Permit CITY OF T MECHANICAL
f11
DEVELOPMENT SERVICES PERMIT PERMIT a MEG98 -0577
DATE ISSUED: 12/30/98
PARCEL: 1S135DC- 04301
SITE ADDRESS...: 11950 SW 95TH AVE
SUBDIVISION....: ZONING: R -4.5
BLOCK LOT JURISDICTION: TIG
CLASS OF WORK..:ALT • FLOOR FURN....: '0 EVAP COOLERS: 0
TYPE OF USE.....: SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES........: 0 BOILERS /COMPRESSORS HOODS : 0
FUEL TYPES • 0 -3 HP....: 0 DOMES. INCIN: 0
:GAS 3 -15 HP : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP ° 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30 -50 HP....: 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP....: 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 1
FURN < 100K BTU: 0 <= 10000 cfm: 0 • GAS OUTLETS.: 1
FURN > =100K BTU: 0 > 10000 cfm: 0
Remarks : Gas fireplace insert and gas piping
Owner: FEES
ALYCE THOMSON type amount by date recpt
11950 SW 95TH AVE PRMT $ 25.00 B 12/30/98 98- 311829
TIGARD OR 97223 5PCT $ 1.25 B 12/30/98 98- 311829
•
Phone #:
Contractor: -----
B & T GAS SERVICE INC
KEITH TEASDALE
8528 SW 190TH AVE $ 26.25 TOTAL
BEAVERTON OR 97007
Phone #: 642 -7243
Reg #..: 000911 •
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
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 by 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 BUNG by calling
(503)246 -9187.
•
• $ r .
Issue By: 15 ce - Permittee Signature. _! 0 ,, 1._�
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
- Plan Check #
CITY OF TIGARD Mechanical Permit Application Redd By if
` 13125 SW HALL . BLVD. Commercial and Residential Date Recd AN
TIGARD, OR 97223 - Date to P.E.
M 1 (503) 639 -4171, x304 Date to DST
F Print or Type Permit # 1��- ° 6 - OS�
Called
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
Table 1A Mechanical Code OW PRICE AMT
Job Street Address Suite* A) Permit Fee -0- -0- 10.00
Address
Bidg# City/State zip B) Supplemental Permit 3.00
t Name (or name of business) 1.) Furnace to 100,000 BTU 6.00
a Owner [,h 1 (2_ -'f 5o/J incl. ducts & vents
h ! mg { 4ddress Oct() C 2.) Furnace 100,000 BTU + 7.50
9 / ✓ incl. ducts & vents
C r Zip Phone 3.) Floor Furnace 6.00
t �l()y ind. vent
Naameo n n of tfu�) 4 .) Suspended heater, wall heater 6.00
.� or floor mounted heater
Occupant Mailing Address 5.) Vent not incl. in 3.00
appliance permit
City/State Zip f Phone 6.) Boiler or comp, heat pump, air cond. 6.00
1 to 3 HP; absorp unit to 100K BTU
Name c- 7.) Boiler or comp, heat pump, air cond. 11.00
13*-T S E]2u / CD Or 3-15 HP; absorp unit to 500K BTU
Contractor `� , \ ) 8.) Boiler or comp, t pump, air cond.
15-30 HP; absorp unit .5-1 mil BTU
15:00
O`� l�J
Attach copy of nyrs+ate ���� �yyp� Zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
Current Licenses 2Q.UQ f'�. do ( 7(t)1 f2La= l 2 30-50 HP; absorp unit 1 -1.75 mil BTU
Oregon � t Cont. �
�.# Exp. Date � � � 10.) Boiler or comp, heat pump, air cond. 37.50
( > > 50 HP; absorp unit 1.75 mil BTU
CDT T ° Exp. Date 11.) Air handling unit to 4.50
7z /0 f7 10,000
Architect Name D 12.) Air handling unit 7.50
10,000 CTM +
or 7 m9 Address 13.) Non portable 4.50
evaporate cooler
Engineer cityrsrate 14 Vent fan connected 3.00
to a single dud
Describe work New 0 Addition 0 Alteration 0 Repair 0 15.) Ventilation system not 4.50
ij " - to be done Residential ® Non-residential 0 included in appliance permit
Additional • tion of work 16.) Hood served by
1 3 : �1 klQ ' G _ /� - k C IL-) mechanical exhaust 4.50
,3
4 4 - - " 17) Domestic incinerators 7.50
Existing use of 18.) Commercial or industrial 30.00
building or property . •• type incinerator
•
i -
19.) Clothes dryers, etc. 4.50
a Proposed use of 20) Other units 4.50 0
building or property
ri r� -.e.. � •
o
ii Type of fuel - oil 0 natural gas ® LPG 0 electric 0 21) Gas piping one to four outlets 2.00 *�
ff
a I hereby acknowledge that I have read this application, that the 22) More than 4 -per outlet (each) .50 ze
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL '; . � `.' O.
laws. „' "x l'e' `!> ' J Signature Owner/Agent Date 'SUBTOTAL X. "
C" • / M L 5 %SURCHARGE I
l Contact Pe • Name Phone PLAN REVIEW 25% OF SUBTOTAL 1 : <3, rr 6r-z2A0/1/76. oli,)--2,9-(6 TOTAL . 1; .., . _ N
eldstimechpmt oc , . *Minimum permit fee is $25 + 5% surcharge j
Rev 7/96: Y n{� rZ 'C.
6/16/00 Activities for Case #: MEC98 -00577
2:00:23 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 12/30/98 B RECD DST 12/30/98
MECA008 Create Permit 12/30/98 B DONE DST 12/30/98
MECA799 Final Inspection 1/5/99 WDJ PASS WDJ 1/5/99
MECA705 Gas Line Insp 12/30/98 1/5/99 WDJ PASS WDJ 1/5/99 Secure gas line at exterior of
house Gas tag #344103
MECA750 Misc. Inspection 12/30/98 1/5/99 WDJ PASS WDJ 1/5/99 Gas insert
MECA060 (F) Issue permit 12/30/98 B PASS DST 12/30/98
MECA800 Case Finaled 1/21/99 JT 1/21/99
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ ;� =.;'?l BUP
/.', 27 Date Requested /�_�/ Y 9 AM >(X PM r r
Location /79_50 5 t) % 714 A/6_ Suite MEC 91" — 015
Contact Person ��� jf / 62-s Ph 62V_D -7 5 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC ="
Retaining Wall ELR "!�
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing 5 C�cit e 2 4. 0 4- �L.Fiu�t3^ c
Insulation
Drywall Nailing :2
Firewall Y Y O�
Fire Sprinkler CL.0 I
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
MECHANICAL
Post & Beam
Rough In
as Line 06 5141e "
mo a Dampers /J
A SS PART FAIL AL, (N� i�G� //
ELECTRICAL ..
Service
Rough In 7
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 I IS 111 Inspector W,VV\O./ Ext (//
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.