Permit C ITY OF TI GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2000 -00238
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/16/2000
PARCEL: 1S136AB-01703
SITE ADDRESS: 10170 SW 72ND AVE
SUBDIVISION: METZGER ACRE TRACTS ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 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 existing furnace with like kind.
Owner: FEES
LONGFELLOW, THOMAS NEIL + Type By Date Amount Receipt
EUNICE M, CO- TRUSTEES PRMT GEO 06/16/20( $50.00 0003040
11750 NE LAUREN LN 5PCT GEO 06/16/20( $4.00 0003040
NEWBERG, OR 97132
Total $54.00
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 624 -2704 Final Inspection
Reg #: LIC 00076359
PLM 34 -175
ORIGINAL
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 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9189.
Issue By: Permittee Signature:
CaII (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Plan Check #
CITY OF TIGARD Mechanical Permit Application Recd By
13125 S HALL BLVD. Commercial and Residential Date Recd
TI OR 97223 cy c i____ Date to P.E.
(503) 639 -4171, x304 Dat to DST
Print or Type ermit #,f i -- 66A
Incomplete or illegible applications will not be accepted Called
N of Development/Project Description
1 fi e i 1 1,nn9 -e l Ipt..c) Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fee 16.00
Address )v/ 70 uJ '702 n� 1) Fumace to 100,000 BTU pp
Bldg# City/Stale zip including ducts & vents see footnote 1,2 9.65 7 , 7
2) Fumace 100,000 BTU+
i rd 9 7P 73 including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Fumace
Owner f �e (' I 640/1 C( l (OW including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
/0) 70 6td 7,= floor mounted heater see footnote 1,2 9.65
, 5) Vent not included in appliance permit 4.75
City /State Zip Phone ,i-'6, 3 Check all that apply: *Boiler Heat Air
Tin yJ 97a� .Ry,'6o 7,376 For Items 6-10, see or Pump Cond Qty Price Amt
N (or name of business) footnotes 1,2 Comp
6) <3HP;absorb unit to
a /11 e 100K BTU 9.65
Occupant Mailing Address 7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
City/State Zip Phone 8) 15 HP; absorb
unit .5-1 mil BTU 24.15
Contractor N 9) 30-50 HP; absorb
�1` unit 1 -1.75 mil BTU 36.00
vl um b i a. IPad, n J wl� /l j1 J G 1 0) >50HP; absorb unit
Prior to permit afffng Address >1.75 mil BTU 60.15
issuance, a copy 6 Bo „2,263q7 11 Air handling unit to 10,000 CFM
of all licenses State i Zip Phone5 7.00
are required if /, a rci O2- 2a f' ) 3 o '-/?704 12) Air handling unit 10,000 CFM+
expired in COT o cons/. Cont. Board Lic.# Exp. Date 11.75
database 7b.159 /Owl -v0 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or Mailing Address 4.75
15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes.k No O 18) Commercial or industrial type incinerator
Residential Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove/gas FP /other units /clothe dryer /etc.
7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas LPG 0 electric O 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL -Q.Q$
I hereby acknowledge that I have read this application, that the information 9% SURCHARGE 4 1 , 0
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL
Sig re of • • er /� l ent Date i4-OL
f . / / Other Inspections and Fees:
i f , ' a - °�'' /S - 0o 1. Inspections outside of normal business hours (mininum charge -two
- - Co n t d e t Persot.Nafne , Phone hours) $50.00 per hour
3j / ,t,, as h ( 9 ron lbe�cd 6 01 r��� y 2. Inspections for which no fee is specifically indicated (minimum
tl� r 9 f charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge - one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. *State Contractor Boiler Certification required
"Residential NC requires site plan showing placement of unit
I:snechperm.doc rev 02/4/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (0/24/(7O AM PM B •
Location I C71 0 7 2_2 54(x. Suite iji -40 Z 8
Contact Person Tri Ph CP -Z PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: / SGN
Slab N ��-�' ` � ' SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
HAN IC�I�
Po E 'dTf�
Rough In
Gas Line
Smoke Dampers
a
PART FAIL
,. TRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 67)- Pro Inspector e Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.