Permit • CITY OF TIGARD MECHANICAL PERMIT
4 A111 fk DEVELOPMENT SERVICES PERMIT #: MEC2002 -00580
- .- I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 12/17/02
PARCEL: 1 S134DC -02200
SITE ADDRESS: 11670 SW 114TH PL
SUBDIVISION: 114TH PLACE ZONING: R -4.5
BLOCK: LOT: 015 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: 1
Remarks: Installation of gas piping and gas fireplace insert.
Owner: FEES
CINDY OLSON Description Date Amount
11670 SW 114TH PL
TIGARD, OR 97223 [MECH] Permit Fee 12/17/02 $72.50
[TAX] 8% StateTax 12/17/02 $5.80
Phone: 503 - 598 - 7701 Total $78.30
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -669•
Issued By: _A► � �� - Permittee Signature: ()AI
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
•
Dec -11 -02 05:52P P.02
- _..
. ' Mechanical Permit Application
- Date received: ,t /1 D_ • rant no.// ' 'DOS'/
,41'.. - l City of Tigard FRn Uappl.no -: Expire date:
N !� � ,, Ins
Address: 13125 SW Hall T3lvd', ' i i
City of Tigard a A• 1 itte issued: Hy: I Receipt no.: _
Phone: (503) 639 -4171 ,fie
�
Fax: (503) 598-1960 700 '� j 33 ! I xe fileno.; Payment type: .. Land use approval: 6 Building permit no.:
l'!..11)}. IL.' 'CRMIIT
'4 2 family dwelling or accessory ❑ Commercial/industrial U Multi- family U Tenant improvement
U New construction ❑ Addition /alteration/replacement U Other: „. _____..,,.
,LOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 1(1 Q 1 4 ' .01 a — indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: - 3 Suite no,: _ value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account nn.: profit. Value $ -
Lot : ock; I Subdivision: •Scc checklist for important application information and
project name.: ./ jurisdiction's fee schedule for residential permit fee.
Ciry /county: CA Z — 1 % I I': ' 1 .4 2 FAMILY UWEL(.1NG PERMIT l l`E'S('IIEDTIT.F,
Description T , location f work un premises: -. - • — AND COMMERICAL /INDUSTRIAL LOU PMENT SCI IEDI'LE
Q
, r• , G■ C -t` - Fee (ea.) Total
Est_ date of completio /inspection; Description Qty. R4N.unly Res.only
IIVAC:
Tenant improvement or change of use: Air handling unit C Flvl
Is existing space. heated or conditioned? U Yes 0 No . •
Air conditioning (site plan required)
Is existing space insulated? U Yes U No A existing HVAC system,
MECHANICAL EC'IIANI('AL ( :ONTRACIOR .oiler/compfessors
State boiler permit no.:
Business name:�,, �(� fa C G (,- ' - }4Q r,4 ►, . T HP _ Tons 11111.1/H Address: IA `2, tl� 0..0..... mpers/ductsmoke detectors •
, 1 �. . " ' Fire /smokeda
City ' 4 `: • Sta 7 `> . Heat pump (site plan required) —
Phone, J -' F ax �.' C -ntaiL - Install/rcplacefumaec /burner 13TU /II
7 In ductwork /vent liner ,ct 0 No �r _
CCB no.: — instaltJreplace/rehxalt:heater suspended.
wall, nr floor mou nted'
City/metro lie_ no.: _l. c - • -
Name (please print): s h _ t_ v —., C,- Vent for appliance other than furnace
Re sorpt i n units BTU /II
Name: ,. Chillers
ance: Chillers _ HP
- Compressors _ , ... I IP
Address: _ Environmental exhaust and ventilation:
City: Stott : 1 ZIP
Appliance vent
Phone: Fax: E -mail: Dryercxhaust
OWNER y 11oods, Type I/ lures. kitchen/hazing
hood fire suppression system .. .. • •, . —
Name: 0 SO NG fan with single duct (bath fans)
` 1 l l• e it , Exhaust system apart from heating or AC
Ci t y : b addre s: i 1 . _ , > Fuel piping and distlr}M,if�on (up i.i 4 outlets
r ye )
City: t • J l'ta j ZIP: a�
Tyre. .. U'G NG _ Oil � ��
Phone Ammo Fax: Email: Fuel piping each additional over 4 outlets IMI
FNGINLLR ' racess piping (schematic required )
Number of outlets
Name: other listed appliance or equipment:
Address: _ _ t)ecnrative -
T
City: _ I State: l %11'' Insert type --
_ El
Phone: 1 Fax: J;- rttail: W siirve/pellctstove . _
Other:
Applicant's sig u 1 U:u m i .0_ b _. _
1
Name (print): IJu 1 ... s ll 50 .. •
Permit lee , $
Nat all jvai9dantiettas tes cravlit cant., I>u:as:• f all juriaiicliun Iv! m oM rn
infar:atiui Notice: This 'mind applicatiuu Minimum let. S
V Visa ❑ MasterCas exp if a permit is n o btained , (`
(watt caul nUml#r . __ .. Plan rY.V4C.V,' (:It %.) __ � 1
E nt within 180 days after i t h a>_c b e e n
1 S tate stiteharic (8%) ,.,. $
accepted as complete. TOTAL $ C
Name
tit cardholder ax x cardholder ho +n on credit cud $ _
t
Cadholder cignatutc ... Annual 41041517 (firtlu/COMI
X5 3
CITY OF TIGARD 24 -Hour
BUILDINGr" • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 3 -/D AM PM BUP
Location 1 ! ( 70 1 / y Pt- Suite MEC ODO a — " 5-8'
Contact Person Ph ( ) sV' 7 7 / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
( ------- 2
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
Rou• I -In
•ke Dampers
AO PART FAIL
ECTRICAL
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: Ei Unable to inspect — no access
Fire Supply Line D �j /
Approach/Sidewalk
Date ✓ e , o� Inspector Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL