Permit C ITY OF TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00612
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/14/2004
PARCEL: 1S136DC-02504
SITE ADDRESS: 07295 SW DARTMOUTH ST
SUBDIVISION: PP1995 -013 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 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: 2 cooling coils and related ductwork and (2) roof -top condensing units.
Project Value: $11,714
Owner: FEES
SUPERVALU HOLDINGS INC Description Date Amount
BY BURKE + NICKEL [MECPLN] Plan Rev 9/14/200 $64.00
3336 E 32ND ST #217 [MECH] Permit Fee 9/14/200 $255.80
TULSA, OK 74135 [TAX] 8% State Surcharl 9/.14/2002 $20.50
Phone: Total $340.30
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202 Cooling Unt Insp
Phone: 239 - 4600 Duct Inspection
Reg #: LIC 33135 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
(5036` °
O
I sued By , �� !i ; � _ 1 h 1 ; Permittee Signature: 4
Call (503) 9 -4175 by 7:00 P.M. for inspections needed the next business day
„ -
Mechanical Permit Application -1".. • :;:::A':--4.4..... - 1 , ?-:. - - -:''''.
- n 1. -: 1 ;:' ; ' ''' ' : 17 :: - •• - r '%•'' :' FOR:OFFICE USE OMANI , -A. -- • ' It ''' ' -',- '.'" -
City of Tigard-. - , Received
. Date/By: Permit No. l'ff & it... , .-60 t . 2.---
13125 SW Hall glvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
& Date/By: - . .14,1""Of i A li Other Permit:
. 4.Y P Inspection Line: 503.639.4175 _.1 4
.., ... . • Date Ready/By: furls: Fa See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 4. Supplemental Information
•
731" ; :g:'.1 : 4•N : IP ' .h 9 0; -:--- e l l'•:•ik k oi : *:6Iik ; rff5 .; :` 2"; ; ' ' ' ''' :4.-- " ?:' ' ' '§dift1if1U: USCHE .
_ ,,,:: ::::'''-P, •,....14..::-^ .:,_,, ,, :"' , ?, :,'':. ' ' '.."."''''' "" , ..,,,, , .., ° ,;::, .:-:.. , ''' . ',. '..',•" ' . - ' 7: , , ' - . •- -
0 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
CI Demolition CI Other: mechanical materials, equipment, labor, overhead, and profit.
. '".' - --'' Value: $ i 7,; , co
7- . .*SIDEIsITIAL 4 E0I1014EI■It/ SYSTEMS FEES*
0 I and 2 dwelling VCommercial/industrial E1 Accessory building
For special information use checklist.
0 Multi 0 Master builder 0 Other:
Description Qty. Ea Total
..,- I ' l ra EMZN 411.413 - 41 ;1611 - fi r UP'dkileiVIKViftiairei , iA -.5 ' ''; ::: ' He •
L's,6p-Att ,..:,;.,.,,: -.,.L:.....o,...., :: et - ,: ''`<:, - .: '', <''',!, - , -
Air conditioning or heat pump
Job site address: 7.2 ,115- 6 (A) 1
(requires site plan showing placement) 14.00
City/State/ZIP: 7 0 , -, d. Furnace 100,000 BTU (ducts/vents) 14.00
.., Furnace 100,000+ BTU (ducts/vents) 17.90
'Suite/bldg./apt. no.: Project name: ti . Z 0 s/
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
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.: ,
Other: 10.00
Tax map/parcel no.: Other fuel appliances
`;:f3-$ Water heater 10.00
A ni , 74: , a5-12•VWM;Z•'1:1. , 4.i:WOWU,,,,, , ,,,,,,:,,,,,,..t.,.,,,,,jb...,,,,,.A. - ' , 0•;:;"'3F , -V`;' , „:-",
Gas fireplace 10.00
P d AC. ,.,-1 ),(.. , ,-,:n tkr% !+-1, Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
. Wood fireplace/insert 10.00
. extir P Chimney/liner/flue/vent , 10.00
Atk. el !': - *ROPERTINO,WNERu ...TENANiEr.:•7.,-
.51 : ::ilt.:. O 10.00
Name: Environmental exhaust and ventilation
Range hood/other kitchen •
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 •
gfim 6.4. i
,Wif,Tir V- #65f4i1=:•,:iiim::,,-,:i:'6 Attic/crawlspace fans 10.00
Fi=:::'4=i:t ''4:i - .-*,,, , ,, „..;.;,'; ;A., 75,
Other: 10.00
Business name: 1 e ,
.7) ),..,..„ ' car )1, . /...h.:-,1 .1,C, r
. Fuel piping
--, ‘ 1 _
Contact name: --- 12'.e:„ 1 }40, , ,, tr, e,4-7- $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: ) 373,9 E 6 ,,,,L col , ::, .).:.-
Gas heat pump
--....._ ,
City/State/ZIP: 1-do r+) a r .,j, , o te. c.? 72 2.„ . Wall/suspended/unit heater
Water heater
Phone: (642: ) 2,. 9 ... 1 b0 0 Fax: : (B ) a . : . ;) , _... 0
- Fireplace
E-mail: Range
VirRIIMV.AAMM,'04•PNW•4M-1,SEa■IsfaEff5egritV.,-';4:.149.fi.'WVON'f; Barbecue ' :?,..
Clothes dryer (gas)
Business name: 1 4, y ," r „,,,,i r a ).,.) e 1 i„„,„, - I . ) , c ,
Other:
4
Address: t, at 3 9 e. E: ,.....,;.,-d.,„., ,.., , -,.....4.- .-., ,.-...,..,,, ... :MECHANICAL PERMIT- FEES*
City/State/ZIP: 1-", (-- .t(k " ,c.1 ., ) p - 7 20 (..,....._ Subtotal 13-.5.80
Minimum permit fee ($72.50)
Phone: (9 31 )3 ) ? ,. ,y z o,9 Fax: (3 "-:,;) 2 ?'? - -' S ....„,
Plan review (25% of permit fee) 4if
CCB lic.: 7.1. - 'r." -
-,;,..... "9...-. ; ....:. ---,
State surcharge (8% of permit fee) 2.0 ;?4 TOTAL PERMIT FEE
.ILT.....
/".. r ‘ 1 - • X' I '' ' 3 10 so
This permit application expires if a permit is not obtained within 180
Authorized signature .. - ,...e .?-..;.' 4..-
days after it has been accepted as complete.
Print name: 7:! ,,,, ,.-47„, . „._, ,--- :-./.-/ Date: :/-- 7---4“/
, . * Fee methodology set by Tri-County Building Industry Service Board
iAnuilding\Permits\MEC-PermitApp.doc 12/03 440.461 7T (II /02/COM/ WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Bysiness Line: (503) 63 gT
Received Date equested /S AM PM P
Location 7o)-- q 5 fiVid iik- C^ Suite r ; — (90 1 1 :—. 004/ ) --
Contact Person Ph ( ) PLM
Contractor Ph ( ' ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /911, c �� en , j : SIT
Post & Beam --.> G��'e'�
Shear Anchors �j 6 �� c) ! �_ c d S t� 6.
Ext Sheath /Shear [� `! C
Int Sheath /Shear
((:;/ V 36 ( bo-fq- i/t- '-v;= )
Framing ,
Insulation
Drywall Nailing
Firewall
Fire Sprinkler �j/
Fire Alarm r O 6 0 of 9/ C C )
Susp'd Ceiling L/'
Roof
Other: / . ,
Final
PASS PART FAIL — / � A
PLUMBING
Post & Beam
Under Slab
.-\,‘, . 0 , 01, - /
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain i. Shower Pan
Other:
Final
PASS PART FAIL
CAL .J :
K
Post & Beam
Rough -In
Gas Line
S - • - Dampers
- ' : ma y PART FAIL
-� TRICAL
ervice
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 �9
ADA (0 XX ti lt ,
Approach /Sidewalk Date - (6`-'( Inspector `"'� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL