Permit CITY TIGARD MECHANICAL PERMIT
I ��
i DEVELOPMENT SERVICES PERMIT #: MEC2004 -00726
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/2004
PARCEL: 2S 114BA -06400
SITE ADDRESS: 09815 SW COOK CT
SUBDIVISION: COPPER CREEK ZONING: R -4.5
BLOCK: LOT: 006 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace and install a /c.
Owner: FEES
SHELTON, WILLIAM N JR AND . Description Date Amount
HERMELINDA B [MECH] Permit Fee 11/8/200 $72.50
9815 SW COOK COURT [TAX] 8% State Surchar 11/8/200 $5.80
TIGARD, OR 97224
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Heating Unt lnsp
Cooling Unt lnsp
Reg #: LIC 76359 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 -66 .
Issued By Permittee Signature: ' /RAM
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Nov 04 04 10:1Ga PAM DALBY 503-598-0270 p . 2
y.-
t\lechapiarPermit Application FOR OFFICE USE ONLY . .
City of Tigard Received j , , Y 097,
,
1
Date/By: i/ ix/ Permit No.:1-46
7)125 SW Hall Blvd , Tigard, OR 97223 9ECEIVE - 0 ,,,& ,
Plan Review
Phone: 503.639.4171 Fax: 503.598.19p Date/By: Other Permit:
Inspection Line: 503.639.417.5
ACM I I Date Ready/By: ,,,,...— . See Page z for
Internet: www NOV 4 .cistigard.or.us Notified/Method: 1 / i 0, m
Suppleental Information
0 2004
1 vo.00w...,:,i*: - .,...CHEC
U New construction f2 Mgt" ralegigi t Mechanical permit fees' are based on the value of the wed:
performed. Indicate the value (rounded to the nearest dollar) of at:
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and Fort t.
'f• L‘....--,,a,•ir-..., - -, :pa .• ,,, ,. V . 1`1 `, .. S - •••• •• - • • -.
.,i.',INI)Uogi.4;Q:J.) / SYSTEMS FEES
- and 7 - family dwelling 1 Commercial/industrial 0 Accessory building
Far special information use checklist.
?vit.:In E Master builder [7:] Other:
Description Qty. Ea Total
' :'• ' r'• --. "• I'V"'4 " . " -'- ' 24. f -. 34: ,' ai:ooKopolivokairge:f000W,'':: . ;'.i ,,,, :- ,. .. s ,:4 ,: .;..:.;:.:ii , ;:: Heatin
Air conditioning or heat pump
Job s:te address
c:7'0 '-- 5" t e i r no ie.__ ei>t_. (requires site plan showing placement) / 14.00 j
Ciry/State/ZIP• Furnace 100,000 BTU (ducts/vents) / 14.00
, Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: I Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work ;4.00
Hydronic hot 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/vent for any of above 10 00
I .:
Other: 10.00 I
Tax map/parcel no.: Other fuel appliances
.4 :;,. z:V , Water heater 10.00 I
Gas fireplace 10.00
/Lei) / C.■ r e 9 ,.... c , ... 7 e 1. ...L.,/".,.... c... , .e.. Flue vent for water heater or gas
fireplace 10.00
j.t r ..9774-4-- /9-4--"' Loglighter (gas) 1 10 00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
' - -' - •,. 1 Chimney/liner/flue/vent
I ' 443t
10 00
Name.
fal. ,.... S.j . e /"yet9 Environmental exhaust and ventilation
Range hood/other kitchen '
Address: ' ,0' .. :5 .-- ...5 Git)c. /e._ c*:-., equipment 10.00 1
City/State/ZIP:
- 777 a " c/ Clothes dryer exhaust 10.00 1
---
Single-duct exhaust (bathrooms,
Phone: 2i3 e: 9 / /3 F) Fax: ( ) toilet compartments, utility rooms) t . 6.80
Ylilf !rI' A tti cicra w I sp ac e fans. 10 00 '
Other: 10.00
Business name:
Fuel piping
Contact name: /4/1-e 0/1. th 2/ $5.40 for first four; $1.00 for each additional
—
i I I Furnace, etc. I
Address: i !
I . Gas heat pump .
City/State/ZIP Wall/suspended/unit heater I
h
Phone: ) 0,2 v ,>, ,,,,. 7 0 ,./. I Fax: : (3 ) Water
eater ... 5"?‘ 62., -F.,-/ D
Fireplace ;
E-mail:
Range
l'Il kra14111Vigitiftf.0 Barbecue i
i I•
Clothes dryer (gas)
Business name: C a.f h /el_ Ac...4 - 4-- Cc. e. f/ el..iee_ I
.-kddress: 0 ao x ,:;. 3b 3 7 Ni-Mi'N4,
City/State/ZP: Subtotal I
7 4 A-441 C. ? 7d..,-7,3
Minimum permit fee ($72.50) 1 -za. st...,
Phone (56) 4 c 2y azio „ Fax: ) ,..5 ... 9 , sp. 6 e:,
Plan review (25% of permit fee) I 1
! CCB lic.: 7C- OS 9 State surcharge (8% of permit fee) i 5-, go :
TOTA_L PERMIT FEE 7S. 34 1
AL:thorized signature: c 8_?7Z-c__4 ea--e---ea This permit application expires if a permit is not obtained s:i chi n 1 SO
days after it has been accepted as complete.
Print name: /% c 4 4 4- ,.„,... /6 ,5/ I Date: /:// _v 9 v . Fee methodology set by Tri-County Building :itclustry Service BO: rc
I '3 Adin g ,...< rrruts■MEC • P crmg App.doc 1103 440-4617T (11i02/COMIWEB)
Nov 04 04 10:17a PAM DALBY 503 - 598 -0270 p.3
661?T,4
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
0
•
JOB ADDRESS: 7g 56t) Goo r�
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
• BUILDING Inspection Line: ; 639 -4175
INSPECTION DIVISION Business Line: (, 13) 639 -4171 MST
BUP
Received Date Requested / — / AM PM B
Location q q I 3 Suite 4 -011 -e,
Contact Person Ph ( ) Co —a7o T PLM
Contractor Ph ( .) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ' ELC
Fog Drain A ccess: t�v R � b I �� . r. S Serxr4 -�
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear �✓ j X �, ) _ _ e l 21 Q o
Framing �� v
Insulation
Drywall Nailing STA Gam
Firewall A-1� P �� r / & z , A P
Fire Sprinkler t�
Fire Alarm /4 /G t)2•/ i /__ i 's 2v A-ti P
Susp'd Ceiling /
Roof
Other:
Final Al le SCE e . g c / CMG
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water Service
Water Service
Sanitary Sewer '' E
Rain Drains
Catch Basin / Manhole
0
Storm Drain r'
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL / j,t;�
Post & Beam �
Rough -In /��" (
Gas Line j (!
Smoke Dampers � `
dir
PART FAIL
TRICAL
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 E Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date //' J • 04( Inspector `l Ext
Other:
Final DO NOT REMOVE this inspection record ` rom the job site.
PASS PART FAIL