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9900 SW LANDA2. PLACE
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CITYOF TIC ARD MECHANICAL PERMIT
DEVELOPMENT SE WICES PERMIT#: MEC2003-00316
13125 SW Hall Blvd., Tigard, OI 97223 (503) 639-4171 DATE ISSUED: 6/12/03
PARCEL: 1 S125CD-05900
SITE ADDRESS: 09900 SW LANDAU PL
SUBDIVISION: PP1990-051 ZONING: R-4 5
BLOCK: LUT: 003 ,JURISDICTION: TIG
CLASS OF WORK: 01R FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATF�iS: VENT FANS:
OCCUPANCY GRP: R3 V7-1.;TS %Ann P,PPI-: VENT SYSTEMS:
STORIES: _BOILERS/CCMPRESSORS HOODS:
FUEL TYPES_ 0 - 3 KP: 1 _ DOMES. INC!N:
15 Mr: COMML. INCIN:
M 1X INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 504 HP: CLO DRYERS:
FURN < 100K BTU: AIR HA_NDI INr UNITS OTHER UNITS.
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
'emarks: Installation of new a/c.
Owner. �--- FEES
DAVID HOLD Description Date Amount
9900 SW LANDAU PL _ $72.50
TIGARD, OR 97223 �fvil'(111 Permit I-cc ri/12/03
'FAX I K" Stow'h, 6/12/03 $5.80
I� Phol•c. 503-246-I804 Total $78.30
Contractor: _
OREGON HEATING +A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS_______
PCooling Unt Insp
Phone: 53x-295i
Final Inspection
Reg #: LIC 125815
This permit is issued subject to the regulations onntained in the Tinard Mt-nlcipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will sxpire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth i ,GUAR 952-001-00
i
Iss d 8 ' / .� Permittee Signature:
Y _
Call (503) 94175 by 7:00 P.M. for inspections needed the next business day
OFFICE USJK ONLY
Mechanical Permit Application
--- — Date received: 6F /1/0 C? Permit no.: �-�p���G'
• City of Tigard Pmjee_t/
pno.: Expire date:
r Y(y a/'Tikurd Address: 13135 5W IlalI lllvd,Tigard,Oft 97223 gate ixsued: Cty: no.:
Receipt
Phone: (5U.1) 639-4171
--etp _--_--
Fax: (503) 5911-1960 Case file no.: Payment type__
Land use approval' - rinillline,permit no.:
"New
ly dwelling or accessory UC.'ommcl::ial/Industrial U Mulls U'renant i'pprovement
LUI construction 'J \Illllrio,n/alteratiort/replaccrlu:.„ U Wt.,
JOB SUE 1 1 VALUATION SCHIEDULE
Job address: G�QD /�/� L. �1 -- Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: suite no.: - value of all mechanical materials,equipment, labor,overhead,
rax m_apltax lottacc-o lilt no.: profit. Valur:$
Lot: liluo k� Subdivision: "Sec; checklist For important application information and
Project name: _ jurisdiction's fee Schedule for residential permit I'ce.
City/colutty:
Description and locati n��lwork gn premmisses/_
�r�'RN/ Mt& f"V_>'1/ti - tee(ea.i t ural
Est.date of completion/inspection: De.c tlnil ._ Rem.only Res only
tenant improvement or change of use: Air handling unit _ CF,%A _
Is existing space heated or conditioned'?U Yes U No Air_-Jog(site p an reyu-tiraT—
I�eri'+'ink ;pal c insnlntecl71,Yrs CI Nn Alteration of existing IlVAC system
1 Boiler/compressors
State boiler permit no.:
Business name: -OREGON HEATING lip Tons BTIJ/11
Address IR CQIILQIILQISLI INC,_ ire/smoT tramper twt smoke detectors
City: p, go LIP: enc pump(site plan required)
sea
_Phone: (51) rba8.2953 E-mail: rep ace utmace urner /FT
_ Including ductwork/vent liner U Yes U No
CCB no.: / _ _ Ttn r
Cirep ace e of ate enters -vuncspec .
ty/metro tic.no. r7 _ _ wall,or Floor mounted _
` - - --
�ann I Irlr,rtr llnnt t 'ti/jr�i-. bent ora Lance of er ..furnace
e7rrTgere on:
Absorption t nits __ _- _ BU/11
Chillers .--_.,_. lip
-- - - Compressors - - IIP
\ Llress: nvinrnmeala exhatrst and veMila on:
City: _ --�- State: ZIP: wPPliance v.:nt
Phone: Prix: �r, tn;Iil -- Dryer ex ust _ -
HoMs,TypeU Ifre t.lciteTient- mat
howl fire suppression system
Name: _ L_- PI _ Exhaust than with single duct(built farts)
Mailing address: ��-s� - p�- Ex tnuvt v stern apart Ftm)ie itin or AC
tie p nq and dildribufforr(up to 4 outlets)
City: Stat /IP:��-- type: I Ki _ _. NO Oil _
Phone' -I 1. F-toast: Fie
P,
m Cac t a t iiiunal over out eta
roc",piping(schematic required)
Number of outlets
Name: `--- -v --- __-.-_- r app once nr e_gU1-per.—
Address. Decorative fireplace
City: State: .�I I' nscrt type ---
- - Woods ove/peet stove
I'hone: Ot er
Applit:ant', 2
Name(print). r/✓ r U L- --
_ Pc rtni t fee .
Not 111 110101011111%Iccept ante c.lrdt,plal.ie r.dl pnadiction 6ir nnnr mfurmnuon Notice: Thi91 erndt Iicalion
-1 Visit IJbinstcr('nnt p 'pp h.iuillturnfr.c
/ espl if a pern't is not ohlnined r'latl review(lit
I'tmht cord munNar. within 180 days Alcr it has heel'
r,plrw y SUttr;llrchargc lJi",r) ... .� S .o v
Fiiinc of c.trdhiddc;In dumn.nl o�cdit card at:ccptCtl as cotttpletc.
iorAL.................... 7 8b.3/
S
--�— t'.Irdlnddcr ugreuure -- iuunmt
Ill).lilt 7 th tut, �t l
Jun 12 03 08! 00a OHRC SHOP 503-537-9235 P. 1
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__ELEC_TRICAL PERMIT
CITY OF TIGARD PERMIT#: EL132003-00338
DEVELOPMENT SERVICES DATE ISSUED: 6/9/03
13125 SW Hall Blvd., Tigard, OR 97223 (!jO'1) 639-4171 PARCEL: 1S125CD-05900
SITE ADDRESS: 09900 SW LANDAU PL ZONING: R-4.5
SU. IIVISION: PP1990-051
LOT : 003 JURISDICTION: 1 IG
BLOCK:
Project Description: Install 1 branch circuit to AC.
TEM! SRVCIFEEDERS MISCELLANEOUS
_RESIDENTIAL UNIT ------- --� PUMP/IRRIGATION:
1000 SF OR L =SS: 0 - 200 ai,1p:
EACH ADD'I. 500SF: 201 400 amp: SIGN/OUT LINE LTG:
401 - 600 amp: SIGNAL/PANEL:
-IMITED ENERGY: MINOR LABEL (10):
R:
M ANF HMI SVC/ FD601+amps 1000 volts;
ADD'L INSPECTIONS
SERVICEIFEE_DER -_ BRANCH CIRCUITS
W/Sf_RVICE OR FEEDER: PER INSPECTION:
0 - 200 amp: PER HOUR:
201 - 400 amp: 1st WIO SRVC OR FDR: 1
EA ADD'L BRNCH CIRC: IN PLANT:
401 600 amp: PLAN REVIEW SECTION
601 1000 amp: _ -- > 600 VOLT NOMINAL: v
1000+ amp/volt: >=4 RES UNITS: J
Reconnect onl SVC/FDR>= 225 AMPS: - CLASS AREA/SPEC UCC:
Contractor:
Owner: OWNER
DAVID HOLD
9900 SW LANDAU PL
TIGARD,OR 97223
Phone: 503-246-1804 Phone.
Reg #:
FEES__
Desc,lp:lun Date Amount Required Inspections —
1 I.I.PftMT'j GLC1'cnnit r ' -v $46.85 Rough-in -
I AX]9%Stutc'fay r '� t —-$3.75 _ Elect'I Final
Total $50.60
This Permit Is Issued subject to the regulations contained In the Tigard Municipal Code,State of OR.Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. Thla permit will expire if work is not started within 180 days of issuance,or if work is suspended
ffor orth in OAR 952-001-00`10 through IOAR 952001 010n law 0. Yod may obtauires vou to in copies of w rules hese by
or direct the Oregon tulestons to OUNC at(5 3)246-6699 ortiOn Center. Those rules e t
1-800-332-2344.
Pirmit Signature.
Issued By: ---
OW_NER !NSTALLATION ONLY -----
Tne installation is being made on property I own which is not intended for sale, lease, or rent.
DATE:__
OWNER'S SIGNATURE: ------
—
CONTRACTOR INSTALLATION ONLY -
--- -- -------- DATE
SIGNATURE OF SUPR. ELEC'N:
LICENSE NO --- __�_�_.----__._—_ ----- -
Call 639-4175 by 7:00pm for an inspection the next business day
FOR OFF U$E.ON4J
Electrical Permit A� lication KeC1VCd I . ccultal
---- — Dot Y.
: lG - L.J Permit No.: •^� �OQ� L
Planning Approval Sign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd, Plan Review Other
Date/By: Permit No,
Tigard,Oregon 97223 i_
Phone: 503-639-4171 Fax: 503-598-1960 ,,,, Date/By:Post-Review: Land Use
Uete/ Case No.:
Internet: www.ci.tigard.or.us Contact J /a See Page 2 for
A-hour Inspection Request: 503-639-4175 Name/Method: / ' I Supplemental Informatlon.
TYPE OF WORK PLAN REVIEW(Please check all that apply)_
New construction DemOhtion Service over 225 amps- Ilazar-care faction
- commercial ❑Hazardous location
Addition/alteration/replacement Other: ❑service over 320 amps-rating of ❑Building over 10,000 square lect.
JAciccssory
CATE — F CONSTRUCTION i&2 family dwelliops I•our or more residential unit.%in
2-Famil dwellin ('ommercial/Industrial ❑System over Goo volts nominal one structure
❑Building over three sto ies ❑Feeders,400 amps or more
$utldin r Multi-Family []Occupant load over 99 persons ❑Manufactured structures or RV park
ster guilder Other: ❑FBress/ligh:ing plan ❑Other
Submit—sets,of plans will'any of the above.
JOB SITE INFORMATION and LOCATION The above are not applicable to temporary construction service._
Job site address: t-fti'N S vJ 6 L FEE'SCHEDULE
Sui: #: _ �ld -Pt#• _.� Number of fns ections per pe mit allowed
Description Qty Fee(ea.) Total
Pro'ect 1` ame: - New re%Idential-single or multi-famlly per
Cross Street/Oirectlon8 to Job site: dwelling rnit•Includes attached garage.
Service included:
1000 sq.R.or less 145.15 4
Each adJilional 505's .n.or rtion thereof 33.40 _ __. 1
LimitrJenertly. evidential 75.00 2
Subdivision: Lot#: Lir• ed energy non residential 15.00
Tax map/parcel #; '.ach manufactured home or modular dwelling
90.90 2
lllSf'
, RIPTiON service and/or feeder OF WORK Services or feeders-Installation,
U I_ l S tc �-tP_�ILT —(a �- alteration or relocation:
L
80.30 _ 2
-- 201 amps to 4W ams `— —_ 106.85 2
- -- —- -- — 401 amps to 600 amps 160.60 2
--- -- 601 am to I OOO am — 240.60 2
PROPERTY OWNER TENANT _ Over 1000 ams or volts 454.65 2
Name: �_L� 'T1l�LD Reconnect only
6G,85 2
Address: 9IQ_5W //�1�/ZN 9L a'cmptservicesnrfeeders-Instrllatlon,
alteration,or relocation:
City/State/Zip: "[ ill 2z 3_ 100 amps or less 66.85 1
201 amps to 400 ams ____ 100.30 2
Phone:S-V3 - Zit 6 -1$� Fax: 401 is 6a)ant -- 133.75 2
APPLI_A_'i CONTACT PERSON Branch clrcult%-new,alteration.ar
Name: - extension per panel:
--- A.Fee for branch circuits with put chase of 6.65 2
Address: __ service or feeder fee,each branch circuit_
City/State/Zip: _ B.Fee for branch circuits without purchase ut
service or feeder fee,first branch circuit / 46.85 2
Phone: FaXx Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included)
Each um or irri %tion circle 53.40 2
CONTRACTOR Each si I or outline It liting 53.40 2
Job No: --L?W t) le Signal circuit(s)or a limited energy i•anel, 342 9
alteration or extension P
Business Name: _—_ __ Description
Address: -- -- F:ach additional lost Winn over the allowable ton of the above:
City//State/Zip: Per iia coon r hour min 1 houtr 62.50
Phone: Fax; _ Investigation fee:
Other:
CCB Lic. #: _ Lie. #: Electrical Pertnit Fels
Supervising electrician Subtotal a
signature required: Plan Review 2Z5 of Permit fee S
Print Name: Lic.#: State Surcharge 8%of Permit Fee $ 3.
