Permit 4 f
CITY TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00419
. ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
PARCEL: 2S114BB -13100
SITE ADDRESS: 16465 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R -12
BLOCK: LOT: 072 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:
ELE 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:
> GAS OUTLETS:
10000 cfm:
Remarks: AC install.
Owner: FEES
MORENO, JACOB Description Date Amount
16465 SW 104TH AVE [MECH] Permit Fee 6/29/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 6/29/200 $5.80
Phone: 503 - 598 - 0299 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 - 640 - 3607 Cooling Unt Insp
Final Inspection
Reg #: LIC 66578
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: 411111 - 'T 7 Permittee Signature: i - ._i /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mee,han•a1 Permit Abp cati FOR OFFICE USE ONLY
— Received / Mechanical Pa/ r�
�•
Date/2 : ° �t Permit NO,:
/ "
City of Tigard `� planning pp . e! Building
1312:; SW Hall Blvd. Date/By Permit No,:
^ �� O \, Plan Review Other
Tigard, Or :gon 97223 DateDy: Permit No -:
Phone:: 503 - 639 -4171 Fax: 503- 598 -1960 1 " Post - Review Land Use
4 Date/B nterr ct: �`wvV.ci- [igard on us CaseNo.:
I Contact Jl ^ - ® Sec 2 for
nt hour In -w winn g d.o r tt 503-639-417,5 R
Name/Method: Supplemental Information.
_ ^ - TYP E. OF WORK _ COMMERCIAL FEE* SCS3 DULE - USE C YLh CKl.15T
❑ New c mSn- action Demolition Mechanical permit fees* are based On 'the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
• CATEGQRY OF CONSTRUCTION materials, equipment, labor, overhead and profir-
_ ❑ 1 & 2- .Family dwelling Commercial/Industrial value: S See Page 2 for Fee Schedule
Aces ory Building ❑ Multi- Family - RESIDENTIAL.EQUIPNIENT /SYSTEMS FEE* SCHEDUYE: •
❑ hlasrct Builder I Other: DesertP °O" I Qty I Fev(ct.) J Total
J(t:13 SITE IN FORMATION and`I;OCATYON Heating/Cooling
Furnace - add -on air conditioning** t f 14.00
Job site address: to uf 1,r S $ , Ot--, Gas heat pump - _ 1 14,00
Suite Al: I Bldg. /Apt. #: _ Duct wo 14,00
Project Na me: Hydronic hot water system 14.00
Cross stret•t/Directions to job site: Residential boiler
(fur radiator or hydronic system) I 14.00 .
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) f 10.00
Subdivision: L ' Repair units 12.15
Tax map /p Ircel #:
Water Fuel Appliances -
Water heater _ f 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fire face) _ 10.00
'`� Log lighter (gas) I 10.00
- • wood/Pellet stove I 10.00
Wood fireplace /insert 10.00
Chimney/liner/flue/vent I 10.00
• PRQPEii •T'Y QWNFR . • TEIYANT • , • Other; 10.00
Name : , I L ,oYJ, 11-A-.01.2.-^-41 Sc
Environmental Exhaust ventilation
Address: Range hood/other kitchen equipment I 10.00
Ci /.i tate, Zip: Clothes dryer exhaust 10.00
PlLOiltt: � � t. Single duct exhaust
'I S i , 5 y Fax: (bathrooms, toilet compartments,
!♦ APPL`{C.ENT . .. " O CONTACT PERSON utiiiryrnnms) 6.80
Name: Attic/crawl space fans 10.00
AddFt'S5: Other: 1 0.00
City/State/ fate 71 -_ Fuel Piping
—�' * ($5.40 for first 4, 51.00 each additional)
Phone: I Fax: Furnace, etc, I •*
E -mail; - Gas heat pump
"" Wall/suspended/unit heater —
_ CONTRACTOR Water heater ••
Bus rrame:
� c C -k -c5- ra Fireplace :*
Address: L- G 1 � g
t ` z 7 I
City /State /Zi r� v.-cc Range *w
BBQ ••
H 6(. ,,_ )- ZT
PhOIlE' Clothes dryer (gas) •,,
360 Fa x: i v4 ` - 1- c 1-53 Other: .*
CCB Lie. 1E: ( Ur S y Total:
Authori :ed r
Signature! I G
�
Si ` t i ✓ �� Mechanical Permit Fees*
1 � - i- C : Date: /'/ r /o`/ Subtotal: I $
_ ytin itnuut Permit Fee $72.50 1 5 - 4 - z..- s v
— F - ` i -, ` -f ` U 1 c---'--, Plan Review Fee 25% of Permit Fee) 5
(Please print name) State Surcharge (8% of Permit Fee) 1 S ' - c'b
TOTAI PF.RMlT FEE I S '- i' Z c.
Notice: his pi unit application expires if a permit is not obtained within ' methodology set by Tri - County Building Industry Service Board.
180 days after is has been accepted as complete. **Site plan required for exterior A/C units.
i :\DStsWermit F. irms'MccperrnitApp,doc 01/03
2' BILO 136S COS 21.4I R'4Tezoadg dGT :IO 1s0 82 unr
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SITE PLAN
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S TREET
Specialty Heating & Cooling, +Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620:5643 Fax 503.598.0718
Hillsboro Phone 503.640-3607 Fax 503.681.0793
6'4 BILO 86S EOS ZurzeaH RieToacIS (AST:TO 40 R2 unr
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Bueiness Line: (503) 639 -4171
BUP
Received V � AM M �� r BUP
Location /b / Suite ,f gr c rOs' -
Contact Person Ph ( ) 64 ✓ O1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC C" ` � LP/
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors - b 9 _ Q LL 1
Ext Sheath/Shear �1 1
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: r `
Final
PASS PART FAIL
PLUMBING
) 34 7
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P RT FAIL
ECHANIC
Post & Beam
Rough -In c
`
Gas Line �'
S • ` Dampers
_RT FAIL
TRIC
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
41211r11•• Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
-' = PART FAIL
SITE Please call for reins•ection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector A Lf
� Ext
Other: � / v
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL