Permit - A CITY O TI GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00263
..�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/11/2004
PARCEL: 2S103CB -11400
SITE ADDRESS: 13482 SW 122ND AVE
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 072 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Install exterior A /C, do not place within the required setbacks
Owner: FEES
JEFF MALDANADO Description Date Amount
[TAX] 8% State Surchart 5/11/200 $5.80
[MECH] Permit Fee 5/11/200z $72.50
Phone: 503 - 524 - 1474 Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Phone: 538 - 2953 Final Inspection
Reg #: LIC 125815
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: Permittee Signature: ,�Ap/
Call (50 639 -4175 by 7:00 P.M. for inspections needed the next busi ess day
Ma 10 04 12:47p Oregon Heating and Air 503 - 537 -2172 p.2
0
'i Mechanical Permit Application OFFICE USE ONLY
Dale received: Permit na
"_,_ ;i city of Tig �� L� tit y -ao 243
_ 41.. Project /appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti 97223 -_
Phone: (503) 639-4171 ;Y 1 V L Dale issued: By Receipt no:
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approv r)IVIsION Building permit no.:
1 & 2 family dwelling or accessory D Commercial/industrial U Multi - family O Tenant improvement
❑ New construction ldition/alteration/replacemeut U Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: • f
A.9,. r7� ' / -e.. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: j Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name jurisdiction's fee schedule for residential permit fee.
City /county / 41/ /..0,1 I ZIP: Q -3 x.7 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
9 e a 'on . s ■ r . at' otwor p rises AND COMMERICAUINDUSCRIAL EQIIIPI1 ENTSCIIEDI LF.
f ry " ' . J,(4' (. /7 e; t7 77 •
Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existitl' Air handling unit CFM
o space heated or conditioned. 0 Yes 1] No Air conditioning (site plan required) .r '
Is existing space insulated? D Yes U No Alteration of existing HVAC system
MECHANICAL CONTRACTOR RAC( OR Boiler /compressors
Business naii Jz `_ L State boiler permit no.:
• t itan HP Tons B rs
Addr:t .: Fire/smoke dampers/duct smoke detectors
Cr ' OH • E' 5= �1�ES` Heat pump (site plan required)
' mix( v rdiE -mail:
Install/replace fumace/burter 13TU/H
CCB no.: �! — Including ductwork/vent liner ❑ Yes O No
'� 1 a Install/replace /relocate beaters - suspended, ,
". City/metro lie. no.: wall, or floor mounted
Name (please print) of ' l, , 0 t A - Vent for appliance other than furnace
CON'FACI• PERSON Refrigerehan:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors Hp
Environmental exhaust and ventilation:
Ciry: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OwN1ER Hoods, Type I/ Il/res. kitchen/hernial
�, hood fire suppression system
Name: /, N AM " L # ,D Exhaust fan with single duct (bath fans)
Mailing add a, AUWM11.� , / Exhaust system apart from heating or AC
City: ' !fir / �7T
_ • Fuel piping and distribution (up to 4 outlets)
Phone *M CSC E-mail: Fu pre rp- Type: LPG NG Oil
each additional over 4 outlets '
ENGINEER Process piping (sc emetic required)
Name: of outlets
- Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type '
Phot, Fax: F.-mail: , Woodstove/pellet stove
teaP t'' +' ' �l
p Piit r� 1 111M Other:
Other:
Name (print): UMNI I.' , • a
Not sit jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ '
R yist Cl MasterCard Notice: This permit application Minimum fee $ 7d --S & -
'Credit card number: 1 expires if a permit is not obtained Plait review (at %) $
Expires within 180 days after it has been
State surcharge (8%) $ j
Name of ardhholaer as shown on credit card accepted as complete.
S TOTAL �a . )
• C'ar4b l,tcr signamur Amount —
440 -0617 (6 /00/COM)
1 10 _ 04 12:48p Oregon Heating and Air 503 - 537 -2172 p.3
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First Floor
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Job #: Oregon Heating & NC, Inc. Scale: 3/32" = 1'0"
Performed by for: Page 1
Jeff maldonado P.O. Box 397 / 992 Highway 99W Right -Suite Residential
Dundee, OR 97115 5.9.34 RSR28586
13482 sw 122nd ave 2004 May - 08 03:07:35
tioard, or 97223 Phone: 1- 800 - FURNACE Fax: 503 -537 -217 C: \Program Files\Wrightsoft HVAC ..
Phone: 503- 521 -1474
T
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
1g 7 BUP
Received Date Requested ' 3 c' And/ PM BUP
Location l3 $gam .-'Gc) / — "' Suite MEC V ��?
Contact Person / &.r , ol3h ( ) PLM
Contractor Ph ( 5 /' /4Z7� SWR
BUILDING Tenant ELC 0 -N 0 a
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: Vaf V) k C- )‘&4 c SIT
Post & Beam
Shear Anchors i1 77 �0 o Q 61;5)
Ext Sheath/Shear ! -I 4 J l
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: f) I ;jot �t
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan I L C v19 127g \ Hicf p1 c, \0)3,L-19
Other:
Final
P T FAIL
ME HANICA
Post & eam /
Rough -In (�
Gas Line
• .e Dampers ( - e
! PART FAIL
� i *T AL
Service
Rough -In C )iv
UG/Slab
Low Voltage
.-Ei[@ Alarm
Fi -ice Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI — II El Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA �j
Approach/Sidewalk Date v 43t Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL