12532 SW 123RD AVENUE` rz
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
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Date Requested: `� _ AM. P,M, MST: _
Location: . l'u ^� ! — BUY:_
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Tenant:--_ _ Suite: ,Bldg: MEC:
ContractorVX �t. _Phone 5��.��" 7•� PLM: _
Owner: 1 Phone: ELC:
ELR:
SIT:
BUILDING BLDG(cor,'t) PLUMBING I�QH?I_ L�P.L ELECTRICAL SITE
Site Post/Beam Post/Bcarn PosLlBeamCc ver/Service Sewer/Storm
Footing Roof UndFl/Slab Rough- _ 1 , ' I C;eiling Water Line
Ch
Slab Framing Top u ras r Q)-�" Rough-In UG Sprinkler
Foundation Insulation Sewer )uct Recomiect Vault
Bsmt Damp Drywall Sion?) Furnace Temp Service MISC.
Masonry Ceiling Rain I hain A/C UG Slrb
Shear/sbenar Fire Spklr/Ahn Crawl/Found Dr I lent Dmie Low Volt
Approved Approved pproved" A,mroved Approved
Appr/Sdwlk Not Approved Not Approved of pproved Not Approved Not Approved
FINAL, FINAL FINAL FINAL FINAL
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,a 1 rot reinspection O Reinslxxtion fee o,S re III red t e'nre next inspection r]Unable to inspect
pector: Late: _ ___ Page__or
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171 1
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Date Requested: 6 L—�=v / _ A.M. —` P.M. MST:
Location: � � cJl_ C .� --- BUR ---
Tenant:- �� .�/,, Saite: Bld _ _ MEC:
Contractor: - ,/�—"" f ��•[ ,��?-Phone: �_ g -- PLM:
Owner: _Phone: 4� -` EI.C:—
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SIT:
BUILDING BLDG(coni) PLUMBING MFCH WAYELECTRICAL SITE
Site Post/Bearn Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFUSlah Rough-In Ceiling Water Line
Slab Frarning Tt p Out Gas Line Rough-In IJG Sprinkler
Foundation Insulation Sewer Ikwd/1)uct ' Reconnect Vault
13smt Damp Drywall Storni Furnace Temp Service Misc.
Masonry Ceiling Rain Thain A/C iJG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found IN I feat Pmnp I,ow Volt _
Approved Approved Approved Approval Approved--
Appr/Sdwlk Not Approved Not Approval Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
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O Call for reinspection D Reinspection fee of S rel rired ire next inspection D I Jnable to inspect
Inspector: — Date: 16 367 C Page_--of
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-11our Inspection Linc: 639-4175 Business Phone: 639-4171
Date Requested: `� ` -;-1 1 D _ A.M. i'.M. MST:
Location: 1 ��� ��� 1 ?f a'j h BUR q
Tenant:` I ^_ Suite: Bldg: MEC: / L�
Contractor: _ Phone_ i�Ir _ PLM: _
Owner:A,cr✓ Phone _.
ELC:
ELR:
SIT: _
BUILDING BLDG(con't) PLUMBING [CAl, �iELECTRICAL SITE
Site Post/Bemn Post/Beam Post/B �+(� Cover/Service Sewer/Storm
Footing Roof UndFl/Slabqa ,
- S pr Ceiling Water Linc
Slab Framing Top out Ge Rough-In UGSprinklcr
Foundation Insulation Sewer Hood/Duct 11V� Reconnect Vault
Bsmt Damp Drywall Stonn Furnace 'Temp Servicc MISC.
Masorry Ceiling Rain Thain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Ptunp I,ow Volt
Approver Approvedp r Approved Approved
Appr/Sdwlk Not Approved Not Approved Not A proved Not Anproved Not Approved
FINAL FINAL iL F(` FINAL
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reinspection O Reinspection fee or S ____r uired before next inspection 0 Unable to inspect
spcx tor. —� _ Date 1.2.c / -- – Page of
CITY OF T MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd.,Tigard,OR 97223 503 639.4171 PERMIT r#. . . . . . . : MEC97--0415
( ) DATE ISSUED: 10/24/97
PARCEL: 2S 103131'-07300
S1T1:_ ADDRESS. . . : 12532 SW I'L'?1RD AVE
SUBDIVISION. . . . : LANE TERRACE ZONING: R--4. 5
;31_OCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .41Q11 JURISDICTION: TIG
CLASS OF WORK. . :fAL.T F_OOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . -SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :R3 VENTS; W/O APPL-: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL_ TYPES' - ___.._.___...... 0-3 HF'. . . . : alDC'IhES,. I IVC I ISI: 0
:GAS 3--15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT. 0 BTU 15--30 HP. . . . 0 REPAIR UNITS: 0
FIRE DAMPERS". . : 30--50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . .. : 50i HP. . . . : 0 CLO DRYER ). 0
NO. Or UN I T a ______.____ AIR HANDLING UNITS OTHER UNITS, : 0
FURN ( 1001" 13TU: 0 f- 1O000 cfm : 0 GAS OUTLETS. : 1
FURN > =1O0K FTU: 0 > 10000 cfm : 0
Remarks : Whitworth, Run gas line.
Owner: --._____._-_ _.-.__.___._..____....__.._._____... ______.______._.-.____-- FEES
PERrY WHITWORTH type amoi.rnt by ante recpt
12532 SW 123RD AVE. PRMT $ 2:5. 00 ,.TSD 10/24/97 97-300370
TTGARD OR 97x 3 S;PCT $ 1. 1-25 JSD 10/24/97 97--30037n
Pflone #:
OWNER
26. E5 TOTAL
Phone #:
Re g #. 99'3999
REQUIRED I NGPELT I ONS
'hit permit is -issued subject to the regulations contained in the Gas Lina Insp
'igard Municipal Code, State of Ore. Specialty Codes and alp other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if worN is .mot started
+ithin 180 days of issuance, or if work is suspended for more
`han 180 days. ATTENTION; Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules ate �!
-et forth in OAR 952-001-0010 through OAR 952-001-0080. You may
,btain copies of these rules or direct questions to OUNC by calling
- '503?246-9187,
' s s r.l f• B y » ���--'� _. ____ __._._.._... Permittee a i g n a t l.r r�
_ _
F++4-++++•+++++4-+•++++++++-1-++-F�+++-F+++++++•+++++++-+++++++++++++-F• ++++++4-+++++.-F++4++
Call G39--4175 by 7.00 1). m. far inspections needed the next bv.(siness day
++4 #+-1-++4++-++++4....................M++++++++++4...............4........4-+++1-+4++ i
I
Plan Check# _,_
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
Date to P.E.
TIGARD, OR 97223 Date to DST
(503) 639-4171, x304 Permit#441c 77-7>-O(1i
Print or Type Called iia T<
Incomplete or illegible applications will not be accepted
Name of DevelopmentlProlect Description
�T 3� I ..L�_ Table 1A Mechanical Code On PRICE AMT
Job Street Address +� Suiteu A) Permit Fee -0- -0- 10.00
Address It
Bldg# CityrState zip 1.) Furnace to 100,000 BTU 6.00
including ducts&vents
Name(or name of business) 2.) Furnace 100,000 BTU+ 7.50
- including ducts&rents
Owner --
Mailing Addre --- 5.) Floor Furnace 6.00
including vent
6.00
CityrState Zip Phone 4.) Suspended heater,wall heater
or floor mounted heater
Name for name of business) �.) Vent not includeEin ppliance pemlit 3.00
A aoJ�OCCU ant Meiling Address 6.) Boiler or comp, ump,air cond. 6.00
P to 3 HP;absorb 100K BUT"
CityrState zip Phone 7.) Boiler or comp,heat pump,air Gond. 11.00
3-15 HP;absorb unit to SOUK BTU"
Contractor Na r' 6.) Boiler3H comp,heat pump,air Bond. 15.00 -
15-30 HP;absorb unit.5-1 mil BTU"
Prior to permit Mailing Address b 9.) Boiler or comp•heat pump,air cond. 22.50
30-50 HP;absorb unit 1-1.75rnil BTU"
issuance,a copy Zip Ph 10.) Boiler or comp,heat pump,air cond. 37.50
of all licenses Crtyrs ate
are reouired H >50 HP;absorb unit 1.7ided
expired in COT
Oregon Const.Cont Board Lic.p Exp Date 11.) Air handling unit to 10,004.50
database L -- 4,50
Architect Name 13.) Non-portable evaporate
or
Malllm�Address 14.) Veit fan connect.-rr to act 3.00
C tyrState 'I=Phone 15.) Ventilation system not i 4.50
Engineer appliance permit
PP
Describe work New O Addition O Alteration O Repair O
16.) Hood served by mechaust 4.SU
to be done Residential r Non-residential O _ - 7.50Additional Description of work. 17.) Domestic incinerators16.) or industria30.00Incinerator ---Existing use i ' 19) Repair units4..50building or property ---- 4,B020.) Wood stovei
Proposed use of
21.) Clothes dryer,etc. q5O
building or property -
22.) Other units
� Type of fuel-oil O natural gas I.PG O electric O
23) Gas piping one to four outlets
I hereby acknowledge that I have read this application,that the^� 24) More than 4 per outlets(each) -
5U
information given is correct,that I am the owner or authorized agent of QTY.SUBTOTAL
the owner,that plans submitted are in compliance with Oregon Slate
F- laws. -
Signatu►l Qf OwnerlAgent Date 'SUBTOTAL 7('
J\
'
5%SURCHARGE
w f_ , a ILA Ai
JPhone PLAN REVIEW 25°%OF SUBTOTAL
Ant Pers Name
TOTAL � `r
i Vnechpmt doc (rev 9 Minimum permit fee is$25+5%surcharge
-Residential A/C requires s0te plan showing placement of unit.