Permit ` L CITY OF TIGARD MECHANICAL PERMIT
�;� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00227
Ag- - f� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/13/2004
PARCEL: 2S110BC -02700
SITE ADDRESS: 14640 SW 120TH PL
SUBDIVISION: WALL PARTITION /MLP2001 -00006 ZONING: R -7
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install exterior A/C. Do not place within the required setbacks.
Owner: FEES
BARRY DOWSETT Description Date Amount
14640 SW 120TH PL [MECH] Permit Fee 4/29/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 4/29/200 $5.80
Phone: 503 908 - 9727 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 640 - 3607 Final Inspection
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: c�Lt -tc t oc -�! �C� Permittee Signature: A40 '0,_&/(X--,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Me�chilnical Permit Application
•
FOR OFFICE USE ONLY
111511V91/' I Mechanical ^
Permit No.il - I - p.a
City of r Tigard Planning Approval Building
Date/B : Permit No,:
13125 SW I [all Blvd. Plan Review Other
Tig Orel ;c,il 97223 Date/13 3 .: Pcmta Nu..
Phone: 503.639 - 4171 Fax: 503 - 598 - 1960 Post Review band Use -
A i J Date/B Date : Case No.:
w
Internet: ,ci,ti: ard.or.D$ _ tiY.. ` �( Contact ea ® See Page 2 for
24 -hour In.q ection Rcqueat! 503- 639 -4175 '""'- N Su lemental Information.
g251/ b
TYPE OF WO1» COMMERCIAL ME* SCLEDULE - USE CRECKLIST
❑ New construction ❑ Demolition Mechanical permit fees" are based on the total value of the work
• Additio ialteration/replacemetit ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION '..,.' mechanical materials, rquipme.nr, labor, overhead and profit.
❑ I & 2- Family dwellinz ❑ Commercial/Industrial Value: S See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL.EQUIPMENT /SYSTEMS FEE" SCHEDULE
Deseripdon 1 Qty ( Feo(ea.) j Total
❑ Master 3uilder ❑ Other:
Ileatin Coolie _
• JO 13 SITE INFORMATION and`LOCATION • .. urn • - add -on air conditioning "" 1 14.00
Job site address: i L( (o L•(. 0 s� l e t , Gas heat oumn 14,00
Suite #: Bldg. /Apt.#: Duct work j _....- 14.00
Project Nat ne: Hvdronic hot water system 14.00
Cross stree !Directions to job Site:
Residential boiler �`
(fur radiator or hydronic system) 74.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) ( 10.00
Subdivision: Lot #: Repair units ( 12.15
OIhcr Fuel Appliances
Tax m a p . / p — Ai:
Water heater
OESCR.t}''1ION Or- WORT(
t o.ao
Gas fireplace 10.00
Flue vent (water heaterigas fireplace) 10.00
Tt dn a-Q, 1'9-C-- Log lighter (gas) ( 10.00 E
wood/Pellet stove 1 0.00 j
Wood fireplace/insert j 10.00 I
Chimney /liner /flue /vent f 10.00 t
jr PROPER IT OWNER . • j ❑ TENANT Other: 10.0
Name: a x` j � (, _ Environmental Exhaust & Ventilation
- � l Range hood/other kitchen equipment 10.00
Address: Clothes dryer exhaust 10.00
Cit /State/Zip: Single duct exhaust
Phone: (- 4 --r •Z. -- Fax: (bathrooms, toilet compartments,
• APF'i.ICA:NT • • . CONTACT )PERSON •< ": � . . ' utility rooms) f, 80
Name: Attic/crawl space fans 10.00
Address: Other: j 10,00
Fuel Piping
Cit /State/ Zip: "•($5.40 for first 4,51_00 each additional)
Phone: Fax: Furnace, etc. ,•
Gas heat pump *
E -mail: Nall /su3pcnded /unit heater _ •*
_ _ CONTRACTOR • • • • • • :. . - Water heater • W '
.s
Busins name; r ,; c . k l c.i. (1.4 c - t r Fireplace •w
Address: 1 is G 1 Sc V i v tC- r- (. Range
BBQ j.r
Cit IS tate/ Zip : fi 6 (St cv , z , ° 7 }t L T Clothes dryer (gas) •+
-
Phone : �,- -S (: L } F (' ' - 0 T `"1.3 Other: I *"
CCB .Lie.: : L7 1t7 C 3' 'S Total: , T ,
Authori.Eedp Mechanical Permit Fees'
Signature: . j_ t11'N- u._�- �� i_.e ti Date: (4',2- -- Subtotal: j S
Minimum Permit Fcc 572.50 S ^ . Z,. -3'D I-1 k (_..,- L l fir' -
Plan Review Fee (25% of Permit Fee) S
(Please print name) State Surcharrge (8% of Permit Fcc) 5 r - 5 c,
TOTAL PERMIT FEE S 44/ . ;' o _
Notice: This p irmit application expires if a permit is not obtained within *Fee ntethodoloE' set by Tri -County Building Industry Service Board -
180 days after t has been accepted as complete. * *Site plan required for exterior A/C units.
i Msts\Pt:rmit F Srms\MecPermitApp.doc 01/03
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SITE PLAN
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S TREET
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
E'd BILO 86S EOS ZuzzeaH RziezvadS eZz :oi 170 82 ,add
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION B sinew Line: (503) 639 -4171 MST
'7/ BUP
Received . Date Requested • = �! ■41. ; � PM BUP
Location / 540 . (Las. MEC ;91r �" �.z -7
Contact Person Aixd- Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 1 �C
Int Sheath/Shear /,MAN I
Framing 4 '� • d
v r
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL r 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
ANICA
o &IFam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
EL 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 Ins ectoN Ext
Approach/Sidewalk Date p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL