Permit k
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00538
`'` �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/10/2004
PARCEL: 2S111 CC -09500
SITE ADDRESS: 15730 SW GREENS WAY
SUBDIVISION: SUMMERFIELD NO.2 ZONING: R -12
BLOCK: LOT: 122 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:
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: Furnace replacement.
Owner: FEES
MERRITT, MARY Description Date Amount
15730 SW GREENS WAY [MECH] Permit Fee 8/10/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 8/10/200 $5.80
Phone: 503 639 - 0103 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 76359
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: 1 �.._/ !i 4 Ar Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
I. 09 RECEI 04 01:30p PFIM DP115 503-598-0270 • p . 2
(
, • .
iechanical Permit Application FOR OFFICE USE ONLY
City of Tigard .
1 SW Hall Blvd.Tigard OR 97223 aek AUG 0 9 2004 , Received,/
Date/By:X /0/06/ di5 -• en
Permit No„
1325 , , i
Plan Revi
Phone: 503.639.4171 Fax: 503.598 I tiTY OF TIGARD Dacer3 y: in Other Permit:
Inspection Line: 503.639.4175 Dat Ready/By: ...21 sir . 2 See Page 2 tor
Internet v. ci.tigard.orus BUILDING DIVISIO ,.,-4 ttl
Notified/method: / ic Supplemental Inforrnaron i
.-''.:-::'1 stair5:61.i,2- - USE, CHECKLIST
Mechanical permit fees* are based on :he value of the work
0 Ne.. construction Addition/alterationireplacement
' performed. Indicate the value (rounded to the nearest dollar)
1 0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, 27ci pro: i
'ZIX.11.". ';: .. Value: $
. XI - and 2-family dwelling 0 CommerciaIiindustrial E Accessory but:cling —
For s n pecial informatio use checklist
1 0 Multl-family 0 Master builder 0 Other: Description Qty. 1 Ea. I Thu:
'll,':',',.':.,'.-'_'''''.,1::',-•"..,:it''',i,7...,-.P.1:,'Sg::.P2P-if.0141:14914;;-tk,"513.?0:31:CO301tilfi,',i;,t;.:.i,'.;:,::: ,:10.t7,.;;',: Heating/ cooling
Air conditioning or heat pump I :
I Job site address. /5 0 sm. a &et A , ... e /4 y (requires site plan showing placement) ' I 4.00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) / 14.00
Furnace 100,000+ BTU (ducts/venis) - -
1 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 1 4.30
I Cross street/directions to job site: Duct work I J 4.00
• ' Hydronic hot water system 1 14.00 '
Residential boiler (radiator or •
_ hydronic) 14 00
Unit heaters (fuel-type, not electric), I •
•
. in-wall, in-duct, suspended, etc. 10.03 •
. 1
1
Flue/vent for any of above i 10 00
Subdivision. I Lot no.: I
I 10.00 i
Tax map/parcel no.: Other fuel appliances
.-,..; ,;.,.',;-:.'.??,.-,:,'N•'',:4::!-:'?;41P-1-1:::',ii--;*--i''.!trti'fitWiia'aii5t434,SVl.gyio'rii."-Wc-/-'P'fl,i'l-:::il:141.,:kili r.1.?it';,' Water heater
10 OU
•
. ,
. il ..?,-i,.,. ... 1... _-....,„...ti-i ..-..w
,-. Gas fireplace MOO
,
s i ceA.A...--x ) ow F iu c vent for water heater or gas .
fireplace
Log lighter (gas)
10.00
1 .
. , Wood/pellet stove 10 00
Wood fireplace/insen • 10 00 1
• ;0.00 1
.: -t . .... , f,...11,, , , Chimney/liner/flue/vent
I 1 10.00 I
('lame: p . Environmental exhaust and ventilation -
I Range hood/other kitchen i
. Address: /S7:9 ..51 7e-e■f/--C a/e4Y equipment 10 00
CIty/StateIZEP:
! 77-9,49‘210 Clothes dryer exhaust 10 -30
Single-duct exhaust (bathrooms,
. i
j Phonei(S3 )g 9 0 i 1 Fax: ( ) toilet compartments, utility rooms)
b SO I
1,-...t.Fut.tk --....snliWA ' '...: ` , : 41 .": , Attickrawlspace fans 10.00
W
4Y.562:..11.1.4.1.%Wtsit*,INv.,*,
Other:
Business name:
Fuel piping IC 00
Contact name: A9/ 07)-/e) . $5.40 for first four; $1.00 for each additional
Furnace, etc. I
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Ph"" ) 0; 3 '7 0 4 7 I Fax: : (3-b3 ) , 5?1 , 42;?/../a ; Water heater _
E-mail:
Fireplace
Range
z'zil'42 r,:', Barbecue
-T -- -: • ':,t-'1:-..v-•',■•",+:''!'1-7..,':',70,-..■4, _
4
Clothes dryer (gas)
1 Business name: 44 t.A /-1 .6 / a. ri-/-e.--#1 - rid-J( -4 Ca e. ( d dv Other:
Address: (;) 60)( tr%' 3 .3 1 '7 7 144`4:6n.ic - 4.4'.01.1 . 6 . Zi , '11E121itit.EES*
City/State/ZIP: Subtotal 1
7 0/1_. 9‘ 742 . - 3 •
P l an Phone: i ) c, a t „ . 2 . 7 6 , ei e I F ax'• (
I , I' 3 ) . S r 6 0 ' 1 74, Minimum permit fee
an review (25% of permit tee)
,
CCB tic.' 74- 9,, ? I State surcharge (8% of permit fee) I 3 .0
TOTAL PERMIT FEE i 7 8. 30
Authorized signature: ‘ a--c--ey This permit application expires if a permit is not obtainec wit h; n 145
days after it has been accepted as complete.
I Print name' ) ct4 4 1 I Date: S----c:. I • fee methodology set by Tri•County Building Industry Service .3.:
i. do c I2/C3 44C.4417T (I Ii02/COM1WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
V BUP
Received Date Requested AM PM BUP
Location S 7 3 Q Suite e;20.0 ` �' 70 S38
Contact Person -�'Yl PIS ) 60.R. y 6 { - 2-7 PLM
(
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 14/
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam G 4
Shear Anchors
Ext Sheath/Shear
hit Sheath /Shear
Framing V /� ✓� �`�
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 PART FAIL
MThCAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers `
leganlip • RT FAIL
ELECTRIC - Strrvie-
Rough-In
Slolt
Low
Low A
• e Alarm
Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
E l Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line ��
ADA
Approach /Sidewalk Date y inspector !� Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo site.
PASS PART FAIL