Permit CITY OF TIGARD
MECHANICAL PERMIT
I n, DEVELOPMENT SERVICES PERMIT #: MEC2004 -00188
l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/14/2004
PARCEL: 2S 109AD -00300
SITE ADDRESS: 14580 SW 126TH AVE
SUBDIVISION: BLUE RIDGE ZONING: R -7
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace and AC.
Owner: FEES
CRINO, ARTHUR D + SALLY J TRUSTE Description Date Amount
14580 SW 126TH [MECH] Permit Fee 4/14/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcharl 4/14/200 $5.80
Phone: Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 1441 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: L2Z.L Permittee Signature: d7 C-ork 7
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Apr -13 -04 10:13A P_02
FOR OFFICE, USE ONLY
' Mechanical Permit Application Received 4 � .' 7 Mechanical
F)ate/9y. / � y /
v .te / '
� Permit No.:m ��
O Planning Approval Building
City of Tigard E - Date./By: Permit No.:
13125 SW Hall Blvd. RE G��v Plan Review Other
Tigard, Oregon 97223 �� 1 `� �tt4 Date/By: Permit No^ Land land Use
Phonc: 503 - 639 -4171 Fax: ir. 9a 1h60 ",, �,� I .. D - Re v se
I See Page 2 for
Internet: www.ci.tigard.or.us A ft * 4. ti �l i Contact
J icmental Information.
24 - hour Inspection Request: 5�3t�$ t y s Name/Mc / / Supp ' etil .0
TYPE OF WORK ' : '' ' ` ;, ' . `' ?COMMERCIAUFFE* SCHEDULE - USE :CHECKLIST • - .
❑ New construction Demolition Mechanical permit fees arc based on the total value of the work
❑ Addition /alteration/replacement 0 Other: performed. indicate the value (rounded to the nearest dollar) of all
mechanical mater equipment, labor, overhead and profit.
CATEGORY OF.CONSTRUCTION : See Page 2 for Fee Schedule
2- Family dwelling; L1 Commercial /industrial .. Value: S —.
❑ Accessory Building Multi - Family
. RESIDENTIAL EQUIPMENT /SY51'E& S FEIN,* SCHEDULE -- Description _ =Qty I Icc(ea.) - I Total
[ - Master Builder ❑ Other: Ileating/Coolh
JOxi S1TE INFORMATION and LOCATION .. • • Furnace - add -on air conditioning *_ , 14.00
Job site address: [u 5 = c �{t �� j Q� 9,.. heat pump 14.00
CJ .. -
Bld /A t. #: Duct work _ 14.00
Proj K .. - — 1lydronic hot water system 14.00
Proect Name r r rl 0 Residential boiler
Cross strect/Directiofs to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in - duct, suspended, etc.) 14.00 —
Flue/vent (for any of above) 10.00
• , Repair units 12.15
Subdivision: Lot #: - - Other:Fue1 A , glances
Tax ma II/ • areel #: Water heater 10.00
=•;:^ '° ,' . �'. .. t 'u •S' ]1 ieF 'd0' _ '. ' , , ' . . : Gas fireplace 10.00
ij.;r, r: 10.00'
_Flue vent (water heater /gas fireplace)
Log lighter (gas) 10.00 r _
----A-V.--C-L---1 • _
Wood/Pellet stove 10.00
. — Wood fireplace/insert - . _ 10.00
Chimney /liner /flue/vent , 10.00
TEi i : 'F:1?..:t
Other: 10.00
fir :V. OP:�r ' R " ® Environmental Exhaust & Ventilation
2die' r' nU. Range hood/other kitchen cquipme:tt 10.00
Address: ,C� � . I! �X � Clothes dryer exhaust 10.00
City /State/Zip: Single duct exhaust
PI Fax: (bathrooms, toilet compartments,
SP ' PPLWC T 7 .. : CONTACT PERSON " utility rooms) 680
' _
Name: (:,(' <>.L1•`_'} l ✓c:;'l • •� =� Atttdcrawt space fun 10.00 Other. --- 10.00
Address: , , r l _ • Fuel Piping _
L' 5 ' (Si_40 for first d, 51.00 each additional)
Zi
C ity /State/p: .. D�c„ - -)�
Furnace, etc. a
Phone: Fax: .— Gas heat pump s.
• E -mail: - Wall/suspended /unit heater ss
+•:..... r • ' :.1 ' °'' Water heater .cc
;IS:7 F'.', _,,' '�:! p A� TOR :: -' :ii �': ... _ "! ... - -
2,C ✓J� c Fireplace 1 " -
Business Name: C - -' t� � C /�•� � "� Range ss
-
Address: �-1c-1 • 5`e 1'1. `tier -:�+K i_ . BRQ as
C A
City /State /Zip: 4 •1 IC�, ( :: 1 ..2 o .= Clothes dryer Ws) —
• s+ • Phone < - i 1 •�,3 I lax: `;.:, j 1 L Other. Total:
_ •
CCB Lic. #: , ` I ` . - Mechanical Permit Fccse &4_ -
Authorized Subtotal: S .
Signature: Date: • Minimum Permit Fee $72.50S
Plan Review Fee (25% of Permit Fee) S -
State Surchar a 8% of Permit Fee S .\ )
(Please print name) TOT Al. •
PERM FEE S� I1 _ , _ - C
+Fce methodology set by Tn -County Building Industry Service Board.
Notice; This permit application expires If a permit is not obtained within **Site plan required for exterior A/C' units.
180 days after It has been accepted as complete.
is \Tmsta\Permit torn t\MecPermitApp.doc 01/03 6(Q 1 , I< `.
Apr -13 -04 1O:13A P_03
SITE PLAN
7S J
7
( 0 >
�`� ♦ C)IRF.CTION
•
E [OUST:
• - ►
FRONT
STREE ......._
Job Name 4-"1SS- C
' • •``k
�v_._ 2Z
Model 4 t; A (‘\ J
Malec
JACOBS HEATING & AC
4474 SE Milwaukie Ave.
Portland. OR 97202
(503) 234 -733
(50 3} 813 -9257 fax
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 4 a / AM PM BUP
/ `
Location l `7 S 0 /c Y � Suite _ - d C) ���
Contact Person r/ w Ph ( ) ' 3 - �o SAS PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
1761
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam ,Q/p
Rough -In /��
Gas Line
Smoke Da ers
P eA5 e PART FAIL
ECTRICAL
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 • r reinspeition RE: Unable to inspect – no access
Fire Supply Line 2
ADA Approach/Sidewalk Date Inspector ice. — Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL