Permit ki t
CITY TIGARD MECHANICAL PERMIT
� & DEVELOPMENT SERVICES PERMIT #: MEC2004 -00355
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/9/2004
PARCEL: 2S111 CC -19100
SITE ADDRESS: 10345 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R -12
BLOCK: LOT: 250 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: 1 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: 4
Remarks: Install gas furace /piping, water heater, AC and (2) fireplaces.
Owner: FEES
MICHAEL WALTERS Description Date Amount
10345 SW GREENLEAF TERR [MECH] Permit Fee 6/9/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 6/9/2004 $5.80
Phone: 503 684 - 1295 Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 36102 Heating Unt Insp
Cooling Unt Insp
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: / � � / 1 Permittee Signature: ___Z2 r d�,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jun 04 04 01:56p 503 -249 -8260 p.1
Alio' Mechanical Permit Application
Date received: 1 yail Permit no.:m da011 Do s's
1 r ih�i City of Tigard Project/appl. no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City nfTigard Date issued: By €:, I Receipt no.:
Phone: (503) 639 -4171 Pa mcnt type:
Fax: (503) 598 -1960 Case file no.: y yp :
Building permit no.:
Land use approval:
TYPE OF PERMIT
;'l Sr 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 Tenant improvement
0 New construction ddition/alteratian/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /0 34 5 SkJ 0 '. x-race Indicate equipment quantities in boxes below. Indicate the dollar
' Suite no.: value of all mechanical materials, equipment, labor, overhead.
Bldg. no.: profit. Value $
Tax map /tax lot/account no.:
Block: 'Subdivision: *Sce checklist for important application information and
Pot: jurisdiction's fee schedule for residential permit fee.
Project name;: (,L�}..,�'�YS
City/county: ' . a r • ZIP: Ct 7224. 1& 2 FAMILY DWELLING PER:1MIT FIX•: SCHEDULE
• • • I COMMERICALIINDUSTRIAL EQUIPMENTSCIIEDLIE
•
Dc cr iption and IoFat . n of mirk on remi N•' � F�I Total
Est. date of completion /inspFction: it.rYladi V taJjk T G t • r s Description Qty. Res. only Res. only
HVAC
Tenant improvement or change of use: Air handling unit . CFM /
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required) / / g 14 -
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boilcrrompressors
State boiler permit no.:
Business name: • i to e r R,,s F t-rnace_ - HP Tons BTU /H
Address: 3, G d7C'Qad o-Do-A' Fire/smoke dampers /ductsmoke detectors
City: Por*( State:( ZI CO :Z 3 Z
I Heat pump (site plan required)
if Install /replace furnace/burner 92 I3TU /H / , Q _ I4
Phone:5�(S3� y�ax: 1'� J��� Including ductwork/vent liner 0 Yes 0 No 7
CCB no.: So /OZ Install/replace/relocate heaters– suspended,
City /metro lie. no.: / 3 ,r or wall, or floor mounted
�M17 Vent for appliance other than furnace
Name (please print): ♦ ♦ �T�I /I /` Refrigeration:
CONTACT PERSON Absorption units BTU/I1
Chillers HP
Name: 1 � Compressors HP
Address: Yn 1 - L } t E ,, Environme ex an d ventilation:
City: ate: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
_ - , a -- -,---- - -- Hoods, Type I/ II/res. kitchen/hazmat
,--
/,, / O . M � T� y hood fire suppression system
�' l
Name: n / /C,C. tc a e rs Exhaust fan with single duct (bath fans)
Exhaust system apart from heating or AC
Mailing address: f 5 g g �� Fuel piping and distribution (up to 4 outlets) ' �•
City: • • r'• State: 0 ZIP: " 7224 Type: LPG )( NG Oil 4 40
Phone: Arial Fax: E -mail: duel piping each additional over 4 outlets ( I .00 /•00
ENGINEER • cess piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address:
Decorative fireplace
'State: I ZIP: Insert –type Y. C . A'`J
7 /, - � —
City: W oodstove/pell et stove
Phone: ( Fax: E- aiL Other:
Al I Date: – q ._
Applicant's signature: z Other: .
( /,.
Name (print): *° 7 / Permit fee $ 54-. 4 0
Not all jurisdictions accept credit cards. Please call jurisdiction for more information. Notice: This permit application Minimum fee
0 Visa t] MasterCard ex ires if a ermit is not obtained ---"----- / / p P Plan review (at %,)
Credit card number: Capires within 180 days after it has been State surcharge (8 %) .... $ _ •
Name of cardholder as shown on credit card ac ted as complete.
S E C E I V E D TOTAL $
440-4617 (GfnnlCOM)
Cardholder signature Amount
JUN 4 2004
— CITY G-F TIGARD
BUILDING DIVISION
Jun 04 04 01:56p 503 -249 -8260 p.3
•
l yto lleer r
U tsFurnae e
WE'RE THE ONES!
NC Site Plan for the address of:
/0315 S &) ( regn Je.a e -trams
Customer Name and Phone #:
GLa-H r 563 644--/295
0
HOUSE
20
513
STREET
PHONE 503 249 5000 • FAx 503 249 8260 • OREGON CCB #36102
3515 NORTHEAST BROADWAY • PORTLAND, OREGON 97232
CITY OF TIGARD 24 -Hour = ' '
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Received Date Requested O ( t AM PM BUP
Location rJ ! e" Suite MEC v?/;G - o0353
Contact Person Ph ( ) PLM
Contractor Ph ( tea) (' t SWR
BUILDING • ‘1 1 1‘1 1 1( 4 _‘1 1 1( 4 _,h_12__/ � l 70 - �"s(� 0 ELC o OO 9-70 c
Footing �V 1t b 3 \b _ ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: - ,. SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
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
MECHANICAL
Post & Beam
Rough -In /
Gas Line
44
Smoke Dampers
ART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
FL larm
!�
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line Xf ADA
Approach/Sidewalk Date ' �� �� Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Jo ite.
PASS PART FAIL