Permit s
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00834
E �' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/27/2004
PARCEL: 2S112CB -11700
SITE ADDRESS: 15370 SW 81ST AVE
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 131 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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Furnace replacement.
Owner: FEES
JACKSON, KENNETH S Description Date Amount
15370 SW 81ST AVE [MECH] Permit Fee 12/27/20( $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 12/27/20( $5.80
Total $78.30
Phone:
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Heating Unt lnsp
Phone: 503
Final Inspection
Reg #: LIC 72623
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: & Permittee Signature: 771
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
/ Dec =ti22 04 05:47a . TriCounti Temp •Cntrol 5035570919 p.1
Methica1 Permit A p I i cation •
FOR OFFICE USE ONLY
City of Tigard .. -. - ®, ; r`
c Received
13125 SW Hall Blvd., Tigard, OR k' Date/By; O fri /4v .6 Permit No.: h/I 00 . ...0 . % C f ,
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review j 7 '0.J
Inspection Line: 503.639.4175 2. Bm N„ 14V 9 'il Date/By: Other Permit:
Internet: www.ci.tigard.or.us I�D!EC JU 23 26{I►4 ,� ' Y.. Date Ready/By: Ieris:
6i 1a Notified/Method: 1 r �, 0 See Page 2 for
Supplemental Information
i �' COIFIMERC: L F FF * SC E' " ":L SE'CHECKLIST
❑ New construction L' d �; E�,,77 r33 xxg
��i[Y�f�r�S2 t
i
I Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY: OF C ONSL,RUUC 'ION ' Value: $
1 and 2 family dwelling '0 Commercial/industrial SI ? j %•EQUrPME�17C' / iS FEES*
' SYS1E1v
❑Acces buildin
For special information use checklist.
❑ Multi - family ❑ Master builder
:.. n
. S OB ' F:>I£�R14MATIONN1 M I LOCATION
Description
..- ... +... O : -. �,; Qty. I Ea. Total
npt I t �
... ... .. $eadntJcoolin :
Job site address: ■ r tell �1P Air conditioning or heat pump
�
_a_
i 1..� `VV (requires site plan showing placement) 14.00
_
City/State/ZIP: / -
L Furnace 100,000 BTU (ducts/vents) 1 14.00
Suite/bldg. /apt. no.: NO Furnace 100,000+ BTU (ducts/vents) 17.90
Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duet work
14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
• hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Tax map /parcel no.:
. Other: 10.00 ,
Other fuel appliances
Z s .' DE' SGRRf PTI0i�1 OF w o1<iIC �. x '4, Water heater
i_.. ', .4. � : .�,I 10.00
' Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
;: t
f
Wood fireplace/insert
°
a::•aia�: -•, RIt - . iSe : ; ?r' : UI:: l Chimney/liner/flue/vent Chi
.,. .'FYy' „OK!i'�TE ... x�l : '• - • ry . ,,,. ::... , .. _. 10.00
.. _. �; .: i.i:., r f
i,�.;;: - -
,t om , `/ - ,, �, Other: 10.00
Name:
Environmental exhaust and ventilation
Address: !�ir Range hood other kitchen
!1 equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00 •
Ptione: �f) f� �— Fax: ( ) Single -duct exhaust (bathrooms,
- ,D :; A ?P•ZICATIT' r• ';` *', ; r:'`=” "; ' .:::: i :. et/
compartments, utility rooms)
_, toilet b 80
. •- . ,/' I r :•
..._. �• ..., : : t [�. CONTAC PERSON - .4t tic, crawlspace fans 10.00
Business name: } r� CcI�U TO s i Other: I 10.00
C 1 it 1 Fuel piping
Contact name:
p 55.40 for first four; 51.00 for each additional
Address: {,/ �J � J • C �J kn , 111 /7 (� t 4rt/ -, ,. • UC Furnace, etc. 1
(. u 'mil U l U C ( N 04 Gas heat pump
City/State/ZIP: C,\ / - e L� Wall/suspended/unit heater
Phone: (t.0.;5) 557 - 2220 Ell Water heater
E -mail: Fireplace
Range
' :.•' - ?bl.G.:'<s: _ :: i', i �� <.u. - iT ..:34.i.+ -+>
+.M. ' t ' i 7 n � I ^4 04\ .i' .,� r
... �- � tT,>�044.3.00,:k.1.,..:?. ,., �•�,, . 1 `a'r -:.` Barbecue
Business name: ( CCL , Clothes dryer (gas)
Address: _ Other.
• ` � ` �:' �'; IYII <CHAIVICAX::PERiViTf..REPS"''; '`
Emmiamile >� k_ q • ;
Subtotal
Phone: (a�,S . 55 — Fax: (G e • Minimum permit fee ($72.50) •
J� �� �� Plan review (25% of permit fee)
CCI3 lie.: 7- :,2.3
State surcharge (8% of permit fee)
�� _� TOTAL PERI%' IT FEE -
Authorized signature: "� d / ( This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: btZn-e /Vlt, 04 Date: I47 ' Fee methodology set by Tri-County Building Industry Service Board
BBuilding\Permits\MEC• PermitApp.doe 12103 440 - 4617T (I I /02JCO.NWE9)
CITY OF TIGARD • 24 -Hour
BUILDING " , - Inspection Line: (503) 639 -4175
INSPECTION DIVISION r Business Ling (503) 639 -4171 MST
BUP
Received "— J Date Requested `_ c Z AM V PM BUR
Location l S- 37 � . -4-1 / • Suite E 7 d gJa C
Contact Person pa ) _ PLM
Contractor ( ) 5- 5 S 7 -7 - -2 - 2 -° SWR
BUILDING Tenant/Owner l� -�9�' ELC
Footing
Foundation ELC
Ftg Drain Access : - G, " -'
Crawl Drain –� /`7' Q r ELR
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear - ,yam 5 3 / 6 6
Framing '�' ✓ /
Insulation S % " C�9ZQ,
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
PASS - FAIL
M ICAL
Po —
Rough -In
Gas Line
Smoke Dampers
4 1 - ::&1:--‘::: # PART FAIL
ELECTRICAL
- 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 ❑ Please call for reinspection RE: .Unable to inspect – no access
Fire Supply Line •
ADA ,'� Q
Approach/Sidewalk Date Inspector Ext
Other:
Final. DO NOT REMOVE this inspection record fro job site.
PASS PART FAIL