Permit d
A. -
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00678
- 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/12/2004
PARCEL: 1S134BD-07003
SITE ADDRESS: 11342 SW COTTONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5
BLOCK: LOT: 228 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: DOMES. INCIN:
LPG 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.
Owner: FEES
VIGIL, THOMAS D Description Date Amount
PO BOX 55 [MECH] Permit Fee 10/12/20( $72.50
GREEN RIVER, WY 82935 [TAX] 8% State Surchart 10/12/20( $5.80
Phone: 307 - 875 - 2336 Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Phone: Heating Unt lnsp
hone: 538 2953
Final Inspection
Reg #: LIC 125815
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_
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Oct 11; 4 02:O1p Oregon Heating and Air 503 - 537 -2172 p.1
Me an
�h cai Permi.t.App;l'icatiOA
FOR OFFICE USE ONL
City of Tigard A V I� L1=-5 Received /0 `/ d q Permit No : _10067 S
1 3125 SW H Date/By:
Flail Blvd., Tigard, OR 97223 Plan Review �/
/� Other Permit: 503.639.4 171 Fax: 503 •1 200`r„+yf t' � Date/By:
Inspection Line: 503.639.4175 UL 1 I b + 1 'T I' Date Read /B y y: El Sec Page 2 for
Internet: www.ci.tieard.or.us .T1GPBD Notified /Method: I St pplcrnental Information
CITY a 11`b11 @iO�KI
1301LU' 'P OF WORK COMMERCIAL FEE* SCHEDI LE - USE CHECKLIST
Mechanical permit fees* are based of the value of the work
New construction ❑Addition /a![era[ion /replacement
performed. Indicate the value (round. d to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, lak n', overhead, and profit.
•
Value: $
CATEGORY OF CONSTRUCTION.
RESIDENTIAL EOUIPMEN r / SYSTEMS FEES*
I ' - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For speciel informnrfa use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Fa. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
13 . ` ), ),' Co ( 1 on Wood `ood l fl Air conditioning or heat pump
lobsitcaddress: t} (�(1 L ( requires site plan showing placement) 1 14.00
City /State /ZIP: T fj ('� Q Furnace 100,000 BTU (ducts /vents) t 14.00 MX
Furnace 100,000+ BTU (ducts /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 —
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
DESCRIPTION OF WORK Water heater 10.00 •
Gas fireplace 10.00
-)1 aC Q 0-Ova) d u r rI 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
Chimney /liner /flue /vent 10.00
10.00
PROPERTY OWNE ❑ TENANT Other:
Name: g TV /'t m ‘ 9 ` I Environmental exhaust and ventilation
Range hood /other kitchen r
Address: Pat+ OX _ 5 , , } equipment 10 .00
City!Suue!LIP: reen CA YC1 W' Clothes dryer exhaust 10.00
, Single-duet exhaust (bathrooms, i
Phone: Q7) G .-,3 t, Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attie /erawlspace fans 10.00
Other: 10.00
Business name: -
ame: Afr C6r' C Fuel tin
P�P g
Contact name: $5.40 for first four; $1.0t for each additional
I
3c ] Furnace, etc. f
Address: lY ►, {II
Gas heat pump
City /State /ZIP: C?l 3L ro1 J_� Fax: J C� 0 iV CI I 1 J Wall /suspended /unit heater
Phone: (C� C a7_a ∎ -- L,-- --L,-- Water heater i
Fireplace
E -mail: i
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: OREGON HEATING & AIR CONDITIONING, INC. Other:
Address: CCB #125815 MECHANICAL P: ;RMIT FEES*
City /State /ZIP: P.O. BOX 397 Subtotal , '.-
992 H1G f•99W Minimum pen iit fee (572.50) l e'a.. '�
,
Phone: ( ) DUNDEE, Obf'l 97] F Plan review (25') i of permit Ice)
CCB lie.: State surcharge (8'1, of permit Ice) 5-a7,
TOTA1. PERMIT FEE (tgt.301
This permit application expires if a permit is not obtained within 180
A uthor'ized signature: days after it has been at cepted as complete.
Print name: .SIJ i r - ( ' \ g) Date: 10 s) t l Dy • Fee methodology set by'I7i- County 3uitdtng Industry Service Board
— 1 ....- ...._. — -.
CITY OF TIGARD 24 -Hour —
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Re uested — AM PM BUP
r /
Location ° Suite E Oo e - b0 6 7g
Contact Person Oi Ph ( ) 53 S/ ' 95: PLM
Contractor Ph ( ) SWR
BUILDING. t/Owner P ELC
Footing 35 ` q SD I ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear V '\ -v Z I i _ _ Q -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS 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 RT FAIL
NCH AL
Post& Beam 0
Rough -In (i)ttg,0 Gas Line
Smoke Dampers
PART FAIL
‘=.
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 -II for reinspection RE: ❑ Unable to inspect — no access .
Fire Supply Line
ADA /
Approach/Sidewalk Date - Inspector '% Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL