Permit ,�\ I CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00245
q.� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/5/2004
PARCEL: 2S114BB-21500
SITE ADDRESS: 16546 SW 103RD AVE
SUBDIVISION: RIVERVIEW ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 059 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: 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: 1
> 10000 cfm: GAS OUTLETS: 4
Remarks: Fireplace insert, piping, outlets.
Owner: FEES
SCHULZE, BJORN + Description Date Amount
ALLEN, TIMI L [MECH] Permit Fee 5/5/2004 $72.50
16546 SW 103RD AVE [TAX] 8% State Surchart 5/5/2004 $5.80
TIGARD, OR 97224
Phone: 503 670 - 1397 Total $78.30
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Misc. Inspection
Reg #: LIC 51469 Final Inspection
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: / / �JJ/ Permittee Signature: At, , Air 7 � A `
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
May-04-04 02 : 44P P . 0 2
Mee iiiPermit A lication , I ■ )1( (H 11( 1 , 1
City of Tigard BECE.141, Ei 5 Urld
• 0 Permit No. a ... " ....-.. Oa '....
13125 SW Ilan Blvd., Tigard. OR 97223 plan Review
other Permit:
Phone: 503.09.41171 Fax: 50.598.1960 DaretBy:
Intccction Line. 503.619.4175 _W. .1 i
I*AM --- --- Dare ItcadyrEly Se Pag for
0 e e 7
Suppleniental lattraistion
Internet: www.ciLigard,or.u.s Nur ifitii/Method: EN
BD
TYPE OF W§I QING OW (:OMMERCIAL FEE* SCHEDULE - USE CHECKLIST
• Mechanical permit free are based on the value of the work
[1 Ncw construction tal■Lition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition []Other: mechanical materials, ettipment labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION
- RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
trr- and 2-family dwelling 0 CommerCialAndustrial CI Accessory building
For speetal flIfOrlrail01711Se CheCkhIL
0 Multi- family 0 Master builder 0 Other: — —
Docription I Qty. I Ea J Total
- • '
JOB SITE INFORMATION AND LOCATION Heatinu/cuohing
- Air conditioning or heat pump
Joh site addn:ss: / -LT 7 / ( , „„ . .-5 e ...,...) , 1 ,Z2. /9‘) ( (r. site plan showing elaCtalen1) 14,00
.. orm/veinl_ 0
City/State/ZIP: / /c•I4? , ---k. (..") /".--,' c--...; Furnace 100,000 Bill W a 14.0
- 2--.;2
_
Furnace 100,000+ B11/ idneiwycntso 17.90 _
Suite/bldg./apt. no.: __.. I Project nanN:..-.-; i4' / 71-(21 -' Gas heat pump . 14.00 -
cross street/directions to job sLe: --- Duct work . 14.00
I-I/drunie hot water system 14.00
Residential boiler (radiator or
hydronic) , 14.00
Unit heaters (l=1-type not electric). ---
in-wail, in-duct, suspended, etc. 10.00
Flue/vent fnr atmof above 10.00
Subdivision; --- • Lot no.:
. _ — .
Other: _ 10.00_
Tax mop/parcel no.; Other fuel a i , anon
---
DESCRIPTION OF WORK Water heater 10,00
- Gas fireplace 10.00
____
72 / 1/4? // 4 ,0 & ..__L- /2 -.1: c r '7 !lye vent for water homer or gas
— ..-
fireplace 10.00
,- - -- .- Log lighter (gas) 10.00
- Woo dl k__ 10.00
Wood fireplace/insert / 10.00 /a a?)
ea ,
— - - - Chimney/linChimney/liner/flue/vent ,/ 10.00 /a
lir PROPERTY OWNE El R I TENANT
_
—
- -.- Other 10.00
Name: 77; i t e , /3 ....., ; 2 /),.. ............2 12 ,..,... .... Environmental exhaust and ventilation
-i . - Range hood/other kitchen
Address; / L 3 , 4 ...) ,/ r''' lq U (::_, equipment moo ,
City/State/ZIP: -/ - /,:-.?..q. , ..1-e_ on_ c.:i i.:, , Clothes dryer exhaust 10.00 .
Single-duct exhaust (bathrooms,
Phone: ('5623) - i. - / - 2(:)- .4 ci 7 Fax: ( ) ----'--- toilet compartments. utility rooms) 6.80 .
APPLICANT 0 CONTACT PERSON Attickrawlspace fans 10(X)
Other; 10.00
Business name: 2. 0 ee /pi 0 5
A7 _ _ Fuel piping
Contact name: , 4/ ' szVoc /I ti e A $5.40 for first four; SLOB for each iddttloia
1-- Furnace, etc.
Address: /A -5 v=4.) ei egi/e'rd A l R.
Gas heat pump
City/StateIZ13 a,i,- 7iies4 C7/2 / 9' 7 ac _ r,z WalVsuspended/unit hearer
__ --
Phone: (503) 0 v6,.. 6W6 f 7 FaX: : (545 ) Co 5 * cPC V Water hearer
E-mail: .31t
.. _
CONTRACTOR Barbecue
Business name: __
Izi..7*IF RP 4e--. Clothes dryer() ____
Address:
- - - MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal VC
Phone: ( ) _ . . Fax: ( ) Minimum permit fee ($72.50)
-- .- ----- Plan review (25% of permit fee)
CCT3 lic..: ....5") , V(sy ?.... 0 s.,3 p.... State surcharge (II% of permit fee) ,,50
---, . —
Authorized signature: T his PERMIT FEE — 7(F 4, 30
Au
This permit apphleati•si expires If • permit is sot obtarseci within 180
days after II has been accepted es complete.
I Prim minie- - - ------ - 7 r Me ) - — . - -7i P
7 . -
' ::3 — C ) ee methodology set by Tri--County Building Industry Service Board
CITY OF TI -CARD 24 -Hour •
BUILDING Inspection Line: (509) 6394175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested
�, / a AM PM BUP
Location f .S q �P J e A—e Suite MEC ag �U a �S
Contact Person Ph ( ) PLM
Contractor Ph ( ) 6 4 /4 `40. SWR
BUILDING Tenant/0C p ELC
Footing " i3 6 7 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing °l S � !•-' ' C � . ' t :: . X At
Insulation
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
Gas Line
Smoke Dampers
PART FAIL
L
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
Approach/Sidewalk Date S g '� C) Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL