Permit r - CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00755
-A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/17/2004
PARCEL: 1S133DD-06600
SITE ADDRESS: 11736 SW 125TH CT
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 ZONING: R -4.5
BLOCK: LOT: 105 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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Reconnect furnace.
Owner: FEES
QUIDING, FLOYD A + LYNN M Description Date Amount
11736 SW 125TH CT [MECH] Permit Fee 11/17/20( $72.50
TIGARD, OR 97223 [TAX] 8 State Surchari 11/17/20( $5.80
Phone: 503 - 590 - 1967 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 66578
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: _.Q
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busi day
08/06/2000 09:33 FAX fa002 /002
T1 ec a li al Perm � LIVED FOR OFFICE USE ONLY
City of'Txgard D �� �� Oc / 1,s ParrnitNo,: 5
13125 SW Hall Blvd., Tigard, OR 97223 �,cay�a 7✓
Phone: 503.639.4171 Fax 503.598.1960 Pun Review
NOV 17 20 ,,,, ,,.. �`�, Date/B OtherPertni[c • Ste Page 2 for
Inspection Line: 503,639,4175 yw
Internet: uww.ci.tigard.orau CITY OF TIGA` ` Notified /Method: /
j / (f Su pplemoat I Iaformadon
' i ` r '„1 ` " i' ..' ! ? T!' ` Y tw G li . Mb,,, 1 "OF':, WO ,ti.r. 'ti Y d' r -. y. l ' yid '^ r i . i :. -n _ _
I , , c09�fii>�J[�C` A14, •I€BE* "SC IiLE' VSECRE'CKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
1=1 Demolition
`•�� ❑ Other: � mechanical materials, equipment, labor, overhead, and profit.
„t :h' , 1 nr .....,'IM, V0 OF
q} :CON TR C TION Nl,1 l,
:'r„ "I,; ' : j "' Val S
p l- and 2- family dwelling El Commercial /industrial 12 Accessory building RSIA$1STI 'PWl1EPFE / SYS FEES
1:1 Multi-family 1:1 Master builder ❑ Other'
For spatial information We checklist,
kllSl.
it .;� ,i,! rat , Description � Qty. Ea. Total
- �∎ • t;tr,� 1, :„' „ s,;... ,,, 9 4' 1`F 1 !',TIOM::A `; AiiO . i I � , ' � ' .' ., , ; , r
I ^ '' Iicaelnp/coollng
Job site address: 'a- ? ,3t) J3 S---- A - Air conditioning or heat pump
( L (regrres site plan allowing placement) 14.00
City/Stare/ZIP: A e " k , -)- Z 2 -� Furnace 100,000 BTU (ducts/venrs) 1 14.00
Suite/bldg./apt. no.: � J Project name: Furnace 100.000 + BTU (duep /vents) 17,90
Gas heat pump 1
Cross Street/directions to job site: Duct work 14.00
Hydro= hoc water system 14,00
Residential boiler (radiator or
hydronic) 14_.00
Unit heaters (fuel type, not electric), '
in_wall, in - duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /ven for any of above 10.00
Other: 10.00_ _
Tax map /parcel no.: Other fuel uppllancc
.! ' • , }h' ' r u ' .1. ;, i T . SCRIP,,ITr, ._1{r ' a" E14..,, �•,,„1 Water ` „a i.9 y fi, , ON ........ .r,; 3!OTtK . , , 'r ,A- ::.` ' i -1 I, I w 10,00
�• .•:' -• 1” � '� 1 � hi I' V , ? .t .1.:;, ,4 ,'
Gas fireplace 10.00
Flue vent for water heater or gas
J Fireplace 10,00
j\-CliAD
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood tireplace/insert 10.00
,'. '>t$RL>k r P "rt rr IF " "il:. 'rTl} a: Irli..,, y ., M I , Chimnev /l iner /flue/vent 10.00 i
} IS�.; si Y
:ikC�11 •k 1 �.> '. Iy Ahi7"• I r: j. _
, I• err, �� i {9 ' •, .0
} 'c �a4 ,'�- 6,_.,
/ /^� Other: 10,00
Name: j ai d v� .i� j4 n . C� id- , Environmental exhaust and ventilation
Address ` J Mange hood/other kitchen
equipment 10,00
City/State/ZIP: Clothes dryer exhaust 10.00
Phone: ( ) I G j J_ Single -duos exhaust (bathrooms,
7 ax= ( ) toilet compartments, utility rooms) 6,80
'.,., '110. I ..I�s,�L,t', T �, S CRv,i S ' n,, 4 • - . 111. g 1i + ''alC r ?kits I'i + hl,l ' Attic /crawlspacefans 10.00
_ Other 10.00
Business name: s7.� . ` e- �.1- j-4 c G:- fZ i l Fuel piping
Contact name: J � I < i �� S5 -40 for first four; $1.00 for each additiona
Address: lt1 /�� k - 4-- jjj Furnace, e[c •
r7 S e_ • Gas heat pump
City/State /ZIP: 1....1
' j.l 1 ( ,t a ' 6 ,....„-- l , ej J. / t 3 wall/su;pended /unit heater _
Phone: (SD s ) ($ (' i 0 .., 7 (r G ' _ • Faz :: (St-?) ( 4.7 ,�' ) _ c?-: / f Water heater
Fire lace
E -mail: Range
yl Pt ' tt' a%) 4I s_. fit '1-.b1 w.t... �'.. yr ".►_1.19 l �''
R� ,:;T '�:' ��>�"� � , -�i G '�i'�a- '., „c^y��,t;4�1,, - v r,l. �.,- Barbecue
Business name: Clothes dryer gas)
Other
Address: {o, ;'. ' "1. II.64
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee (572,50) '1 ,- Cl
Plan review (25% of permit fee)
CC'S lie.; t .5 - y State surcharge (8% of permit (be)
/ TOTAL PERMIT FEE f .2b
Authorized signature: (� -''1� la .....t....4.- C.. (• }}.r.. L` Thla permit application axplres Ir permit it not obtained within 160
days after It has been accepted as complete -
Print name: f-1 1 e t L — e',„. ' I ' e'.4. Date: ` ( a , c.. • Fee methodology set by To- County Building Indueny S Board
k:\ eulldinnorcm aunMiC- PermitApp.doc 12/03 440- 4617T(11 /O21COM/Waa)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 503) 639 -4175
INSPECTION DIVISION ".14. ( ' 3) 639 -4171 MST
BUP
Received Date Requested ( Z 3 AM t— PM BUP
Location ° d Suite��� `f '0c) 7S�S
Contact Person P ) 6 'v v 7 PLM
Contractor P ) SWR 00
BUILDING Tenant/Owner ELC Iv"Z --
Footing ELC
Foundation Access: 1 Z f3 '+'- / / * L A K c=
Ftg Drain aL 044._c.av i 24 d s ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
1 1 / � l Z 6/0
6 Framing '' Y
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS ART FM ^
IAL ( 5,
Post & Bearrp
Rough -In 1U.
Gas Line
Smoke Dampers
ASS PART FAIL
TR
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: A / 111 Unable to inspect — no access
Fire Supply Line
af
ADA
Approach/Sidewalk Date " 2-1TE) , / '�
`� Inspector Ext
Other:
Final DO NOT REMOVE this Inspection recor from a Job site.
PASS PART FAIL