Permit CITY TIGARD MECHANICAL PERMIT
� � DEVELOPMENT SERVICES PERMIT #: MEC2003 -00407
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/18/03
PARCEL: 25101 AA -08200
SITE ADDRESS: 12455 SW 68TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: • MUE
BLOCK: LOT: 029 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace with like kind, 80K gas package unit
Owner: FEES
ROTH, JACOB TIMOTHY JR + THERESA Description Date Amount
12600 SW 72ND AVE #200 [MECH] Permit Fee 7/18/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 7/18/03 $5.80
Total $78.30
Phone:
Contractor:
SUNSET FUEL CO
PO BOX 42287
2944 SE POWELL BLVD REQUIRED INSPECTIONS
PORTLAND, OR 97242
Phone: 503 234 - 0611 Gas Line Insp
Mechanical lnsp
Reg #: LIC 2374
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 -00
Issued By: Lfryyj��,P Permittee Signature: /,� _ ��
Call (50'3) 639 -4175 by 7:00 P.M. for inspections needed the nex b iness day
MechanicalPermit Application
A
Date received: �' Permit no� _ c -�
City of Tigard RECEIVED Project/appl. no.: Expire date:
City o�gard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171 JUL 18 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD Building permit no.:
111)1, OF Pi R l IT
• C 1 & 2 family dwelling or accessory ,kCommercial/industrial Multi- family O ti improvement
r. L
O New construction •• • ddition/alteration/replacement Othe ■ I<e l L 1 IC-Q
J011 SI 11: INFORM: \TION CON1\I1:RCI:11. V :111i:1110N St 111.1)Ul.l
Job address: l . `t 5 S Si.... C. /3 H.., 1 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ S a 1 R — .
Lot: Block: Subdivision: *See checklist for important application information and
Project name: A _ (_; h , a 4i`a L Z cr.—I.. jurisdiction's fee schedule for residential permit fee.
City /county: C - c.., k ZIP: a 3 1 & 2 F U11 I:I. 1'1:10111• FIE: SC F
Description and location of work on premises: 1 - wlV-c..1►k 1 NI) COMN11 :11.11\1)1:S 111111, l ;ot;I1'111 :N.1SCIIEDI II
S c..L. - - - Fee(ea.) Total
Est. date of completion/inspection: Descri. 1 . Ell Res.o. Res.o. 7
C:
Tenant improvement or change of use: Air handling unit CFM ■ --
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning site plan required)
Is existing space insulated? 0 Yes 0 No Alteration o existing H' A system INE
111:( 11 1NIC:U. ( ON712:1('1 Boiler ,■�
e boiler permmit t no.:
Business name:
State
- _ HP Tons BTU/H
Address: •]i,- _ Po ....x... 0A _ F smo . edampe duct smoke detectors NM
1117.11 State: or& iffairgrEffi eat pump site p an required) w
nsta 'rep ace Sumer �'•'.•-e': /H .121� )
Phone: 3 -p _ \ E 1 Including ductwork /vent liner O Yes O No WM 72! RE CCB no.: .'3 ns . Yrepla re ocate • eaters- suspended, ■ --
City/metro lic. no.: 2, y S -). wall, or floor mounted
Name (please print): 'eat or y . • , ce other than ace :
('ON 1:1(`l 1'1 IISON
Absorption units BTU/H
Name: Chillers HP
Co ressors HP —
Address:
�'T , yen dm on: ■ --
City: State: MP: Appliance vent
Phone: Fax: E - mail: a er dust
MN
- • . . , - • _/ - f res. tc • e • • azmat ■
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) -
Mailing address: - al , aust s stem • art • • m • eatm : or AC =
: rn,,.• �rr • up to ou et ■ --
City: State: ZIP: LPG NG Oil
Phone: 651 . - - a l Fax: E -mail: Fir .1 . in : , : • • ition over • ou ets I _
1::\ G I :\ I :I R ' , p , schematic requ - •) -
Name: Number of outlets
el I!' ap' 3 or -, ,, plant: ■
Address: Decorativef -lace
•
City: State: ZIP: nsert- i• MI
Phone: Fax: E -mail: }' . • . tov • et stove MN
in•er. IM •
Applicant's signature: , ---■-■--- Date: 1 :, , _ --
Name (print): -
Not an jurisdictions cards, ctio .00ept cruet c , please can information. jurisdiction for mere information. Permit fee $ 9.9 .0,
O Visa 0 MasterCard Notice: This permit application Minimum fee $ 7 a . S • O
Credit cane number: / 1 expires if a permit is not obtained Plan review (at _ 4b) $
Expires within 180 days after it has been State surcharge (8%) .... $ 5 .8 0 •
Name et cardholder as shown oo credit card _ accepted as complete.
= TOTAL $ 7 Z • Z O
w
Cardholder signature Ammo 440.4617 (6•401C0/4)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION ,, r Business Line: (503) 639 -4171 MST
BUP
Received Date Requested Z AM PM BUP
Location /‘,2 Vic 6 c Suite MEC — 4 " �
Contact Person Ph ( ) c57— PLM
Contractor /nom Ph ( SWR
BUILDING Tenant/Owner v " '� � 'A/ A-L. ELC
Footing
Foundation Access: p ELC
Ftg Drain 0' /o v "4 1 arc 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
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS FAIL
CH NIC
Pos eam
Ro -In
Pampers
Final
ART FAIL
EL i ICAL
Service
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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date / 2.1- / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL