Permit CITY OF TIGARD
� DEVELOPMENT SERVICES MECHANICAL PERMIT PERMIT #: MEC2000 -00177
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/10/2000
PARCEL: 2S 111 AD -16000
SITE ADDRESS: 14972 SW 91ST AVE
SUBDIVISION: MALLARD LAKES ZONING: R - 4.5
BLOCK: LOT: 026 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: 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of an air conditioning unit. NC units cannot be placed within the required setback areas.
Owner: FEES
DANIELSON, MARK A + SHARON E Type By Date Amount Receipt
14972 SW 91ST AVE PRMT GEO 05/10/20( $50.00 0002060
TIGARD, OR 97224 5PCT GEO 05110/20( $4.00 0002060
Total $54.00
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Cooling Unt lnsp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
()RION.
•
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 •pie o these . es or direct questions to OUNC by calling (503)246 -9189.
Issue By:
e , � � Permittee Signature: ��
Call (50 ,49-4175 by 7:00 P.M. for inspections needed the next business day
' • Plan Check #
CITY OF TIGARD REcEpftchanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 MAY 1 0 2000 Date to P.E.
(503) 639 -4171, x304 Date to DST
COMMUNgY DEVELOPMENT Print or Type Permit # /{k Ab617 - r66 /q�-
• Incomplete' or applications will not be accepted Called
Namect Development/Project Description • V -
,u no R Ac, Ma _ i p Table 1A Mechanical Code Qty Price Amt
Job Street Address -- _ J - • so-vu si;ite# A) Permit Fee ",' :A 16.00
' Address ) L) 97," 3 co � s7 1) Furnace to ducts & 0 BTU
_ including ducts & vents see footnote 1,2 9.65
Bldg# Cit /State Zip 2) Furnace 100,000 BTU+
1 GG c ( oR 9 jr aQ L' including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner Y�CZ - )c b yv t �1 Off% including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
V. or floor mounted heater see footnote 1,2 9.65
) - 97c 9 I 3to I 5) Vent not included in appliance permit 4.75
City /State Zip / Phone Check all that apply: ( `Boiler Heat Air
- 5. ` a rC1 � 02 s ] vacDef i,,a .P59 For items 6 -10, see or Pump Cond Qty Price Amt
Na rh2 (or name of business) footnotes 1,2 1 -omp
6) <3HP;absorb unit to /
100K BTU I ) 9.65 ?, 6
Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
9) 30 -50 HP; absorb
Contractor � me unit 1 -1.75 mil BTU 36.00
LoCO1 Re CC t yu J Er A 1 0- 10) >50HP; absorb unit
Prior to permit Mailing Address / >1.75 mil BTU 60.15
1
issuance, a copy Ll e )i /1 /GU t t Uv) P 4.1-e • 11 Air handling unit to 10,000 CFM
of all licenses city /state - Zip Phone - -
are required if � el- )Fyyt Ole ?706 a 3 L/- 733) 12) Air handling unit CFM+ "• •
expired in COT- Oregon Const. Cont. Board Lic.# Exp. Date - . 11.75
database i 4 1 y 13) Non - portable evaporate cooler
Architect Name - 7.00
14) Vent fan connected to a single duct
4.75
or Mailing Address
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) Repair 0 Replace with like kind: Yes O No O 18) Commercial or industrial type incinerator
Residential 0 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 0 LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL a (5 CC
I hereby acknowledge that I have read this application, that the information 95 A SURCHARGE :!:04:4W 2 /.06
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 `'� , //JJ
Signature of Owner /Agent Date J%
/� / c Other Inspections and Fees:
. ./J'L/AA 2J `'LO - (5 - 3 '00 1. Inspections outside of normal business hours (mininum charge -two
Contact Person N41 Phone hours) $50.00 per hour
2. Inspections for which no fee is specifically indicated (minimum
1� I ✓ C U $ L(Q (A) 073 L/ - 233 / charge -half hour) $50.00 per hour
Foonotes for com 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:\mechperm.doc rev 02/4/99
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 .Business Line: 639 -4171
BUP
Date Requested , AM PM BLD
Location d 4 / 7 /'( Suite MEC , , e 9 0 ° 6 3 1 77
Contact Person Ph PLM
Contractor Ph SWR
• BUILDING Tenant/OIL I tad/' �� g /<S 7 ELC ( 9-607 60238
Retaining Wall ELR
Footing
Foundation Access: �_ 1< _� FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear "
Framing
Insulation
Drywall Nailing 7-tt 1-4) t C) /97
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling " e9t 2 -7?
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out We.
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smo a Dampers
ASS " ART FAIL
'ErEttRICAL
Service
Rough In C
UG /Slab
Low Voltage
Fire Alarm
CM'
PASS 'ART FAIL
trrr
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 eV Inspector Ext
Final
PASS PART FAIL 0 NOT REMOVE this inspection record from the job site.