Permit A - CITY OF TIGARD MECHANICAL PERMIT
l; DEVELOPMENT SERVICES PERMIT #: MEC2004 -00659
s�'I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/1/2004
PARCEL: 2S 103CD -04400
SITE ADDRESS: 13530 SW 121ST AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
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: 1
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: 1
Remarks: Kitchen remodel gas piping for range and range hood.
Owner: FEES
BROWN, MICHAEL J + Description Date Amount
RIES, JUNITA M [MECH] Permit Fee 10/1 /200 $72.50
13530 SW 121ST AVE [TAX] 8% State Surchari 10/1/200 $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Misc. Inspection
Final Inspection
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct quystios,tb OUNC by calling
(503)246 -6699. / ,'
Issued By: Permittee Signature: ,#w i (1'
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Meehteical Permit Application r()R 01 i icf l'A-• 0\1
City of Tigard AI N le31111111111111110 Pe 1 6 (/ - AO . ' 9
13125 SW Hall ri
all Blvd., stard, OR 97M Men Review
Phone: 503.639.4171 Hat: 503.5911.1960 tptSGei Sopooneetaib
Other Norte
Inspection Link 503.639.4175 Fa
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huarset vrww.ci.ligantkrun
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- . .: • • : ':': :- . ' ,: : ..-.: . - • Et-..- -• ' --.': • :-: tYrt• Cl litOkA L: ; '• , i-: :: :-: ;3;: ' : ....-' • -:i : it0PARSO-Mil Jrfaki A610 Saii*ZaCILCt,
0 New construction jErt • ''. htecbanical panic feces nre based as the 'sloe of dm wodt
performed. indicate the value (rounded to die markt dollar) of an
1:1 Demolition 0 Other medienical wateria1s. warksneut. Mot. ovetheod, and profit
- • : :.;'..- . ..airactAirtoptiOtitt 2 -: • . - 7 ... •••• „ ... Valor S
:: : RsailrrtPtum.I.MT ! sr:*4
' 11 2.6010 dwelling 0 Commercialfsedusnial 0 Accessory building for special isfirwielya use checklist.
0 MOW-family . 0 Master builder 0 Other: Denciiinioo 1 QIY• 1 EL I Tool
:. ' • .:. • . : , •,:. • :- ' : • j011 Sr* HiktitillAtION : ft* ibcA716$ :. : • ':. :••• :•* : - f : • ;- . - BeatbeikeoSug
Job site address: za 5 , ix , .. ,,-. 9 2 / Az eye- Air conditioning or heat pomp
neeekes site aka stewing alketneet) 14.00
City/Sata/ZIP: `1, i ff . 2____ _ Rama 100,00013W hweeitventst 14.00
Furnace 100,000+9W (dectstvons) 17.90
Suiteibkit no.: Project maw ass hag pump
14.00
Cuss street/dimetions to job site: Duct %veldt 14.00
- %diode hot taw sYstwn 14.00
- Residential boiler (Minter or
Indolok) 'c 14.00
. Unit' beaten (1bel-type. not electric),
iowall, io.duct, sigie--etc. 10.00
Lot so • Flushunt for fag of above 10.00
Subdivision: I
_ .: , Odra: 10.00
Tax natp/parcel no.: 0 fad anollames
:. . ....:. . .• : . ' • :•pescRornorp Or _Wo- ....: .; - . • ... , . :.--... • c :.-.:.... Wm:cheater 10.00
Go fltepkee 10.00
A Zd - ,, ,,/ , -- 1 1: -,---: , ..." 0.,-..;;.-: 7 " .....7•10 Fin vent for water heater or gas
thoplace 10.00
''-'-.- LoR *Pew (lus) 10.90
Wow/peak nave 10.00
Wood firepheefituest 10.00
10.00
'.. ... •.0 raCii*"0 ':.t.l: ••:: .1' ...' '.:.- '•'. ', i '1. (P-Ttli •- . 4 * 1- %- -- : •-• • • Odor 10 00
Nallic XEr . '3 fr :-‘0,49e , . / "J ilovirosweand admit and ventilation
Rano hood/other ldtebts
" dress: 1 S C) .S- Ce., . /? / " 5 -- .1-- rf--.---- teasitnnent / 10.00
City/State/ZIP: 7 ,0 cloth. drier exhaust 10.00
Stegkoduet cchaust (bathrooms,
Phont:_fg.3) _5170 -'a 3 7? Flocip toilet coonotemeins, utak, mooed 6.80
'...• ' i • : • • ' '• ' .Wttrilt.Ii4j4T . r':!. '- . ' •: - • ;:'• ''''' 0 ootroo .pgloopi : • - , • Alticiaawlapaco Suns 10.00
• Onus: 10.00
Budy: "Imle://"...,-- - At.=_-- )21 .,..r•St.eill' 4 V.,:-A- : Fut MPiati
Contact name:
Av - ..., -4=v7Z-___. SS.40 he Oral B $1.0 four S1 for each addilkits1
Address: ././ ' - & t#4-7s/e'-2crerQ' S 2-7: ois Ferslacmte •
City1State/ZIPtf - 4-2 6.20e 1C , 7 2.... Wallhoisecodedfonithater
Phone: (Sr" gg-ii7 - 4444-Fax ee43--e742// W41°1911
Pimple=
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Busitess name: . a r,_.-.. , x Ar j r , _ A.4,.. „ ..,... 425..... aoaxi drerfias)
Other.
Adtket 1/40/e7 5 •ed , 404-Av - - --.:-._:.:. ;E.i :..;i4gototaiscatix
City/State/El': ri Ooe- ‘2 7 Z.Z..g", subtotal
pb e : 42 4...ei I Fax: csb 6 / 3 Winners posit fee (S72.50) 1_2_ <0
Plot review (2516 await fee)
CCB1k.: 5 4, sum lowbrow (114 of prank
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Autrized signanne:‘si,e1hire•K • Torm.rattwirrnz /3. .3
ho
- This pang( typIleades alpine We permit is set ebtaismet wittia lee
dos after it les beta moped as emeplete.
Date: Agff • • Pet inethodology set by Tri-Oserty Staldies bdusey Service Boleti
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (593) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�- BUP
Received Date Requested ®2 .+� AM PM BUP
Location /as-so / -/ Ave • Suite MEC � b - 0 0 (PI'
Contact Person B_ it Ph ( ) S — PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner dap .20c3ii" 0063Y
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall /
Fire Sprinkler /
Fire Alarm J
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING r l
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA,ART FAIL
CHANIC
Post &
Rough -In
Gas Line
Smoke Dampers
in
RT FAIL
ELECTRI
Rough -In
UG/Slab
Low Voltage
Dre Alarm
a Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ? ` �
ADA Approach/Sidewalk Date -' ` � / O� Inspector "�� 11 / Ext
Other:
Final DEYNOT REMOVE this inspection record from the J ' b site.
PASS PART FAIL I