Permit CITY O F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00239
� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/9/03
PARCEL: 2S103AB -05100
SITE ADDRESS: 12254 SW 114TH TERR
SUBDIVISION: WALNUT GLEN ZONING: R -4.5
BLOCK: LOT: 009 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:
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: Install exterior AC unit. AC cannot be placed in the required set backs.
Owner: FEES
AU DIEP Description Date Amount
12254 SW 114TH TERRACE
TIGARD, OR 97223 [MECH] Permit Fee 5/9/03 $72.50
[TAX] 8% StateTax 5/9/03 $5.80
Phone: 503 709 - 7687 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 72623
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 4, Permittee Signature: ( Gj sit
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
t
Mechanical Penult Application tt1'r1(Y•. 151, 0 \1
Date received
- 3 Permit no, ■
44.41 City of Tig v E,._. add ,
S Address: 13125 SQ OR. igard, O 97223 Projecdappl. no.: Expire date:
City of Tigard
t '
Phone: (503) 639 -4171 l - Date issued: Receipt no.:
Fax: (503) 598 -1960 R, 41 Fax: b \. 1 Case file no.: Payment type:
Land use approval: It5 Building permit no.:
. I & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
0 New construction D4.ddition/alteration/replacement Q Other:
Job address: 1-2..Z. 5 - 5' �� / r y S� • �7 • ,, - Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value S
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: 0 jurisdiction's fee schedule for residential permit fee.
City/county: i ,.� �,. f I ZIP: .97 2:23 1 & 2 1: tNIIt.1 M1 El.LI`(: PER lI f FEE S(IIF.I u:
Description and locat'fon of work on premises: %ND (ONI tlERI(• 11. /INDI STRI U. FQI I PNUE NT SCHEDt'LE
./4- ( .40M o.-,.
Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Is existing space insulated? 0 Yes 0 No Air conditioning (site plan required) i'
Alteration of existing HVAC system
1l (.11-%:\ U. CON IR,1Cl OR Boiler /compressors
Business name: Trl County Temp COrZtrQ] State boiler permit no.:
HP Tons BTU/H
Address:
1 31 50 S . Clackamas R • ver Dr . Fire/smoke dampers/duct smoke detectors
City: Ore • on Cit State: • C ZIP: a (, Heat pump (site plan required)
Phone: 557 Fax: 557091 t E - mail: nsta rep ace mace .urner
CCB no.: 72 62 3 Including ductwork/vent liner Cl Yes O No
City/metro lie. no.: 1 1 2 6 InstalUreplace/relocate heaters - suspended,
wall, or floor mounted
Name (please print): Giesele Saha • on Vent for appliance other than furnace
('( /\ 1.1(1 Pf_12S(1\ Refrigeration:
Absorption units BTU /H
Name: Giesele Sahagon Chillers HP
Address: Same As Above Compressors HP
Environmental exhaust and ventilation:
City: I State: J ZIP: Appliance vent
Phone: 5 57-2220 Fax5 5 7091 9 E -mail: Dryer exhaust
Hoods, Type 1/ ll /res. kitchen/hazmat
hood fire suppression system
Name:k e ; /J Exhaust fan with single duct
r g (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: State l ZIP Fuel piping and distribution (up to 4 outlets)
Phone: 7 ,7 Fax: E -mail: Type: LPG NG Oil
Fuel pipineach additional over 4 outlets
Process ptptng (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: ZIP: Insert - type
Phone: ax: ail: ' Woodstove /pellet stove
Applicant's signature: _,/,,..e • WI Date: 5-//12_3 Other:
Name (print): Y. ;42 S / j __ /�
Other:
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee 5 _
0 Visa ❑ MasterCard Notice: This permit application Minimum fee S �7P IV) ,{� S
Credit card number: / expires if a permit is not obtained Plan review (at _ %) S - �(.�
Expires within 180 days after it has been State surcharge $ A 1j/ $• &'
arg (
Name of cardholder as shown on credit card accepted as complete. ♦ r
Cardholder signature $ TOTAL $ Art. ` __ —
Amount
.Q . /7S"
v._ .
a'd 6 (EOS) uo2eyeg a lase i
9 e S2:80 ED f3UJ ReW
Ma 08 03 08:25a Giesele Sahagon ['503) 557 -0919 p.3
•
"T=.1/4k4l
C4
5t--,__
_z,
r \
cam.
L ��
CITY OF TIGARD , 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INS TION DIVISION • Business Line: (503) 639 -4171 MST
'.
BUP
Received 5 • Date Requested S � CO AM PM BUP
Location 1 22 S 4- 4 T- Suite _ S- dQ 2-
Contact Person Ph (gS ) SC-7— 22 2-0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
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:
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
i PASS • 'T FAIL
t AL
Po . :earn
Rough -In
Gas Line
Dampers • Air
RT FAIL
C TRICAL
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 El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date,../ 1 � Inspe Ext
Other:
Final DO NOT REMOVE this inspection record rem the J : s site.
PASS PART FAIL