Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00316
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/23/02
PARCEL: 2S 110DA -09200
SITE ADDRESS: 15287 SW 107TH TERR
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 053 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: Install exterior AC unit. Cannot be placed in required setbacks.
Owner: FEES
DENZIL DAVIS Type By Date Amount Receipt
15287 SW 107TH TERR. PRMT CTR 7/23/02 $72.50 2720020000
TIGARD, OR 97224 5PCT CTR 7/23/02 $5.80 2720020000
Total $78.30
Phone: 503 - 620 -8504
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
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 copies of these rules or direct questions to OUNC by calling (503)246-9189.
Issue By: &,zi-a -c_et_ /5e, 6A, Permittee Signature:
in day
Jul- 1.1 -02 06:07A P.02
el
. ` . •
' � r j i Ti
Mechanical Permit Application
Date received: 7/9.3 y Per no. � - C V b
t City of >tgard 11 , .� `q' Projecdappl_ no Expire date:
f n
city Ti old Address: 13125 SW Half Blvd. •i t23 -
Y Phone: (503) 639-4171 Date Issued: - BZ I Receipt no
Fax: (5(3) 5') -19611 JUL 1 I 2 " Case file no.: - Payment type:
-
Land use approval: , ►_ l L �tS Huildin ermitnn
s l;p.:
TYPE OF PERMIT
• & 2 family dwelling or accessory CI Commercial/industrial LI Multi- family U Tenant improvement
• New construction U Addition /alteration/replacement CI Other: _.. .
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ' ri IC fti T k‘ /.- t . Indicate equipment quantities in boxes below. Indicate the doll:u
Bldg. no.: / .t 2-__ }' 7 { `uitr tut.: - - value of all mechanical materials, ntluiprittml, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: Block: [Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
�-' I : a_ 2FAMILI ' 'DW`EL11NG`PERMIT a"SCI I rout
City/county: t t {}l -- FLIP: CO � .,,J � -
Dcscriplior td ation f work on pren li.ir. ti: .,.__ { AND COMMERICAL/INDUSi'RIAL EQUIPMENTSCHEDl1LE
-- _ -._.. . ...- I'cc(ea) Total •
Est. date of completion/inspection: Descripdon Qty. RCN- only Res. only
-
'Tenant improvement or change of use: IiVAC:
space heated or conditioned'! U Yes U No Air handling unit C -__
Is existing p" Air conditioning (site plan rcquired)
Is existing space insulated? CI Ye.s ❑ No Alteration of existing IIVAC system
AIECHANItAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: _ • ' & F 4. e- HI' Tons BTU /II
Address: ��°L �(. • l 1• . Fire /smoke dampers/duct smlokedetecwn -
City: ' + �(� s 1,,C')( I ' /Il'.(._, _7.. Heat pump (site Plan regwrett)
Phone - D - � - ' Fax: ' ` i , 3 f i -mail: Install/�eplaeefm'nat furnace/burner BTU /1 I
including ductwork/vent liner 0 Yes U No
(_CI3 no.: r - - _,_,_„ - Install/ replace /relocate heaters -sn:ij nilcd,
City /metro I ic_ no.: (> _ _ wall, or floor mounted -
f Vent for
Name (please print): --' _ A Or C.: �_, ....., appliance other than furn , I
CONTACT PERSON ' Absorption units Absorption units 111'tr /11
c� T Chillers . __..._... HP
Name: �• (; r t,.,, Compressors HP
Address: ._..,. _ F,mironmental exhaust and ventilation:
City: _ I Slim!: I ZIP: Appliance vent
Phone: Fax: I E -mail: Dryer e ^.,T_ . - - -' _
• OWNER I Ioods, Type 1/ II/res. kjtchen/hazn at
\----) hood fire suppression system
Name: ,( < 7. , \ (;t} , 5 Exhaust fan with single duct (bath gene) I . ,..
Mailing address: I ' - ' ` J \ r -e --- . Exhaust system apart from heating of AC -
City: 'r • Stater I %l i'�� L uc p tptng and urn when ( to 3 au('dls1
- Type' -- -LPG - NG I _
Phone: . • t w` ._ 1 ax: E. mail: Fuel i in each additional over out leI
ENGINEER Process piping (schematic required ._
Nuttber of outlets
Name:
_ _ Oilier race appliance or equipment: •
Address: I )ccorative fireplace __
_
City: I Stit: 1 7 P: Insert - type ..... _
Phone: i Fax: 1E mail: 7 / Z � Woodstove /pcllet - _.. -
l�at Other: i •
Applicant's Sig a u Other: '
Name (print): .
—_... • . --
Pcrntft rep .....
Nor all tnrisdicriuul acredit rrk
eFx credit rants please call ja c ixl,�ua� I�.a ma nrtv. mn
n .v � ......... �.... • - .... -. ' -
Notice: This permit application Minimum ......
❑ UMasferCoit ...... .
expires if a permit is not obtained , review
Creditcudauotbe+. _.._ -
}Ian ir'ti ( :It __ <' - %) T+ _ -/ j
- .
t..:P,r „s within ISO days alter it has been , S _1J state
- Manx of cudi+okSo as shown on credit cad accepted as complete. rOTAi, S • (6/(101C. !�
( * ,auii,ter aignarore A mount , • 4 404617 OM)
6 0 2 S
Jul -17 -02 06:O7A P -03
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503 - z3 V- 7 33 /
!ax _ 5O3 f ?i5 - 172_57
CITY OF TIGARD 24 -Hour
BUILDING fa Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST -
* BUP
Received Date Requested g I AM PM BUP
Location / /.0 7 5 Suite MEC 3/ {v
•
Contact Person ( c Ph ( ) (o— J 85 LI PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC oe73
Footing
Foundation ELC
Ftg Drain ess: ELR
Crawl Drain
Slab Inspection Notes: Q SIT
Post & Beam U. 3 0 s 3,30
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
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 FAIL
HANICAL
Rough -In
Gas Line
Smoke Dampers
, PART FAIL
' ICA
e e
Rough -In
UG /Slab
Low Voltage
Fire Alarm
i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line /
ADA Approach /Sidewalk Date o ` ` a ! b � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL