Permit •
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00259
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/11/2004
PARCEL: 1 S 134AC -07200
SITE ADDRESS: 10898 SW 111TH AVE
SUBDIVISION: JEFFREY ESTATES ZONING: R -4.5
BLOCK: LOT: 005 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: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace with like kind.
Owner: FEES
REESE, LYLE A + MARCELLA D Description Date Amount
10898 SW 111TH AVENUE [MECH] Permit Fee 5/11/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 5/11/200 $5.80
Phone: 503 - 557 - 5562 Total $78.30
Contractor:
MILWAUKIE HEATING & COOLING
9961 A HIGHWAY 212
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 104102
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 4 l e • .ugh OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) • 6 -6699.
•
Issu - • By: ) _ �• jr , , � ... � Permittee Signature: ` A& c.. p414 (I �
Call (503) • 39 -4175 by 7:00 P.M. for inspections needed the next • usiness day
M 0 04 07:26a v Mi. lwaukie Htg_8, Clg 503 - 557 -0790 y p.1
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Mechanical Permit Application
► EG L. vt D 13 ,eceived: O.,/ t t :, 11-
'
City of projoctlalepl pc-: due:
Crry aff'igard Addr 13125 Ball Blvd, T 0
td. Date issued: S no.:
Phone: (503) 639 -49-4 171 .I
Fax: (503) 598 -1960 Ao..
CITY OF TIGARD Building
Land use approval:
1 & 2 family dwelling or accessory CI CommerciaYndastnal C Multi- family 0 Tenant improvement
CI New construction 0 Addition /altaatioefrepincetfent 0 Other:
JOR SITE F\FOlC%1AT1ON - • • COMMI :1R(I \L VALUATION SCHEDL LE
lob address: f LJ I / Indicate equipment quantities m boxes below. Indicate the. dollar
Bldg. no -: 1 Suite no.: value of all mechanical materials. equipment_ labor. overhead,
Tax map/tax lot/account no.: profit. Value $ .
Lot: - lino& 1Subdivisiioa •Sex checklist for important ilpplication iuSotnnation and
Pro'cct name: jurisdiction's fee sctrcdule for residential permit fee.
Ow/county: IIMPro11111111111 ZIP: • 2, i I S. 2 FA%llI.Y D11 LI LING. PERMIT FEEE. SCHEDULE
Description and i , r worA. on premises: AND COMNIERICAI.• N131.'S ;R1 41 EQL:IY1I ENT SCI 1ED1'LE
`(- [�4S 'Ff.)irr�c (.. Fee (m.) Torsi
—
Fat. date of completion/inspection: ,'�- 26 —U 4 Qty. a Res. only Irmo* Ten ant improvement or change of use � H unit tf
Is existing space heated O honed? Id lies 0 No (y�ccplant aittircd) .
Is existing space insalatrd4lJ Yes 0No 1 Alteration ofex sdn. HVACaystem .
MEC:HAMM(AL CONTRACT
Business name: a I fillargiginriMMIN t Stare boiler pecnirno.:
HP _____„ Tons BTU/11
Address ICI C-, ( i 2, _ Firefsmottedanwers /duttmaokedetccwrc
City_ a c ab►-L State:(* ZIP: ' / lira.. ., , elite pberequlrod,
Phone. fax: ST -07f6 Trntat ins ;1 -... -1 - - "r' . - L7:
Including ductworklYcat liner ' ' es 0 No • CCB - o �� L - _ Insull/reptacelrelocareh -- suspended. •
City /metro tic. no.: j () • i wal, or floor mounted
Name (please perm[): -tie < (4\i< I . Vmr for apprizesother than funteoe
(ONrAC'I .ICRSON
_ Absorption units g"ru/H _
Name: -C L(( IC (r ti Chinas HP
•. SEP
Address: _ ental exhaust and sainasaliose i .
OW: State: 1 ZIP: Appliance vent
Pftottc Falc E-mail: ■ Dryer
�� OWW ER Roods, Type t7IVrcs tttcbes1baz
11L::k.CiM I s hood fn a n with n system
e tict
h 1 e L i cod fire s ingle dtra (bath ferns)
e - a system (an hating or AC
C tu"liag 1n 7 2s 1 F1aet piping and a rice (up to. enacts)
� w" • T • _LPG NG t?A
Phone: ft•/�r�l Fax: E-mai : 't*s y, n . each additional over 4 oa ss
LNGINF.F.it . - - - _ ..
Name: . ` Ntmibcr ofoutlets
OtherlistaiapKtance or equipment
Address. 1 Detutativcfirepinee
CUT 1 State J ZIP: I , —ty — ., .
I 1E-mail: Woodnnvelpet eiatovc
AApp icant's sigaultce: -,,. . I Date: 5—/eX- G tt °th .
Name (print): "7 l /11� I
Faf
cwt ,tl eedu c.ax prove can JeA1eeb star mac reoeiae� Permit fee ........... _... $
o VSsa o Nlotioc. This perm app Minimum tee $
c]•ail airs .mew / / expires if a permit n not obtained Pla review (u %) $
Es1a..a within 180 days eta it has beta State (8 %) .... $
Name of alder n uborn o0 oath coo accepted as coaipletc TOTAL ..... ..... .. ..........::. S
• S
______ _ assort Moms , 410 ‘000003 1
0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 639 -4175
INSP�ECTHDN DIVISION Business Li (503) 639 -4171 MST —
.,,
BUP
Received pate Requested - 7 - AM PM BUP
Location / 0 S g // / Y+ /r1/'— Suite 66 , V -66 215
Contact Person a� 'ILL Ph ( ) 557- ..576 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ v _3 — T 9 S3 ELC
Footing f. •
Foundation ELC
Ftg Drain Access: me era:- IDAKor' lo, G el l a r9=
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear � - �( n
Int Sheath/Shear \/\i'\ /l 'A9 '/ n v \ —6__/ ) / '+
Framing ►� ►� 1
Insulation 2, ��"
Drywall Nailing � �
Firewall
Fire Sprinkler
Fire Alarm GyT (--t �l U � �/
Lo /CL- EC"?v ti/
Susp'd Ceiling 1
Roof /S_ve - N — r
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
--------• Ir P 6
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
CHA fAL
Post &Beam DO G-
Rough -In
Gas Line
Smoke Dampers
it* PART FAIL
CTRICAL
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 ice r7 Approach/Sidewalk Date r ✓ D Inspector _ �A Ext
Other:
Final DO NOT REMOVE this Inspection reco i from the job site.
PASS PART FAIL