Permit r
A C ITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00243
_`" .. II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/5/2004
PARCEL: 1 S136CB -03300
SITE ADDRESS: 11205 SW 83RD AVE
SUBDIVISION: STEVE + HUGHIE'S PLACE ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 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: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install a/c unit.
Owner: FEES
KELLEY, JIM D + STACY L Description Date Amount
11205 SW 83RD AVE [MECH] Permit Fee 5/5/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 5/5/2004 $5.80
Phone: Total $78.30
Contractor:
•
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223 Cooling Unt Insp
Phone: 503 624 - 2704 Final Inspection
Reg #: LIC 76359
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)246-669*.
•
Issued By: /10
A' / Permittee Signature:
� , - ' �� r
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
4 11 : 53a P A M 153 503-598-0270 p . 2
' L
0
I Permit AR3ficction FOR OFFICE USE ONLY
City of Tigard & 164
A Received
Date/By:
Plan Review •
•
12Y 6
13125 SW Hall Blvd., Tigard. OR 97223 1
Phone.: 503.639.4171 Fax: 503.598.1960 1 •
ne. ., ( - V , . Az:A" 4 I it\ Date/By: 11"2111211Mir Permit: AMY
Inspection Line: 503.639.4175 Gq1 V s it I
1 NG 'CP" Date R.cady/By: . luris RI See Page Z for
Internet: www.ei.tigard.or.us BOLO NotiftedfMetbod: / JO). Supplemental Information
I . .. , : .''''.":•'...-.:,:' .. •'" . - . . • .... . P.Y i:WORK .:.,: :;.-...,;.:-...;-. ::„: :.4 .: :i -.,.-. .:.... :;COSIMEltClk1;:IFEE* :SCFLEDLILE - USE CHECKL EST
New construction Addition/alteration/replacement
Mechanical permit fees* are based on the value cf the wo;
. 0 cig
performed. Indicate the value (rounded to the nearest do::ar) of I.
0 Demolition 1:I Other: mechanical materials, equipment, labor, overhead, and nrofi:
. .: .: , f.;..: . .•: ekt :: ::: - ,.,..•.. , 1 : - . .... , : f .i.::,T , •.;,.. ,. ..... :: i12' . ....:: . . .. .. .. , . Value: $
. / SYSTEMS FEES*
F44; and 2-family dwelling 0 Commercial/industrial D Accessory building
For special information use checklist
0 m-LI:i-famil 0 Master builder 0 Other:
Description Qty. I Ea. I To:a:
. . 10 1 3. :SITE:*,!**tTOIY, , 4`4itdiekil . p14 : . - 4:, • : . .' :. ...:.: . ; - ,.:.: , Heating/cooling
Job site address! 1/,,2(..,) 5 .5-1...d 8, Air conditioning or heat pump
(requires site plan showing placement) i / : 14.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) J 14.00
Furnace 100,000+ BTU (ducts/vents) . 17 90
Suite/bldg./apt. no.: Project name:
Gas heat pump I 14.00
Cross streetidirections to job site: Duct work I 14.00 I
Hydronic hot water system 14.00
/ ^ Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, no: electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
..".'..-".,...":'• .. 1 Water heater 10 00
Gas fireplace l 10.00
/ A/ 5 7 ./4- (..—.. Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
. Wood/pellet stove 10.00
Wood fireplace/insert 10.00
....--- ...,-... -........v.i . • • •-• - • . c ... -• •...., .:;, ,..-- Chimney/liner/flue/vent
lliie:tie .,:,,,....,.. ,..,,,-,:...!:.: . IG.00
10.00 ,
Name: c, j i _ r / / T ., / y v _ Environmental exhaust and ventilation 7
,'4 -i3' Range hood/other kitchen
Address: //c9? 0 .5 1 ,..41 r,3 equipment 10.00 i
City/State/ZIP: — 7 - 7 9 a.A.G.I.• 9 7.9.e9.3 Clothes dryer exhaust I 0.00
Single-duct exhaust (bathrooms,
Pho
( _ 1 .... - 3.... Fax: ( ) toilet compartments, utility rooms) 6.80
; ... -;......, 0 ywiliiki Attic/crawlspace fans 10.00
Other: 10.00
Business name: i
, Fuel piping
I
Contact name: $5.40 for first four; $1.00 for each additional --i
Furnace, etc. 1
Address:
Gas heat pump
City:State/ZIP: Wall/suspended/unit heater
i •
Phone: ( ) Fax: : ( ) : Water heater
Fireplace 1
E-mail: Range
':.:" ... ..i;'7'.';'! :.'4:'..' 6i3Renicia;g4ije.. ::::',.;:!-...''.'':':'.... . Barbecue • • .
• t Clothes dryer (gas)
Business name: C 4 4/1 6 , /1.C.,14 .77"14,. •4••• CR ft I, 4,C,,, i I
Other: I h 1 i
Address: 0 49 cr x, cR 3 '''7' !.:
City/State/ZEP: Subtotal
7/ 4 ..9-4-e) ora_- 9 7,,
Minimum permit fee ($72.50) 7 A..50
Phone: ( ,"63 ) c 4, , ,,, ri2 .... 7 0 07 ‘ I Fax: (520 ) , f a a 7 -
Plan review (25% of permit fee)
CCB tic.: 7 4 .9,5 9 State surcharge (8% of permit fee) :
TOTAL PERYLIT FEE 7 • 1.)
Authorized signature: ,!0...2-72..0.-40-.-e129e4--"--18-7, This permit application expires if 2 permit is not obtained within ISO
days after it has been accepted as complete.
Print name: i‘ 4_ 4, I Date: ,...._ 5 — _,..4/.--i3 5/ • Fee methodology set by Tri-County 3uilding Industry Service Roam
i ;3uilding\PermuNAIEC-PermitAppdoc :2:55 440 I 7T I :131'COMAVEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspectio ine: (503) 639 -4175 MST MM.
INSPECTION DIVISION, Busin Line: (503) 639 -4171
BUP
Received., I Date Requested AM PM BU
Location / 3 4e/ PVJ Q - Suite 00 — 00
p
Contact Person / Ph ( ) 6.R L i — R7 C' PLM
Contractor Ph ( ) SWR 1�
BUILDING Tenant/Owner ELC 1 `�-
Footing
Foundation ELC
Ftg Drain Access: Pp - & ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 1()��/ * 66. /
Framing V /
Insulation CZ-
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 PART FAIL
MECHANICAL
•
Post & Beam
Rough -In oil(/'
Gas Line
Smoke Dampers
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 0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line / �
ADA /� - �� D
Approach /Sidewalk Date v Inspector . f�� Ext
Other:
Final DO NOT REMOVE this Inspection record m the job site.
PASS PART FAIL
Mai 04 04 11:53a PAM DALBY 503- 598 -0270 p.3
r�
P4f'q. f x
eacitnev,4
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223 c
(53) 624-2704
FAX
(5 3) 598 -0270 RECEIVED
MAY J 2004
CITY OF TIGARD
BUILDING DIVISION
/ 0'
JOB ADDRESS: //47 !J-S c_SCA/
SITE PLAN FOR AC OUTDOOR UNIT .LOCATION