Permit I r
p
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00366
ma 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/11/2004
PARCEL: 2S 103CC -07000
SITE ADDRESS: 13670 SW 124TH AVE
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 017 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:
FUEL TYPES 0 - 3 HP: 1 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: AC install.
Owner: FEES
SINGH, PARIK Description Date Amount
13670 SW 124TH [MECH] Permit Fee 6/11/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 6/11/200 $5.80
Phone: 503 970 - 0058 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 76359
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. yy//
Issued By: �G��G(4) Permittee Signature: pO1 Q(1)121Laet
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jun 04 11:38a PAM DALBY 503 - 598 -0270 p.2
Mechafficd1 Pe 11460 FOR OFFICE USE ONLY
Received permit No.
City of Tigard D / a /0 � 6 nipx lg04/ 3�o
13125 SW Hall Rlvd., Tigard, OR 97223 n to 4 � ; Plan Revi w
Phone: 503.639.41 i l Fax: 503.5!J6 ay � - ll� . ry : ) '\ Date/By: .v Other Permit:
Inspection Line: 503.639.4175 ARD Date Ready/By: kith: See Page 2 for
Internet: wtiv.ci.tigard. onus GO OF T ► 1 V 1S10N Notified Method: t Supplemental Information
•
.TYPE „QB WOR `I COMMERCIAL-? FEE* SCHEDULE — USE CHECKLIST
❑ New construction Addition /alteration replacement Mechanical permit fees are based on the value of the ".pork
performed. Indicate the value (rounded to the nearest do'lai) o.` al'
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profi .
1 C1�TEGORY O )CONSTRUCTION
Value: S
gSIDENTLAL EQUIPMENT / SYSTEMS FEES'
4 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use check:'isr
❑ Multi family ❑ Master builder 0 Other: Description I Qty. I Ea 1 To:a; 1
{
JOB Sr1'E' INFoRlyrapobl. AID LOCATION heating /cooling
Air conditioning or heat pump I
Job site address: / j 1 4.00
3 � � Q � � l � � � (r site plan showing placement) / I
City/State/ZIP: ' Furnace 100,000 BTU (ducts /vents) 14 00
Furnace 100,000+ BTU (d'acts'vents) ; 17.90 '
, Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site:
Duct work 14 00
Hydronic hot water system 14.00 :
•
Residential boiler (radiator or •
' hydronic) 14.00
1 Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10'00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: j . 10.00
Tax map /parcel no.: i Other fuel appliances
` »ESCRIP ° TIOIV OF WORK = k Water heater 10.00
0 . - Gas fireplace 10 00 1
/4 /.5 V /.s 9-// At .. Flue vent for water heater or gas
fireplace , 10 "00 I
Log lighter (gas) 10.00 1
Wood /pellet stove 10 00
Wood fireplace/insert 10 00 1
PPERTY ,OWNER; s ' .i •i TEV ANT Chimney /liner /flue/vent 10.00
'� RO
, . •: ... .._ Other: I 10.00 I
Name: e -.57 2 !,� y' A Environmental exhaust and ventilation Range
Address: /.36 76 54..) ,/,'7•174 ,/,'7•174 + equipment l hood/other kitchen 10 00
City/State/ZIP: / Clothes dryer exhaust 10 00
• Single -duct exhaust (bathrooms,
Phone:50 ) 9r7D Q 0 Fax: ( ) toilet compartments, utility rooms) 6.80
, I 'APPZYCANT , : -r Y , O , �+ ❑nC s�.C P E, QJN Attic /crawlspace fans 10.00
4.na ..
Other: 1 10.00 ,
Business name: Fuel piping
/ � 1
Contact name: 19R thy $5.40 for first four; 51.00 for each additional
Furnace, etc. I t
Address: / 7
Gas heat pump
City/State/ZIP: Wall /suspended /unit heater
Phone:AO ) C y a.-7 O y Fax: : ( ) Water heater
: Fireplace f
I
E -mail: Range
"'CONTRAL"toR . f ri J . Barbecue I
� / Clothes dryer (gas)
Business name:
C.o 7u � `-f 6 /a. tJtA-rlr►itA - CAD a /. Ade. Other: 1 I I
Address: 0 60y, 3 e> 3 97 Y r; ` MECHA1`tICAJ. PERIviiT
l
City /State ;ZIP: 7 , . R-4-'1 02. e)7oteR.5 Subtotal
Minimum permit fee ($72.50) 7a, SD 1 '
Phone: ,.. 1) 4 a v ai � � L (Fax :�o3) 9 >� 6 a 7 a Plan review (25% of permit fee) I `
CCB lie.: '7 4 3 S 9 State surcharge (8% of perm ;i fee) I 5,
TOTAL PERMIT FEE 17 — 3!7
Authorized signature: Q�� This permit application expires ir a permit is not obtained within 1 SC
J �� , days after it has been accepted as complete.
I Print name: ig.)/f,f e% 4- .pjq /6 Date: /i /0!/1 • Fee methodology se: by Tri- County Building Iaduiry Service P,,■,r:.
Uiude :ngtPerritskMEC- PerrnaApp.doc 12/03 440 4617T( 11/0021COM/WEB)
Jun 09 04 11:38a PAM DRLBY 503-598-0270 p.3
- •
,
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HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624-2704
FAX (503) 598-0270
LIIiIIII
JOB ADDRESS: 73 7 Sed
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line. 639 -4175
INSPECTION. DIVISION Business L' . (503) 639 -4171 MST
BUP
Received �1 0 Date Requested ��� AM PM BUP
Location / 70 .5 /)4 Suite MEC ; r0L '0 - 036 4,
Contact Person / '7* Ph ( ) (,2 4 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ,f1.4 Ra E ELC
6-
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear � /
Int Sheath/Shear 11i (41_ e -,2 ( � ( ;)
Framing
Insulation
Drywall Nailing -s�,,�
T A ( �JC_C C
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In C •
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
41-11ECHANIC _.
Post & Beam
Rough -In
Gas Line
I oke Dampers
SS PART FAIL
EL - ICAL
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 79
Approach/Sidewalk Date Inspe �\ Ext
Other:
Final DO NOT REMOVE this inspection record Am the Job site.
PASS PART FAIL