Permit w
r
dlit. C ITY OF TI GA R/ MECHANICAL PERMIT
DEVELOPMENT SERVI PERMIT #: MEC2004-00418
. .� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
PARCEL: 2S103BD -07200
SITE ADDRESS: 12517 SW 115TH AVE
SUBDIVISION: HUNTER'S GLEN ZONING: R -4.5
BLOCK: LOT: 028 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install.
Owner: FEES
BAYLEY, GLEN M + LAURIE M Description Date Amount
12517 SW 115TH AVE [MECH] Permit Fee 6/29/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/29/200 $5.80
Phone: 503 - 579 - 6112 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 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: ` W _ — _ Permittee Signature: �,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
FOR OFFICE USE ONLY
Ole ha meal Permit Application „Receive. Mecha ,p p D
• . nate/B.d / Permit Nol�gbae -
City t ^[ ilgar d Planning Appr. it
DatefB Building
Permit No.:
13125 SW Hill Blvd. Plan Review Other
Tigard, Oreg m 97223 DatrJgv: Permit Mrs.!
Phone: 503 i39-4171 Fax: 503- 593- 1960 •� Post
Dates : Land Use
C cNo.:
Internet: wv, w.ci,tigard.or,us ,�a iJ.- .� II Contact >.e See Page 2 for
24-hour lnsp .tenon Request: 503 - 639 °� y
Name/NlCthuJ: liGni Su • • tcmcntat Inform ttioa.
TYt'E OF WORKS . COMMERCIAL FEE* sTR -EnTIt s - USE CHECKLIST .
II New construction ❑ Demolition Mechanical permit fees" are based on the total value of the work
❑ Additiol 1/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION . mechanical materials, equipment, labor, overhead and profit.
• �' l & 2 -F tmily dwelling El Commercial/Industrial Value: S See Page 2 for Fee Schedule
DI Ac :essc ry Building El Multi- Family R STDENTTAL:EQUIPMENT /SYSTEMS FEE* SalEM LE
Desc ption 7 Qtv I tee( { Total
❑ Master l3uilder [l Other: Heating/Coolin
• • JO13 SITE INFORMATION and LOCATION • . " Furnace - add -on air conditioning!* 1 14.00
Job site adc ress: ( C I i ,. C:.,.5 I (S b Gas heat puma I 14,00
Suite ;:.': Bldg. /Apt #: Duct work I 1400
Pro ect Nat e: Hydronic hot water system I 14.00
Residential boiler
Cross strcc' /Directions to job site: (for radiator or hydronic szctem) - 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) I 14.00
Plue/vent for any of above) I 10.00 .
I O C #: Re units i 12.15
Subdi'r1Siat t: Other Fuel Ap !lances
Tax m _ ap /p;trcel #: Water heater l 10.00
DESCRIPTION OF WORK Gas fireplace ! 10.00
Flue vent (water heater /gas fireplace) _ 10.00
I ,J`�L l:t� �� Log lighter (gas) I 10.00
w - Wuod/Pcllet stove 10.00
_ Wood fireplace/insert i 10.00
Chimney /liner /flue /vent ( 10,00
• PROPENTY OWNER . I El TENANT .. •,. • Other I 10.00
_ Environmental Exhaust St Ventilation
NcitTlEt: C•- l,L`L:Z k` el-4 'y" Range hood/other kitchen equipment 10.
� _ ` h00
� � � _ 1
AddI1.SS. �F} I � � cloth dryer exhaust _ 10.00
CA /State /Zip: Single duct exhaust
Phon : c' G J - 6 i (L= Fax: (bathrooms, toilet compartments,
• AP;'LIC..NT ❑'CONTACT' P ERSON >': utility rooms) 6.80
Name: Attic/crawl space fans I 10.00
---� Other: I I 0.00
Addri.;ss: Fuel Piping
City/State/Zip:. -" 55.40 for first 4, SLOP each additional
�T Furnace, etc. **
Phone: f Fax: - Gas heat pump I **
E -mail: wall /suspended/unit heater I "•
--■.._ CONTRACTOR.' Water heater I " '
Business Name: S ' C--(, i --1-t c r Fireplace 1 a 4
Al It
Address: 1 ti- i• I SC- K� v r 4.e f . ltan_c _ ! **
BBQ .
Cit /Start /Zip: 1fi' 1. IS 4i - \• - c j " , e / t om ( L 7 Clothes dryer (gas) I
Phone: t-i c - ? G t_> . I Fax: Ceti- o 3 . Other: l "*
CCB Lie #: "S Total' , i .
_ Jo la- 3 M echanical Permit Fees
Authorized A Subtotal: ; S
Signal err • L�� ,C -t t :� ��C ,---- Date; ��j(>' Minimum Permit Fee 572.50 I S �t
I .'Z - `. L I. c'e'p Plan Review Fec ( /o of Permit Fee) I S --
-- State Surcharge (8% of Permit _Fee) I S S '. _
(Please print name) TOTAL PERMIT FE E I S -C4 .1 tti
Notice: This permit application expires if a permit is not obtained within *Fec methodology set by Tri- Cuunty Building Industry Service Board.
180 da vs aftt r It has been accepted as complete. "Site plan required for exterior A/C units.
if \Dsts\ Permit Forms\MecrermitApp -doe 01/03
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SITE PLAN
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STREET
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
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: pm) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ' � AM PM BUP �r
Location / a - / 7 /1. Ste- Suite MEC ?& 6 / -0 ° q7 0
Contact Person Ph ( ) d 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner
— r
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain ��/)
Slab Inspection Notes: ElC 2J (j ��( ( Q 7 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
P PART FAIL
Rough -In 1p�l
Gas Line
Smoke Dampers
•!. PART FAIL
ELECTRI L
Se ce
Ro
UG/
Lo tage
Fir m
ASS ART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
ire Supply Line
ADA
Approach/Sidewalk Date Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL