Permit CITY TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2004 -00349 -
I 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/8/2004
PARCEL: 2S 102BB -00409
SITE ADDRESS: 12070 SW KAROL CT
SUBDIVISION: KAROL COURT ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
Remarks: Furnace, gasline and exterior A/C
Owner: FEES
BRICKEY, JUDY F Description Date Amount
12070 SW KAROL CT [MECH] Permit Fee 6/8/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 6/8/2004 $5.80
Phone: 503 620 - 4676 Total $78.30
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 1441 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. -
z
�' r
Issued By: Permittee Signature: 6 a- y -7
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next klusiness day
FROM :Ja cob sHeating FAX N0. : June 04 2004 10:46AM P2
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f o Ti like Review ��Qtt Da y App . ' Pe No.
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13125 SW Hall'
� p►F1 P Post-R :Remit No.:
Tigard; Oregon 97223 Post - Review land Use
Phone: 503 -639 -4171 Fa 1 59 p " �;;� r.'.l �,t, Dote/B - Case
Internet: www.ei.<igard or. �� ®1N s „ Contact See Page 2 rot-
S 24 - hour Inspection Requesti 03 - 639 - 4175 ' '" -- Name/Method: , Su, !.mental I irortnutlon.
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IP New construction .. I■ Demolition Mechanical permit fees' are based on the total value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
tr 4�"/ r �'�>llsl,.. `'i 6a'';t' ii�,iAT,F, sfl`li . ' , Addition/alteration/re . lacement ( loll, ,i il„i?ii;?t ' N Other: �fl 4E r � ! mechanical materials, equipment, labor, overhead and profit.
r ,iY . <t . 1 �d f_)I a rl I � �.1idl� 1 1
WO 2 Farrlil dwells e
n_ Comme rcial /Industrial Value: $ � See Page 2 for Fee Schedule t�'r w :``;I 1,,,�,i ?`� ; " .'�, "' '�`i' :�1'�. "d' @:'1 + :11 �"' " '
r • ►t■ta:f•Yiw II _ M ulti - Family . I?escri r lion 1101 Fee ea. Total
I. Master Builder Ir Other: a .li� :� oil rf
n r ,: r1a r'pr d .•�.fr,'r r Il. ; i 9?i'x ,* i 1
'' 400
X�1 i " '� ?Cp i;l,! � i��' ! (I I n��L�.Sf�l.�'�.�'ll �i „9,1�74,a?.lS�t�l �'�tll� �l �, 4�gi � ' �•� :,•� .. Furnace - add-on a con _ r
Job site address: i! Wrr •♦ter ' Gas heat pump _ - 14.00 __
Suite #: Bid:. A,t. #: _ Duct 14.00
Pro•ect Name: � Ta� Hydronic hot water system 14.00 __
Res boiler
Cross street/Directions to job s e: (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)
w Repair units
e I.ot #:
Subdivision: J
I dell (kierikii lsii ; ... :. r 1 _.._ •
Tax ma I / • arcel #: q Water heater 10.00
,. iX�;y }�ii�tl '�'v'FWiiI1 5� ° � ailiri�l3i � r � , A� .'�!,ti,.. inf rN ''' .r",' Gas fireplace 10.00 ..,
Flue vent (water heater /gas 6roplace) 10.00
Ile s� . i v 1 Log lighter (gas) 10.00 •
LL''� Wood/Pellet.stove 10.00
i _ Wood fireplace/insert _ 10.00
Chimney/liner /flue /vent 10.00
,y ! �: ii" r 'v i ;��,�rii''r' :' lei' :�`I (Mat ,:j.iY!
,lii,.N'II��I iu.'iry "';'� lil Other: 10.00
�•,E; rhi,�i?),t .� ,I.•. Err', ^.�IC1>._�s.o-�t�4�rlr��m EN ,e�,R.,l�..t,.1 ,. . I��LU1 ;,r,��lr�ll� :v:Y�vu'�JVS.�I� • . •,.'. ,•.
�� dviro 19�.?�i.�Jar"� '�� , s' : .
�, f . . • I! ! r Range hood/other kitchen equipment 10.00
Address: /� _ �• ...ilk - 0 C lothes d ryer exhaust 10.00
Magralall �' Single duct exhaust -
P J e: a , � ipl Fax: (bathrooms, toilet compartments,
6 t; . :v, W' ?.` r 1'l'vlyyk, ' artdai3Eti'ii?, ' s; a° i?. 4.; l20,l9u';0.14 ?:,fdfFijli;KI utility rooms) 6.80 .�
. L ■ qc - Attic/crawl space fans 10.00 -
R � Other: 10.00
Address: , 1 � , "' ° •4 4.'Le1= 'r�J < r : " S ` .
-- �+�ir � ' : : `:': . i:: . • ,�;i� ��. I M Al1ylilL! �I : I .� �
City /State /Zip: ;---) L,._,--) _ "(85.40 for first 4, $1,00 ea 1t additional)
Furnace, etc.
Phone: Fa7 _ Gas heat pump
E � p�? �, , f��9 + p a i Wall/suspended/unit heatci s•.* i`. t{1;' �Il�;ri`'. a1. as, "�t',l .�k0 INU�i': f t ,lnfd.�S .s tl :a l` ui�lbw i1lSFf ANIE�::�d�1111i)Ifll�n✓ F'� f.�RI t water heater _ ** . , -
Business Name: r G� -, Fireplace - **
Address: 4 7 `c. v" 1 i <..0 c,t.k. K , .e_ Range "`"'
BBQ ss
Cit /State/Zi.: •t l ' • 1, Clothes dryer (gas) ' • �-
FOR
Phone:`D.2>L4 163 IMMISEINFIE Other: •
_..._ W. _ •*.. •
CCB Lie. #: , _M 1i Ti'aen Fettii# ..: - -,
a / Total:
Authorized ` Subtotal: $
Signature:
«' Date: Minimum Permit Fee $72.50 $
Plan Review Fee (25% of Permit Yee) S 5.
(Please print name) State Surchar a 8% of Permit Fee S
TOTAL, PERMIT FEE $ ,
Notice: This permit application expires tf a permit is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days atter it has been accepted as complete. "Site plan required for exterior A/C: units.
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CITY OF TIGARD 24 -Hour • • ,` ;
BUILDING Inspection Line: (50, e " a - , .
INSPECTION DIVISION Business Line: (50 ' 9 -4171 MST
` BUP
Received (� Date Request; • �� ( AM I PM BUP
Location /3_070 0- l - : %/ 4 � _
3L uite / EC
Contact Person Ph ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LC' N
Footing
Foundation ELC
Access:
Ftg Drain • ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam J-X Wt O ' C,
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing \41/4/(0,4A — — — —
Insulation
Firewall
Drywall Nailing _
Fire Sprinkler
Fire Alarm 8
Susp'd Ceiling
Roof
Other:
r 1
Final vv l
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 FAIL
MEC, A NIC
Post & Beam
Rou h -In
as Line
Damper
PART FAIL
1. • 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 0 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA � �
\
Approach/Sidewalk Date P Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: � (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date quested AM PM BUP
Location / - d - / G � Suite MEC Oa D d
Contact Person Ph ( ) 23 q 73 3 ( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELCgF
Footing
Foundation ELC
Access:
Ftg Drain ( ELR
Crawl Drain '^`
'Slab Inspection Notes: SIT
Post & Beam J�(D C S 1 .. 1 L r(Ev l) v 1.7 p, i),
Shear Anchors , ` }
Ext Sheath/Shear \i
� c�`T°' 0
Int Sheath/Shear
Framing
Insulation \'
Drywall Nailing 1
Firewall `
Fire Sprinkler 0 ra>\ a 6 \ u. , ` J`�l V'1�t� ��j N c A
Fire Alarm
Susp'd Ceiling _
Roof , ` Q b �� C� fa Ltiv D 1
Other: �J
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In v
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
Smoke Dampers
PART FAIL
•
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PASS PART El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 ,SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ( I Unable to inspect — no access
Fire Supply Line
ADA
A
8 / 3 7
pproach/Sidewalk Dat /'�
PP Inspector —.s Ext
Other:
Final DO NOT REMOVE this inspection record from the - • site.
PASS PART FAIL