Permit CITY TIGARD MECHANICAL PERMIT
" 1 DEVELOPMENT SERVICES PERMIT #: MEC2004 -00462
`' ,, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/14/2004
PARCEL: 2S111 CA -08300
SITE ADDRESS: 09925 SW KABLE ST
SUBDIVISION: GULF SIDE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 027 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:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Piping for range and dryer.
Owner: FEES
KEN HART Description Date Amount
9925 SW KABLE RD [MECH] Permit Fee 7/14/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 7/14/200 $5.80
Phone: 503 639 - 3035 Total $78.30
Contractor:
ROSE HEATING CO
9945 NE 6TH DR
PORTLAND, OR 97211 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 2084
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: c Z" (),F A Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Jul OS 04 03: 15p p. 1
,
Mechanical. Permit? App!licanh Chili FUR O1-W Me PSI ONLY
Ruxcivcd _ �/ ,/ A Mcchalti
Date/Bs: 7 /! a7 2Gl`• Permit No. : v :CLOD VOA)
g D Approval Building
�x OA Tigard 1 i, 2 2P1 Date/By: Permit No.:
13125 SW Hall :B1vd. Plan Review Other
Tigard, Oregon 97223 r..ITY OF TIr.IARL` _ DataBV_ Permit No.:
•
Phone: 503 -639 -4171 Fax: 503 - 598 -1960 e'' .1 Post - Review Land Use •
D I i l l 1�l 1',t- �; . ' � Date/6y: Case No.:
Internet: www.citigarclor.us _ , ,.1 I Contact leris.' ® See rage 2 for
24 -Dour Inspection Request: 503 - 639-4175 Name/Method: A'\ U _ Supplemental Information.
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❑ New construction I In Demolition Mechanical permit fees' are based on 'the total value of the work
❑ Addition/alteration/r lacementI llOther: performed. Indicate the value (rounded to the nearest dollar) of all
- .ii,cY: ..T , . .: t ` '4V,I nit•, • mechanical materials, equipment, labor, overhead and profit.
'� .. •,!: ° o!o }ri ; :fit ,;..
1 & 2- Family dwelling • Commercial/Industrial Value: S See Page 2 for Fee Schedule
JJ Accessory_l3uilding 0 Multi - Family 7 =•
�.. •l 5•. I �. a :a :�.�>r_ _a71 r•i. '
rr.
Qty Fee(ea.) Total
❑ Master Builder In Other: •. • Heating/ooiui);'.. >.' :.....!.
_ t k+ZtVg:'r Furnace - add -on airconditioningr• . 14.00
Job site address: GJ 12.3" S C1) A.44.Ri y ,e, 76,14i Gas heat pump . ' 14.00
Suite #: I BldgiApt. #: Duct work 14.00
Project Name: /� -/,/ y t J, -y Flydronlc hot water system 1 a_t)0
Cross sut e t/IZireclions to job site: Residential boiler
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended. etc.) 14.00 .
Flue /vent (for any of above) • 10.00 ,
Subdivision: ' Lot #: Repair units 12.15
Tax map/parcel #: y; ';:;:' .;'Other•Furl :y ixtioei: :,s■. ,.... . .
VV eale --it, 10.00 -46F3-
1 .I.c.Il iMi',A.WAT.e 11MMt!s@IINi i ;1 'l11110IS Gas tireplace 10.00 •
_ Flue vent (water heaters fircptace) 10.00
• L og lighter (gas) 10.00
'' Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chlmney/liner /ihre/vent 10-00
''ff': ;Ze rjarait :3'Mu:R E = :,; ' aj_t' . • :t}, ;7e::: " Other: • 10.00
Name: f�f N $1,4..4 i° : • ' ' :;i ''.;"'Flrivliiiiimeetal"Exhiuet'&;Wi dni '�i;•'= Vi; : : „iii „:
Address: Range hood/other kitchen equipment 10.00
r Z 5 5 Lti � 8 e 2r� Clothes dryer exhaust 10.00
City /State/ -0 c,,4,e, • 17 Single duct exhaust
Phone: . - P33 Fax: (bathrooms, toilet compartments,
iliEu::;:.: � ; ;ics` aSi :u ` .ili'h I.: D; l.f 3.7:_c r •=a� ,, ': utility rooms) 6.80
Name: Attie/c awl space fans 10.00
Address:
Other _ 10.00
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City /State/Zi�: *105.40 for first 51.00 each additional)
Phone: Fax: Furnace, etc. _ _ ••
Gas heat pump • • ,
E -mail: �� !�f1 �,��7���,ry Wall/suspended/unit heater .
r._'-EY.1 ..W.. 'i ' . i SItl �27i.� agY�g 4. :ija iP.' :. :T..N Ai'eii'iiFv : :' Water healer - ' ** .
Business Name: Rosa ,4( ,,v < Fireplace ••
Address: S N " A BBO f • •■
City/State/Zip: // - - (' q 1z/ / Clothes dryer (gas) I `* - -
Phone: 57,3- zY2 - - / i 3 - Fax:- - -7g' - -CP 20 Other: •»
CO3 lie. 41: Q,` Total:
: - • : v :
Authorized • :.: • Meehanital eermlGFas":.::. :, ...,• ::
Signature; I ...r Date: 7 -1 e (i t Subtotal: s�S 4-0
Minimum Permit Esc 572.50 S , ..-) g, , ..�
/ , A 17) ,4 --Y-i-At �•Gcv S Plan Review Fee (25% of Permit Fee) S
(Please print name) State Surcharge (8% ofPennit Fee) $ -c; gQ
TOTAL PERMIT P511 5 • R I)
Notice: This permit application expires If a permit is not obtained within 'Fee methodology set by Tri -County Building ladustty Service Board.
180 days after it has been accepted as complete. "Site plan required for exterior A/C units. •
i :■Dats1Pcmut Forms WocPcrmit 1pp.doa 01/03
CITY OF TIGARD 24 -Hour '
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Re•uested 0 - - AM PM BUP
r
Location a / Suite �-
Contact Person Ph ( ) PLM
Contractor Ph ( ) g 3 - S7 SWR
BUILDING Tenant/Owner ELC 1■1 Cl/�
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath /Shear J /
Framing /3 114 •eD>2 '`, —* -- S 2/3' / 5L
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 • T FAIL
ri L Ox
Pos
Rough -In ' 0
9 ampers
ASS - ART FAIL
R ICAL
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 fl Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA — ,�
Approach /Sidewalk Date
Inspector - . Est
p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL