res. lc cn azmut
hood fire suppression system -
Name: t L v� Exhaust fsrr with single duct(both fans)
Mailing address: /f/(o� �� _ x aunts etem�romheating r AC'
ue p ng on ut on up to out ets
City` �_ State: ZIP:2 Type: L.Pr3 Nr Oil_
S =,x F, trail:
Phone: 0 �� �ue p to cac a edit ora over out els
wessp p ng(schematicrequirr )
Nurr her of outlets
Name: ter 1W app oce or cqu pment
Addtts_s: _ Decorativeftreplace____
City: state: tove
nicer-type-
plrune; I Fax: E mall: oo tov cts
er.
Applicant's signature: Date:
Name rant):
Hrx eats iu
dl Jurrrdscdurr aeeep eredll earrit,plwe dndkunn for marInr
e rattrotien. J` Permit fee.......... ..........$ —
Notice:This permit application Minimum fee................$
U m&a U MasterCard expires ifs permit is not obtained
credu card numbs: __-_ ,�_.�_ plan review(at __ 96) $
-- -�-- within 180 days a(ler it has been State surcharge(896)....$
-- sore afow&dlder w s n ms c hrasl4 carteaccepted as complete.
s TOTAL .......................$ .,._ .._
C*dftwder we _�Aman 410-4617(eaoscr M
Jun 19 03 lO: 09a RODBEN and SONS HEATING 503 238 8849
P. 3
Robben & Sons
Site Plan
Prepared by: MO Date: 7
Customer Name: O pu s Address- l I65 5W 10'2,3oot �L
c1rr� op- 97223
Customer Prlon��• s7-��>`r�����7�� � - �
Property Boundary Line
W
f �
kA 1 follse
i
I
Street I r r�
CITY OF TIIGARD :4-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECT+ON DIVISION Lousiness Line: (503) 639-4171
BUN _—
ReceivE,d ll - Date Requested — L—_ AM__ PM—__..___._ B
Location _�1. 1 ! �_ 1 ��7 ---Suite -3
o�3 ,�-s
Contact Person -- ---- ��� Ph(--) PLM —
Contractor_ _. .- _ Ph( ) — SWR
C N �
BUILDING Tenant/Owner _ �`�-�-"t� ELC _
Footing _ - _ ELC _
Foundation9 \nAccess: Y
V V \n �—�
Ft Drain �� ,' ELR
Crawl Drain ------ --
Slab Inspection Notes: SIT —
Post&Beam
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
PLU_ M_BING_— ——
Post& Beam
Under Slab ------— — --
Rough-In
Water Service - - - - -
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Sturm Drain
Shower Pan
Other --
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough-In --
Gas Line VY'�
Smoke Dampers -- ---
T FAIL --—— --------- -—_
Service --
Rough-In
lt
Low Vo
Low Voltage
Fire Alarm
Final
PART Roinspoctior'de of$ required before next inspection. Pay at City Hell, 13125 SW Hell Blvd.
SITE Please cal;for reinspection RE: Unable to Inspect-no access
Fire Supply Line ADA /
Approach/Sidewalk �� Inspector Fact
Other:
Final DO NOT REMOVE this Inspection recond from the fob site.
PASS PART FAIL