Permit CITY 11 0F TIGARD MECHANICAL PERMIT
A I� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00802
t� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/2004
PARCEL: 1S133DA-06800
SITE ADDRESS: 12920 SW HAWK'S BEARD ST
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 090 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Replace woodstove with gas stove and gas piping.
Owner: FEES
ADAMS AND WETZEL Description Date Amount
12920 SW HAWKS BEARD ST [MECH] Permit Fee 12/6/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 12/6/200 $5.80
Phone: 503 494 - 0524 Total $78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 503 692 - 5563 Ma Line Insp
Mechanical lnsp
Reg #: LIC 126881 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: u Permittee Signature: _ 1-� n ` p f ,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
12!07/04 15:17 FAX 503 494 7086 OREGON CANCER CENTER EJ001
Mec`?`° . ia1 Permit Appication MK OFFICE USE ONLY
City of and
Ti ReceiDate4/Bed y: / '
Permit No , �� d) 00 9
Tigard
/ `�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / >.
Phone: 503.639.4171 Fax: 503.598.1960 Awl/1,4111i \ D ate/B y : Other Permit:
l tiS if tt1� '�
Inspection Line: 503.639.4175 r . .`'_I Date Ready /By:' 6a See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Ai tj Supplemental Information
1: . ; _.: TYPE OF WORK'. • O1VI11 RCIAif.' 'EE *;i $C13.13 ?UI>g + %US < I>✓CKJ%T$T .
❑ 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
GATED OF. "CUNSTRUGTION�� :"
Value: $ 29 0
6 00
iiii&
. :RES iAVEOHI M SYSTBMS'F E9 : ,
® 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. I Total
' :JOB. SITE INFORMATION. AND LOCATION Heating/cooling
Job site address: 12920 SW Hawks Beard St. Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100;000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Shamburg Heating
Gas heat pump 14.00
Cross street/directions to job site: Schools Ferry and Summer Lake Drive 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
Subdivision: Summer Lake Lot no.: Flue /vent for any of above 10.00
Other: _ 10.00 _
Tax map /parcel no.: Other fuel appliances
°.DESCRIPTION OF WORK : . Water heater 10.00
. Gas fireplace , 10.00 1c) . co
Replace woodstove with natural gas stove 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
PRO 10.00
Chimney/liner/flue/vent
TENANT ,
PERTY cQ ': :: ::, '.' 0 :�:' ,.
- .... Other: 10.00
Name: Candyce Adams and Timothy Wetzel Environmental exhaust and ventilation
Range hood /other kitchen
Address: 12920 SW Hawks Beard St.
equipment 10.00
City/ State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)494 - 0524 (work) Fax: (503)494 -7086 (work) toilet compartments, utility rooms) 6.80
r.., : . craw p ce fans
�:: AP$LICAN ` ; (� .,.., , ` ` PEYtSON
A ttic is a
Other: 10.00
Business name: Fuel piping
Contact name: Candi Adams $5.40 for first four; $1.00 for each additional
Address: 12920 SW Hawks Beard St. Furnace, etc.
Gas heat pump
City/State/ZIP: Tigard, OR 97223 Wall /suspended /unit heater
Phone: (503) 494 - 0524 1 Fax: : (503) 494 -7086 Water heater
Fireplace
E -mail: adamsc@ohsu.edu Range
, •
r r ' . - ; : CONTRACTOR : Barbecue _ •
Business name: Shamburg Clothes dryer (gas)
Other:
Address: P.O. Box 829 " :: ., ;, : : : : '.. ,MECFI,ANIGTAL;PEDMIT•;F4T = ,.:';:: :.;' " ::;.` .
City/State /ZIP: Tualatin, OR 97062 -0829 Subtotal
Minimum permit fee ($72.50) 1 O . SO
Phone: (503) 692 -5563 Fax: ( ) Plan review (25% of permit fee) 1
CCB lic.: 126881 State surcharge (8% of permit fee) —
TOTAL PERMIT FEE \e "
Authorizer: signature: This permit application expires 'fa permit is not obtained within 180
$n J days after It has been accepted as complete. .
Print name: Candyce Adams I Date: 12/7/04 * Fee methodology set by Tri -County Building Industry Service Board
it
i:\ Building \PermitsM4BC- l 12/03 440- 4617T(11 /02/COM/WBB) ✓
CITY OF TIGARib 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ! °� AM PM BUP
Location 9 2. �7ZQ.c L)-1 / ►�t�) Suite E o D d g 0„ .
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/99r ELC
Footing 5 0- R 7 7 b ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: j SIT
Post & Beam /012.4-4Zi
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear /� ��� L (( _ Q
Framing U ►`\, �o��� c/ �
Insulation
Drywall Nailing -4i a—AS �r �,,Q S' �T= ' s —� ; _ `5!� , T
Firewall
Fire Sprinkler A" i/a/Ai(f' - --
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
MECHANICAL
Post & Beam
Rough -In 4
rri
Smoke D mpers
Final
(FITS1. PART FAIL
EtEC RICAL
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 for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / �rS Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL