Permit CITY TIGARD MECHANICAL PERMIT
. 1, DEVELOPMENT SERVICES PERMIT #: MEC2000 -00510
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/28/00
PARCEL: 2S 103CA -00602
SITE ADDRESS: 13360 SW 121ST ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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:
GAS 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Replace Furnace
Owner: FEES
SJULIN, JAMES M AND Type By Date Amount Receipt
GREGER, GAY L PRMT CTR 12/28/00 $72.50 2720000000
4028 SE SALMON ST 5PCT CTR 12/28/00 $5.80 2720000000
PORTLAND, OR 97214
Total $78.30
Phone:
Contractor:
ENERGY MASTERS HEATING + A/C
7470 SW 76TH
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 244 -8880 Mechanical lnsp
Reg #: LIC 58556 Final Inspection
PLM 26 -476PB
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: Permittee Signature: Aearia4ea t P
Call ( by 7:00 P.M. for inspections needed the next busine ' day ) Y p Y
. , , ,_ , .
Mechanical Permit Application
�s - -` i s Date received: t [?:� Permit t pt, � ,
s-`� ti City of TI
" "Al. ^ - -. y Tigard ProjecUappl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.: -,
TYPE OF PERMIT ''
A l & 2 family dwelling or accessory U Commercial/industrial 0 Multi- family O Tenant improvement
O New construction (Addition/alteration/replacement 0 Other:
•
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
. Job address: 1 7 3tQ f) OVA l l _ 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 $ .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county :1y / I ZIP: 61 7 'D--, Z 1 & 2 FAMILY 'DWELLING PERMIT FEE SCHEDULE , a ;
Description and l s ation of work on pre; 'ses: AND COMMEIUCALIINDU.STRIAL EQUIPMENTSCI
alr2 f-.' ..( -Z..11.4. ! 4 . 7 all ' . \. "f YdN Fee(ea.) Total
Est. date of comp Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: ENERGY MASTERS INC . State boiler permit no.:
HP Tons BTU /H
Address: 7470 S W 76th Fire/smoke dampers/duct smoke detectors
City: PORTLAND State: OR ZIP: 97223 Heat pump (site plan required)
Phone:2 44 - 8 8 8 0 Fax: 244-925 ( -mail: Install/replace furnace/burner .te•Tl4: TU /H t
Including ductwork/vent liner 0 Yes 0 No
CCB no.: 58556 Install /replace/relocateheaters— suspended,
City /metro lic. no.: 3961 wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Re6ri
Absorption units BTU /H r
Name: WWI N. ,V14 1 Chillers HP
Compressors HP
Address: same as a ove Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U I /res. kitchen/hazmat
( hood fire suppression system
Name: 3 t r Y ' ii Exhaust fan with single duct (bath fans)
Mailing address: 1 "4p 5 Exhaust system apart from heating or AC
City: -- Ft, 0 , I State:I ZIP: 1 1 7 .D.3 Fuel piping and distribution (up to 4 outlets)
` � � Type: LPG ✓NG Oil t
Phone:
.r �+ Fa x: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: , E - mail: Woodstove/pellet stove
A Applicant's signature 1, ► Date: �� Other:
PP g tL�,f� I��T/ .1,Li; r�►R U.� +I Other:
Name (print): _ jl r I,
Not all jurisdictions accept credit cards, please call jurisdiction for more infotmation:s Permit fee $
❑ Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount , 440 -4617 (6/00/COM)
/
- Master Permit
Inspection Description Date Passed By Notes
Grading
Footing /Setback
Foundation walls
Slab
Footing drain
Waterproof basement walls
Plumbing underslab
Crawl drain
Post/beam plumbing
Post/beam mechanical
Underfloor insulation
Post/beam structural
Shear walls /anchors
Exterior sheathing
Plumbing top -out
Gas line & test
Mechanical rough -in
Electrical rough -in
Electrical service
Low voltage
Sprinkler rough -in
Backflow preventer
Roof nailing ������®
Firewall
Framing 4/ Z- /d -3
MFG -Home set -up ✓b
Insulation
Drywall nailing
Masonry/Reinforcement
Rain drain
Sanitary sewer .—
Water service
Pump /fill septic tank
Approach /sidewalk
Grading final
Mechanical final
Plumbing final
Electrical final
Final inspection
Special Reports
SWR - Sewer Permit
Inspection Description Date Passed By Notes
Sanitary sewer
Final inspection
INSPECTION RECORD — MST (MASTER) PERMITS
C ITY OF TIGARD & MECHANICAL PERMIT
'a; l; DEVELOPMENT SERVICES PERMIT #: MEC2000 -00510
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/28/00
PARCEL: 2S 103CA -00602
SITE ADDRESS: 13360 SW 121ST ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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:
GAS 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replace Furnace
Owner: FEES
SJULIN, JAMES M AND Type By Date Amount Receipt
GREGER, GAY L PRMT CTR 12/28/00 $72.50 2720000000
4028 SE SALMON ST 5PCT CTR 12/28/00 $5.80 2720000000
PORTLAND, OR 97214 —
Total $78.30
Phone:
Contractor:
ENERGY MASTERS HEATING + A/C X
PORTLAND, O
OR 97224 REQUIRED INSPECTIONS Ai■
Gas Line Insp
P
Phone: 244 -8880 Mechanical Insp
Reg #: LIC 58556 Final Inspection ! n �,.,t
PLM 26 -476P6 �/��
I
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 if
calling (503)246 -9189. eft
0 Issue By: T a l l / L . Permittee Signature: If
Call 175 by 7:00 P.M. for inspections needed the next busine day ( 3) y p Y