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Permit CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2005 -00300 13125 SW Hail Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/6/2005 PARCEL: 2S 103BB -08500 SITE ADDRESS: 12425 SW 122ND AVE ZONING: R -4.5 SUBDIVISION: LAKE TERRACE LOT: 012 JURISDICTION: TIG Project Description: Relocate gas line for stove & bar- b -que. 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: DOMES. INCIN: 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: Owner: FEES YOUNG, JOHN G VIRGINIA F Description Date Amount 12425 SW 122ND AV TIGARD, OR 97223 [MECH] Permit Fee 6/6/2005 $72.50 [TAX] 8% State Surcha 6/6/2005 $5.80 Total $78.30 Phone: 503 - 590 -1988 Contractor: NW GAS LINES ANTHONY M YOUNG 16731 NE WASCO ST REQUIRED ITEMS AND REPORTS PORTLAND, OR 97230 Phone: 503- 256 -2436 Reg #: LIC 154848 . 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 or 1- 800 - 332 -2344. Issued By: ("�� Permittee Signature: . zi Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. FROM :NW GAS LINES FAX NO. :5032562245 Jun. 03 2005 01:48PM P1 .. _ • vaaa WA ..' u_lA1p Lei UUL Mechanuicad PcrmitApplic �qnn ; . s. ;� -1.1, i :1.;;'- City of Tigard projaot/appLna: Expire data; • Cry ern Bard Address: 13125 SW Hall Blvd, Tigard. OR 97223 C patslasnod: Receipt no.; Phone: (903) 439 nn'' ®3 2 0 5 Fax: (503) 5946t} AUlv Case file rut Payment type: Land use approvals _�7'`t ,-v TI Gs .uddingPa initao_= i •~ 1.I1 1 _ . ■nF! !I!i . • . • . '11 i'1„ 61. Cr:n 11 , A .1. 2 family dwelling or accessory 0 Commercial/industrial ❑ Mu1d- famitilY O Tenant improvement Q New construction z Addition/atr do f ep1wetvent CI Other. _ '.Oli; 5i EL 1 \fORlla•I1 :)N • COMMI.1tt 1.11 VAI :I.+ 11 1RK\ SC111.,V ;l :a•. Jab addles& _ _ Indicate equipment quantities in boxes below. Indicate the dollar Rkig. no.: Suite no.; value of all medumical mateelalr, equipment, labor, overhead, Taal ma • lotiaccotmt no.: profit. Value S Lot; Block: { Subdivision: *See checklist for Important application Intbrmation and I'm ect name: jurisdiction's fee schedule for residential permit fee. Cr (count ; _ _ ZIP; y - _ 1 S 2t'rt:�1)I I' DL %LLL1\ PERMdi`k'E>1 s(Ilt'►)rilf: I lion an 1• cm of work on ses: _ titit) CO!M MLR 1t 1/1 \tit S frileI, i;cil' \ 1i:NI SCHEDULE, r � 2_ A t F e(eer.) Total Est date of co letionrtli specbon. ijtdon _ 91,. lea. . JeS•aut Taunt improvement or change of uce: iiiVoirs c Is existing Space healed or conditioned? 0 Yes 7 No Air l<andlia; volt CFM. oonditionial C a s co v la Existing space insulated? a Yea ©No AI etarloe ox t: . ' ACs eat IIMMIIIIIIMIIII �( TI; f 1Latilt :e�1.. CO'\TRAS'1`Olt . .. �.., - sons �'� (Sadness name: 4 1Ir� + *T! r Snits boiler permit ao.: Addre l• Sr . ^,, . ' Toes _ BTCs _ w /li ==..111 ty: • r . • State: / 'ZIP :. Pi „ L ' 0 1- 0 trump tep an . ail IMMO Phan (p - 13 email: l duearrneldveatliaer ❑ Yes ❑ No CCD no.: Y _ ,.......__._� 1nsta Rep • • . ovii 771,.. _suspen. Ci metro ic. no.: / _ wall, or floor repealed Name (. ease p ir11): vent s. a..1 : ors o • r an cunaee : . 4 . 0 -vv'1! . , it i' T: R SO N • • • ' • Absorption miss BTU/FI • chru HP - - . 1 �� a Compieesass. 1iP ♦ �� tt Z 1 • La= State: Appliance vent , , rsi • ■ Phone: ear - Fax IZEM1111111111.1 ■ acziui►at hood tire suppression wth s system • I ^1, --._ .QVi� 1?xtrattstfan wirhsiu b duct (hat fans) • M smE • addreas: V HxBauat system ap frau Neaten _ or A r City: State: ZIP: 771 :- ; up to 4 outlets Mil Fite: E ,aril: • _ o NG . ... . _.. OD LeM1111111 ud . • . eanh additional over • ors cis ' • • ' • 1 :NGIN1 1:14. • k>raeeta pip ' _ (achematfmrequired) 11111111 - Numb& of outlets -11111.1 • Natr)e: arisaiWlosoel or _ 'T - ■ Addams: - Dccorarivof3replacG City: Stare: Insert- ,e w -- Phone: Fax: ` • .- ... �.� ve 1♦ - Ar • lieant's signature- � � itYPIMI eel,... Name ant) ;• !IIMI.I�i11 �� _ q- s a« (.tt 'a�nna pr. Nat& jeriat3ktinuc accept em m it ess. 5kaee ens} sue - . • fr. ... '► • „ Ryr Min to S gvisa Msenorfpr>i Notice 11115 pounit npptiastioa minimum fee S Glean raid maim _ ...6.4 __ eYpues if s pemsit is not obtained plan review (at _ 9h) S - ' i t h i n 180 days after a ims been State surcharge. (890 .,, , $ new aPeaullokiec n , .t,e ee m gran wed accepted as complete. TOTAI. _ $ '� _ - __ -- Tarilaatder sigma= A,noer+, 44o-ser pvovrcoso CITY OF TIGARD l f* - BUILDING DIVISION PERMIT #: MiEC2005- 0030() 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005 Phone: (503) 639 - 4171 u Inspection Requests (24 Hrs.): (503) 639 -4175 _ =_� I ', INSPECTION WORKSHEET FOR DATE: 6/8/2005 TIME: 7:12AM PAGE: 7 SITE ADDRESS: 12425 SW 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: 012 TYPE OF USE: PROJECT NAME: YOUNG DESCRIPTION: Relocate gas line for stove & bar- b-que. OWNER: YOUNG, JOHN G VIRGINIA F, PHONE #: 503 - 590.1988 CONTRACTOR: NW GAS LINES PHONE #: 503 - 256.2436 Inspection Request Scheduled For: Date: 6/8/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 008750 -01 503 -602 -3643 Y Corrections /Comments /Instructions: . r 1. 9 - y ; 1, • • . . ,....... P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: p Date: .— l7 S Phone #: (503) 718- CIT ■ OF TIGARD • r . BUILDING DIVISION PERMIT #: MEC20CS -00300 13125 SW Hall Blvd.; Tigard, OR 97223 DATE ISSUED: 616/2005' Phone: (503) 639 -4171 1° � th!ypiujp 1 Inspection Requests (24 Hrs.): (503) 639 -4175 k INSPECTION WORKSHEET FOR DATE: 6/7/2005 TIME: 7:17AM PAGE: 4 SITE ADDRESS: 12426 SW 122ND AVE CLASS OF WORK: SUBDIVISION: LAKE TERRACE LOT #: 012 TYPE OF USE: PROJECT NAME: YOUNG DESCRIPTION: Relocate gas line for stove & bar- b-que. , I OWNER: YOUNG, JOHN G VIRGINIA F, PHONE #: 503 -530 -1988 CONTRACTOR: NW GAS LINES PHONE #: 503 - 256 -2436 Inspection Request Scheduled For: Date: 6f7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 008649 -01 603 - 6013543 Y Corrections /Comments /Instructions: / ,4.5 i r %AA [ ---, -- :i ..2. / . S'^:.� , ,e , r/ "ze ,f%T_/(,- =, 0 c (; yisv - »— r� 1 ‘.,! ir ` -1, • il/ ,,,/s' /�-e U,L./ /s,, - .. — i , /g ''#' • .S, ``` IP SS \ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 6- �-��S / Phone #: (503) 718-