TOTAL PERMIT FEE S .
Authorized )rv'w i Notice: This permit application expires Ifs permit is not obtained within
Signature: ___ Date: _ 180 days after It he%been accepted as complete.
*Fee methodology set by Trl-Count% Building Industry Service Board.
vt.(Please print print name)
ODsts\Pemtit Fours\ElcPermitApp.doc 01103
I lectrical Pcr•Init Application - city of"I•ikard
"age 2 - Supplement: I Information
LIMITED FNERGY PFAINI T FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems ................... $75.00
Check Typc or Worl.Involved:
Audio and Stereo Systems*
Iturglar Alarm
F] t iarapt !)oor Opener*
F] llcuting,Ventilution and Air conditioning System*
ElVacuum Systems*
[�] Other-------—-- --_—
COMMERCIAL WORK ONLY: ___.__
---- _ S7S.00
Fee for each system..........................................................
(SEF 0A1t w1 9-260.260)
Check Type of Work Involved:
Audio and Stereo Systems
nNoilerConuals
Clock Systems
Data Telecommunication Installation
MFire.Alarm Installation
L-] 11VAC
L❑ Instrumentation
Intercom and Paging Systems
1-1 1 andscapc Irrigation Control*
Medical
M Nurse Calls
EJ Outdoor landscape Lighting*
Protective Signaling
Other_,__ ---
Nuntt er of Systems
* No licenses arc rcyuircc. I icemen are required tun ull
Other installation~
i\IstsTermit forms\ClcPermitAppPg2.doc 01/03
CITY 4F TIGARD 24-Hour
BUILDING inspection Line: (50 4175 MST __-___ _ ----------
INSPECTION DIVISION Business Line: 15 1 BUN ---
Received —_.—Date R nested_ J — AM ___ PM BUP
I_ocation .-_.---� — —Suite--- MEC - --- —
Contact Person Ph( —) D PLM _
Contractor .______.—._ -- _ Ph( SWR) -----
BUILDING Tenant/Owner
Footing ..'ji �_.J C�^�`� To ELG
Foundation Access: �
Ftg Drain ELR -- -
Crawl Drain SIT _--
Slab Inspection Notes:
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - _ --.------- - �-
Insulation
Drywall ?ailing
- -
Fire Sprinkler
Fire Alarm _ --
Susp'd Ceiling
Roof -
Other
Final - -- - .
PASS PART FAIL
PLUMBING
Posta Beam- -- _
Un -r Slab
Rc jh-In
WE it Service -
Sar Mary Sewer
Rain Drains
Catch Basin/Manhole -
Storm Drain
Shower Pan
Other
Final
PASS PART FAIL
MECHANICAL J
Post R BeamI-11
Rough-In Beam " (-4
5 Q I -
Gas Line 1\s
- —..
Smoke Dampers ------" ----
Final -- _—_ — --
PASS PART FAIL —
j5p
ervice
Rough-In .—
LIG/Slab np G
Low Voltage[?�ire,,Alarrn
Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
S PART FAIL
__ Unable to inspect-no access
SITE [] Please call for reinspection RE -- -
Fire Supply line
ADA Date ._ Inspeel-9 !!i' c7 �y� Ext—_
Approach/Sidewalk
Other: �9j
Final 'DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business line: (503)639-4171,
BUP .r
Received _�1f1ti � Date Renu sted 7-9 - AM PM BUP
Location ___ �_�� — 'c ,.. Suite MEC ��
Contact Person Ph( -) Sr' PLM --
Contractor __-- _ Ph(- ) _-- — SWR -
��U 3
BUILDING Tenant/ ELc 3
Owner _ ___._._ _ ,_ _
FooUny ELC
Foundation Access:
Fig Drain ELR
Crawl Drain _
Slab Inspection Notes:�n��.�--.-�f1�t+sc� t SiT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -- --
Insulation 1 ( —� C (� `� 1
Drywall Nailing �L[ —�-�-="
Firewall rJ
Fire Sprinkler -- �—�--�
Fire Alarm
Susp'd Ceiling ,� /
Roof i ' V �_1___1 IL ,1 C can J
Other:_ -
Final
PASS _PAl f FAIL. ����—��� 'v
�_.
PLUMBING —
Post& Beam
Under Mab
Rough-In
Water Service -- - --
Sanitary Sewer i
Rain Drains -- ------ -- - —
Catch Basin/Manhole
Storm Drain
Shower Pan
Other ------- -
Final _
WS PART FAIL
_ L --
Post& Beam
Rough-In ---
Gas Line
Smoke Dampers —
P_E1SS PART FAIL
_-_--T 31CAL
Service
Rough-In --
UG/Slab
Low Voltage
F je Alarm
Fina - [_jReinspection fee of$ _ required before next Inspection. Pay at City Ha!!, 13125 SW Hall Blvd.
PASS PART �AIL�
SITE F-1Pleasecall for reinspection RE: — Unable to inspect-no access
Fire Supply Line
ADA r
Approach/Sidewalk Date ` .'=�7_ InfpAetor� �t —� r Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS- PART FAIL
/\ CITY OF T I O A R D MECHANICAL PERMIT
DEVELOPMEN T SERVICES PERMIT #: MEC2002-00418
13125 SW Hall blvd. Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/23/02
PARCEL: 1 S125CLr'J570(.
SITE ADDRESS: 099(,10 SW LANCAU PL
SUBDIVISION: PP1990-051 ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT '—_ FLOOR TURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPI_: VENT SYSTEMS:
STORIES: SnI!.cRS/CO_MPR_E_SS:)'zS HOODS:
FUEL TYPES _ 0� 3 HP: DOMES. INCIN-
OIL 3 15 HP: COMIVL. INC;IN:
MAX INPUT: BTU 15 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: CTAS OUTLETS:
> 10000 cfm:
Remarks: Installation of wood stove insert.
owner: -- �-------- FEES -� --- –
BRLNT LAWSON Type By _ Date Amount Receipt
9990 SW LANDAU PL PRMT CTR 9/23/02 $72.50 2.72002000C
TIGARD, OR 97223 5PCT CTR 9/23/02 $5.80 2720020000
_ Total $78.30
Phone:503-260-6366 ---
Contractor:
OWNER
REQUIRED INSPECTIONS
Woodslove Insp
Phone: Firial Inspection
Reg #-
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Cods and all other applicable laws. All work will be done in accordance with approved
plans. This permit will Pxpire if work is not started within 180 days of issuance, or if work is suspended
for more !,ten 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility N'otitication Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You nlay obtain copies of these rules or direct questions to OUNC by cafltng (503?246-9189.
Issue By: .-- Permittee Signature:
�� Call (503) 639-4175 by 7:00 P.M. for inspections needed the ext business uuy
Mechanical Permit Application , �J Permit no Inc.
—_
Date received: ,�
/ la
city of Tigard Projcct/appl.no.: Expiredote:
Address: 13125 SW Hall Blvd,'T'igard,OR 97223 Dateissued: By:� Receipt no.:
CirynJl'igard Phone: (503) 639-4171
Case file no.: Payment type:
Fax: (503) 598-1960 -
Building permit no.:
Land use approval: -
t
��� �� U Multi fault U Tenant improvement
/°"'' "`2 family dwelling or accessory D Count rcial/industrial Y _ -
U Ncw construction Addition/alle.ration/rcl.laccntcnt U Other: —____
Indica,_equipment quantities in boxes below. Indicate the dollar
Job address: — value of all mechanical materials,equipment,labor,overhead,
Bldg.no.: Suite no.: _
_ profit.Value$
Tax map/tax lot/account no.:
Block: Subdivision: *See checklist for important application information and
Lot: lurisciiction's fee schedule for residential permit fee.
Project name _ _
1 _—- 1
City/crnlnty�jQC[ CJ✓ t tIN 1
bescriptiop.a d If nation of work on ptyr.rscs: I n(eg.I Total
/0 ��I )r ,e Ikwcri>tion Qt Res-only Res.onl)
Est.date of completion/inspection: C.
Tenant improvement or change of use: Air handling unit
Is existing space heated or conditioned?U Yes U No Air con itioning(site pan require ) _
Is existing space insulated?U Yes U No teration o existing A system
t t of er compressors
Slate boile,, mit no.:
Business name: �' !U! f ' t—'"•� Ht Tons BTU/H
A '�slatc: �ir smo c amper duct sin
o a electors
tWrcas: h11 ( iteIanrequir
City: ZIP: at um s
Installreplace urnnc urner
E-mail:
Phone: Fax: ,� Including ductwork/vent liner U 1 es U No
CCB no. _ _�__r�__�.— alta rep ace/relocate caters-suspen e
City/metro tic.no.: — wall,or floor mounted
ant for a lance of cr t an furnace
Name( Icase riot): e gerat on:
j'ONTACT PERSON Absorption units BTU/H
HP —
Name: Com ressnrs_ _-- lip
Address: ,nv ronmenta ex gust fn rent at on:
7.§ ate: LIP: Appliance v-1
City:
-- - Tax: I n u� ---------- )ryercx gust --
Phone: Hoods, I ype Tres. itc en inzmat
hood fire suppression system
r s..SO
Exhaust fan with single duct(bath fans)
Name:
:xhaust s stem o art from iea in or AC
Mailing address: c v '10. C let a ue p ping and dist ut on(up to out els)
City; , siale:0w9 ZIP: 72 2 Type: �_._l,l'C; Na oil
_
Phone.' �y, G"W G Fax: E-mail: Fuc ii in leach ad itiona over out cis
roeess p p ng 1 sc sematic require ) _
Numhcrof outlets
sl ern fiance or cq—ujpenent:
Name: t er
Decorativefirc lace
Address: ,i
Stale: alert-ty e
City: oo stov pe elstove
Phone: rax: G mail Ot er•
Applicant's signature:— bate: -23-C2 12 t er:
Name (print): h q-JaU- x -�
Permit fee '
Nni all junsdtctbns accept credit cam,please call jurisdiction felt mcae inrmmamuo Notice:This permit application Minimum fee................$ --_
U Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $ R
Credit card number. __ — — aplrcs within 180 days after it has been State surcharge(896)
accepted as complete. TOTAL ................... $
Name of card of r u s own on crc ft cud $ "'
400.I617(ficparCOM)
Cardholder sl6riuure Amount
GIT'Y OF TIGARD 24-Hour
'IILDING Inspection Line: (503) 639-4175
MST
INSPr FION DIVISION Business Line: (503) 639-4171
�� - BLIP - --
Received ---Date Request —L '� _ AM 1-1.-= PM - BLIP —
Location in ZL '-GLS �� Suittel -� n t MEGA A) +
Contact Person _-- — Ph( ) �-��1 PLM - - -
Contractor —_ Ph( LE -�2 `od ' 3Giw SWR _--
BUILDING _s TenanUOwner -_- ---- ELC
Footing ELC
Foundation A,Xess:
Ftg Drain ELR
Crawl Drain --- --
Slab Inspectior NbtQ �(„ SIT
Post& Beam _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing _✓ 1 r _
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling 04 J
Roof
Other:.----- --
Final
PASS PART FAIL - - r
PLUMBING
Post&Beam -� I
Under Slab --
Rmigh•In I '
Water Service ---__ --- -_-__--
Sanitary Sewer
Rain Drains ---
Catch Basin/Manhole
Storm Drain -
Shower Pan
Other:
Final
PASSPART FAIL
MECH_ANICAL
Post Is Beam
Roiigd-In PA.
Gas line "
Smol.e Dampers
Fina
PART FAIL
TRICAL
Sery ce
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 for reinspection RE: Unable to inspect-no access
Fire Supply Line /
ADA Date Date l Inspector —- Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL