9420 SW LAKESIDE DRIVE 60
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9420 SW LAk FSIDE DR
CITYOF T 1 G R D — MECHANICAL PERMET
DEVELOPMENT SERVICES PERMIT #: MEC2004-00137
13125 SW Hall Blvd., 1 igard, OR 97223 (503) 639-4171 DATE ISSUED: 3/23/04
PARCEL: 2S-I 11 D13-12700
SITE ADDRE.06: 05420 SW LAKE SIDE DR
SUBDIVISION, SUMrAERFIELD Nn.12 ZONING: R-7
BLO!.K: LOT:678 JURISDICTION: TIG
CLAFS OF 1"10RK: PLT FLOOR FURN: EVAP COOLErS:
TYPE CIF USE: ;F UNIT HEATERS: VENT 1 ANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
S i t7RIES: BOILERS/COMPRESSORS HOCDS:
FUEL TYPES 0 - 3 HP: �! DOMES. INCIN:
3 - 15 IP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPER'?: 30 - fit, HP: WOODSTOVES:
GAS PRESSURE: 50 + HP- CIA DRYERS:
FUf I'1 < 100K BTU: _ AIR_ HANDLING llNil_rS _ OTHER UNITS-
FURN >=100K BTU: <= 'I 6OU0 cfin: GAS OUTLET S:
> 10000 cfm:
Remarks: Replace gas furnace
Owner: — --��_._ _—_------------- FEES _ --__----
BURGESS, MARY B TRUSTEE Description Date Amount
9420 SW LAKESIDE OR iMr.c'lIJ Permit I ee 3/23/04 $72.50
1'IGARD, OR 97224 ITAXJ H"r..State Surchaq 3/23/04 $5.80
Phone: qtr?-000)629 Total $78.30—
Ccntractor:
COLW/1BIA HEATING+ COOLING INC
F.O. BOX 230397
8900 SW BURNHAM#E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223 -- ---------------
Gas Line Insp
Phone: 503-624-2704 Mechanical Insp
Reg#: LIC 7635'
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ong.
Specialty Codes and all other applicable !aws. All work wili be done in accordance with approved
plans. This permit will expire if work is riot started within 180 days of issuance, or if work is suspendeJ
for more t;ian 180 days. ATTENTION: Oregon law requires you to fallow rules adopted in the Oregon
utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-00! -0100. You may obtain copies of these rules or direct questions to OUNC- ny calling
(503)240-6699.
issued B Permittee Signature: s . :_ eeT c
Call 1503] 639-4175 by 7:00 P.M. for inspections needed the next business day
Mar 2P 04 10: 5'- PRM DA:_BY 503-598-0270 F,
Nlochanical hl
Permit Application
Recefvad cci cu'
D. J Permit
R EC H VE� Planning Approval — Building
City of Tigard Date/By: Permit No
13 12 5 S%V Hall Blvd. Plan Review Other
Tigard, Oregon 9'223 MAR 1004 Date/By' Permit Nc
Pnone 503.6394171 Fax. 503.598.1960 Post-Review Land Uzi
Date/By; case No. _
intemet. www.e:,,;gard•or.us CITY OFI Aif Contact Juris.' See Page 2 or
24-hour Inspection Request: I§QQLWAI Name/h1• -od: _ �t ;r enol,oforniat,00.
�- TiPE OF WORK ;:r;;COl1'1%!ERCIAL}�FBE"'iSC.HEDUL.E.=USE.CHECKLIST
New constructionDemolition Mechanical permit fees'are based on the total value of the wor
�w heplak
ddition/alteratir.n �ement Other: performed. 1nf,lcatt.the value(rounded-o the nearest dollar)of all
CATEGORY OF CONSTI'.MIUN ..t'. I mechanicar materials,equipment, labor,overhead and profit.
IrfUl & 2-Family dwelling C_onimercial/Irldustrlal Value; S See Page 2(or Fee Schedule
Accessory Buildin Multi-Famil - RESDiMn SASTEMStF.EE•`SC&EDUL:E
Master Builder Other: Description �N�-F'eeTotal
Heath Coolin
JOB SITE INFORMATION and LOCATION Furnace_add-on air conditionin " 14.00 _
Job site address: _ Oas heat um _ 14.00
Suite a: BI _./A t. Duct work 14 or
Project Nar _ H dronic hot waters stem 14.00
Residential
Cross srreeu. tions to job site: iaboiler
radiator
for iator or h dronic system) 14,00
Unit heaters(fuel,not el,�crric)
in gall in-duct suspended,etc. 14.00
Flue/vent for any of above 10.00
Subdivision:-- Lot t;'
Repair units 12.15 _
Other Fuel Ap Ilances _
_Tax map/parcel r: _ Water heater 113.00
DESCRIPTION Ob WORK Gas fireplace 10.00 _
Flue vent(water heats/ as Fre lace) ___ 10.00
Log lighter as _ 10.00 _
Wood/Pellet stove 10.00
Wood fire lace/insert 10.00
_ _ Chirnneq/liner/flue/vent 10.00
PROPERTY OWNER___ TEN/.NT. Other. 1000
leavlroamental t zhaust&Vanulation
Name _
Q�'�rt� Range hood"other kitchen equipment 1000
Address:
000Address: q,r�2S�.J i_6J(;AV A j4d Clothes dr)erexhar.�t 10.00
CIIy ;tate/Zip T _9?u Single duct exhaust
Phone L Fax: (bathrowns,toilmt compartments,
APPLICANT _ CONTACT PERSON utility rooms I 6.80
Name: Attic/crawl ace fans 10.00
. t0A0
Address: Other
----—
_ ._ Fuel PlDlna
Cat /State!Zip: _ -`- ____1!L5!e.for nrst 4,$1.00 each addidana�
PhonemeFax: Fumace etc. -- •�
-- —_ Gas heat pLmp •'
E-mail. _ _ WalUsusoended/unit heater ••
—CANITRACTOR _ Water heater ••
Business Name_ 611L-zll► y LQ01,.lIi.. I Fireplace +•
Address: /0 p � Range — --
__L3 _ �.3.-4- 7-- — ..
City/State,'ZI��C." �_.__`l_7 Clothes dryer(gas) _ — •• _ _
Phone _S-oj L�_��'.� Fax: p,�_.,?�P! o7e f Other: - ---- �• —^
CCB Lic. : J __ Total --
- _ __ MechanicalPermit Peit Fees-
Authunz-d � —
Sllmature ,i u - Ua-r � Subtotal: S _'� �- —-' Minimum Permit Fee S72.50 S
Plan Review Fee(25%of Permit Fee) S
(Please print name _ State Surcharge(8%o[Permit Fee)
— TOTAL PERMIT FEE S
Notice; This permit application expires if a permit Is not obtained within "Fee methodology set by Tri-County thillding Industry Ser+ire iioerd.
180 dais after It has been accepted as complete. ••Pie plan required for exterior A/C units.
00sts`.Permit ForrnikAlecPertnitApp.doc 01,03
CITY OF TIGARD 21s-Hour
BUILDING InspecFon Line: (503)639-4175
MST
INSPECTION DIVISION Business Lin,3: (503)639-4'71
BLIP
Received � -nx_ Date ReGq'�es;ed � L � Gy AM _- tA��--.- BUP
LocationSuite_— (MEC
Contact Person Ph( _) 1P_���— _ PLM
Contractor_ ---.- - _ Ph( --) _--_-_- SWR
BUILDING Tenant/Owner _.___ -___ __ _ ___ ELC
Focting ELC —_
Foundation Access: —
Ftg Drain ELF!
Crawl Drain
Slab Inspectiol Notes: SIT
Post&Beam _---
Shear Anchors -
Ext Sheath/Shear _
Int Sheath/Shear
Framing1J�.. ` /fi1C't /'� /Ilc f_ , �cy ��C:9C, �zZs,,,eL4� ----
Insulation
Drywall Nailing — -- �
Fire vall
Fire Sprinkler ------ —
Fire Alarm
Susp'd Ceiling ----- -—
Roof
Other: -- —
Final
PASS PART_ FAIL
PLUMBING_Post&&Beam
Under Slab
Rouglr-In
Water,service --- - --- — — -- --
Sanitary Sewer
Rain Drains --
CP,&Basii/Manhole
Form Drei i ———
Shower Pan
Other: —
Final - -_-----
PASS PART FAIL
MECHANICAL
Post&Beam
Rough-In -------- — --
Gas rine
Si ce Dampers —
`
PART FAIL -
ECTI'MCAL
Service -- — v- --
Rough-In — — —----- ------- __ ._... --- --
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call iu�rinspertion RE:—_—_.____.. _.______� - ___ Unable to inspect-no access
Fire Supply Line
ADA /f
Approach/Sidewalk Date Inspoc for Ext -—_.--
Other: —
Final DO NOT REMOVE this inspection record ftem the job site.
PASS PAR-,- FAIL.