Permit A - CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00294
= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/10/02
PARCEL: 2S103BA -00129
SITE ADDRESS: 12085 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK: LOT: 043 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:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Replace gas furnace and add exterior NC unit. A/C cannot be placed within the required setbacks.
Owner: FEES
DUTTON, DELOS M MARLE NE Type By Date Amount Receipt
12085 SW 116TH AVE PRMT CTR 7/10/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 7/10/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 656 -1184 Heating Unt Insp
Reg #: LIC 447 Cooling Unt Insp
PLM 3 -286PB Final Inspection
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: , „ C Permittee Signature: T� "I 1 a p C )71-4/1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busines day
1,1/20 15:30 FAX 5035981960 CITY OF TIGARD 0002
.
Mechanical Permit Application
Date received; —
Ahlo
d. l f0 p Permitn ;fil, , -pa) 9V
: r. :'. City of Tigard i k'rroject/ l.no,:
Address: I3125 SVv Hall Blvd, Ti ard, OR 97223 aPP Expire date:
City of Tigard Tigard, _
Phone: (503) 639 171 u Date issued: By Receipt no.:
Fax: (503) 598 -1960 // 'Case file no.: Payment type:
Cii Y Ur 11Url. .)
Land use app oval: re ; - 1 7r•;� .r•.•.3 Building permit no.:
LOv4
rw t ; 4= C.
--
TYPE OF PERMIT
1 & 2 family dwelling or accessory ❑ Commercial /industrial O Multi- family O Tenant improvement
=..�s•1• on ■ -Addition/alteration/replacement ❑ Other:
.1OB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: • ''S uJ I, (4114 J Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
T. , p/ • . • t no.: ..• G 3 profit. Value $
Lot: Block: Subdivision: *See checklist for important application information and
Project name: DO CO mo jurisdiction's fee schedule for residential permit fee.
iry county: to ZIP; • as 1 S 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descriptioi and location of w•rk on premises: IY • AND COMMERICAL/INDUSTRIAL EQ1JIPMENTS('IIEDU1J
iu. 4 t. ' !► 1 " • '
Est. date of completion /inspection: Fee (••) Total ItY1 *vs �� Description Qty. Res. only Res. only
Tenant improvement or change of use: • AC:
Air EMI
Is existing space heated or conditioned? ❑ Yes ❑ No handling ante CFM
Is existing space insulated? ZI Yes q No Aircondhtio exis ung HVAC system sitep an required) cc
Alteration of ex�s —
MECIIANICAl. CONTRACTOR -oiler /compressors
Business name: • ems— N* C.— State boiler permit no.:
c � • HP Tons BTU/Fl
Address: 0 - c _ . .
��:,"... w Ott► rt/� of • Heat pump (site plan required)
Phone' , , E - mail: Insta replace furnace /burner it• BTU/I-I +
CCB no.:
Including ductwork/vent liner 1 Yes ❑ No 1, r Viva
a
ins replace/relocate hearers - suspended, =
City/metro lie. no.: .: `.t wall, or floor mounted
Name (please print): .A AaMill..1 Vent or appliance other than furnace
('(INTACT PERSON _ ° _ t;eratlotr -�
Absorption BTWH
Name: S A %- lr • S Will Chillers Hp
Address: V rillillIMIMIIIMINI Compressors HP
City: State: ZIP:
Appliance exhaust and vend trop:
Appliance vent
Phone: , a Fax: E- mail.: Dryer exhaust
OWNER Hoo. , Type I/ fres. ldtchen/hazmat --
hood fire suppression system
Name: , j t J Exhaust fan with single duct (bath fans)
Mailing address: 2,C) dato ..M111.1M eMiii bxhaust system apart from heating or AC
City 1 Slat = y i ZIP: Q O 1 I uel piping and climb , atm (up to 4 outlets)
Phone 5 .. -le 6 Fax: E Type: LPG NO Oil
Fuel phpin each additional over 4 ou ets
INGINEER ' ' - Process piping (schematic required) I
I Name: Number of outlets
Address: =_ Other hue ■ appliance or equipment:
MEI
� : � Decorative ftreplace
ZIP: insert - type
Phone: IiE ?' Woodstove /pellet stove
Applicant's signature: - 211inill Date: -......." Other:
r i zEmm ummiiimilimmminimm
Name (print): 1 Iki,
t:ot all jurisdictions accept =It cards, please call ju isdietion for more intiormation Permit fee $
Visa O MasterCard Nonce: This permit application
Minimum fee S 7 2. 5
Cre card cumber. , / / expires if a permit is not obtained Plan review (at %) $
—
Expires within 180 days after it has been
Name of cardholder as shown on credit emit accepted as complete. State surcharge (8%) .... $ 7 ,'8,c2 Cardholder signature Amount TOTAL $ - 7 8 .3r)
Amount ,
440 -4617 (6100/COM)
a
I I ,� G U�C ' J \�
aao -oe V m 3 t2
MAP 655 c3 No/1--
bjno
00of 1 2.0 51A) iii (a J
C c t.1 2 %a3
• O
1: r -`E% 6zaco
j 41/4f
G �
CITY OF TIGAAD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ///c° AM PM BUP
Location / 2 0 , Suite MEC - 2,002 - Y2 DO 244
Contact Person Ph ( ) �� F q -34 PLM Z q`}"
Contractor Ph ( ) SWR
BUILDING Tenant/ ner a/ e 5 O ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing Cr�L� /'l�L (. �s�n, L 2J Coy
Insulation 11 II
Drywall Nailing �74. C t/L CusT
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 PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
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
ADA --D
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL