Permit CITY TIGARD MECHANICAL PERMIT
iI DEVELOPMENT SERVICES PERMIT #: MEC2004 -00344
f I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/4/2004
PARCEL: 2S 103CC -08800
SITE ADDRESS: 12130 SW KELLY LN
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 035 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: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install.
Owner: FEES •
SCHIELE, SCOTT Description Date Amount
12130 SW KELLY LANE [MECH] Permit Fee 6/4/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/4/2004 $5.80
Phone: 503 - 590 - 7290 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 66578
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 d. / %� _ ■, Permittee Signature: r� GZ 4a.c t J
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• • • FOR OFFICE USE ONLY -
l�
�? J[ca�ieal Pe;rxx>�(J11Ca Received / /4//` / Mechanical N
0 Date/S ,,t/ : Lr 7 0 / Permit No,: IF / #0 Oe �
3 I
City bf 'I igard � � ® Planning Approv: Building
P � ® Date/B Permit No.:
13125 ,i �V 1I all Blvd - `,' ,` \C? \ G J � Plan_Review Other
Tigard, Orcg Jn 9 �V \J Date/t3 ., I b ei it Nu..
Phone: 503- i39 -4171 Fax: 503-0k48- , •i4r® t Post- Review Land Use • -
Internet: wvt w.ci tigard,or,tts G \ : ,a1( DateB ; Case No.:
\0\ --14.. 111 Contact , ti ® See Page 2 for
24 -hour Insp action Request: 503-483,17.5 Name /Method: Su..Iemental Information -
— •
TYYF.E OF WORK COMMERCIAL FEE' SCHEDULE - USE CHECKLIST' • ....
❑ New cot ,struction L® Demolition Mechanical permit fees* arc based on the total value of the work
❑ Addition lalteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
— CATEGORY OF CONSTRUCTION 4:,:.. ,: mechanical materials, equipment, labor, overhead and profit.
• 1 &. 2 -1 tinily dwelling n Commercial/Industrial Value: S See Page 2 for Fee Schedule
P1 Act:esso Building Multi Family RESIDENTIAL.EQUIPMENT /SYSTEMS FEE* SCHEDULE
Wlaster Builder Other: Description ( Qty I Fee(ea.) Total • II r ng/Cooiina
3011 SITE INFORMATION and`LOCATION•-• ' : - Furnace - Add n air conditionin ^"" ! I 14.00 1
Job sit(: add ess: `a-i,? 0 _Si„) L.r -+�. Gas heat oumD —.--- 14.00
Suite #: Bldg. /Apt.. #: Duct work _ ) 14.00
PTO eel Name: Hydronic hot water system ( 14.00
Cross ;.tx (
eet'Directions to job site: 0 oriel boiler
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
•
(in wall, induct. suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units f 12.15
a
Tax map/pa / CCel #: Other Fuel Appliances
p p _ Water heater I 10.00
_ ... • DESCRIPTION OF WORK Gas fireplace I 10.00
Flue vent (water heater /gas fireplace) I 10.00
�
I 1` y L � -"' Log lighter (gas) I 10.00
- - -J cJ Wood/Pellet stove
I 10.00
__ , _ - Wood fireplace /insert I 10.00
Chimney/liner /flue /vent I 10.00
[k� - FRO PEFC'Y OWNER . • ' 0 TENANT . Other I 10.00
Name: S c,O ,SGT i ( C, Environmental Exhaust & ventilation _
Range hood /other kitchen equipment 10.00
Address:
—.... _..... - .. - - -- Clothes dryer exhaust 10.00
Cit /State./ Zip: Single duct exhaust
Phone: c %( ; ,0.- 74 e. Fax: (bathrooms, toilet compartments, •
U APPLIC.A NT ••• ' • 'CON.TACT'PERSON.';' *: " • utility room, 6 Rt)
Name Attic /crawl space fans 10.00
Address:
Other: 10.00
Fuel Piping
Cit /State/ Zip: * *($5.40 for first 4, 51 -00 each additional) I
Phone Fax: Furnace, etc. "'
---- -, Gas heat pump L "
E-mail: W•il /suspended/unit heater I *-
CONT.RACTOR = . • Water heater _ '"` • BUSIntSS T 'an C 5 ` ( l Cwt. H-4 cs r-‘.3 Fire 'lace It*
(_( t) 1 5-r" �, ,rL y - r -er , Range . . .
.. _
Cit /State/ Zip: H (S L, c- , 7 , e• .i z ? Clothes dryer (gas) I .-
Phone J. i t; S r_ Fax: (via' l — c - 1- 1,3 Other: 1 **
CCB Lie. Total: j
0
Authori::ed ' Mechanical Permit Fees
( ✓ `� Subtotal: S
Signature: j (- 6 � ' — Date:
Minimum Permit Fcc 572.50 1 c - }' :0'
y .,,.t., - ,'` 0 I <<' m Plan Review Fee 25% of Permit Fee I S
(Please print name) State Surcharge (8% of Permit Fee) 1 5 la
- f''OT.aL PERMIT FEE I $ a
Notice: This p trmit application expires if a permit Is not obtained within *Fee methodology set by Tri- County Building Industry Service Board.
180 days after t has been accepted as complete. * *Site plan required for exterior ,VC units.
i :\Dsts\Purmit F )rms \Mcc PermitApp.doc 01/03
2' BTLO B6S 60S ZuzzealA R•3TetoadS eIE :DI 1,o £0 un[
..SITE PLAN
PL
35
?L lig • PL
PL
STREET
Specialty Heating & Cooling, Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640 -3607 Fax 503.681.0793
E'd BILO BGS COS 2uzzeaH RziezoadS eTE :OT I'D Co unf
CITY OF TIGARD 24 -Hour
BUILDING Inspectiq ..i •ef3) 639 -4175 MST
INSPECTION DIVISION Business Li f e: 0 , • :4171
( D� + BUP
Received Date Reque d AM PM BUP �/
Location /(P .,e) X - lJ ,i / Suite o t JSL 9 7'
U ,
Contact Person Ph ( ) 1 vsz0 .- . O 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
• Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
hit Sheath /Shear , \ VY) :.- • LC/- j "1 f 06 33-7--3 Framing
Insulation r \ ie .-C9 R
Drywall Nailing
Fi rewall •
Fire Sprinkler ,
Fire Alarm , � � 1 5 6 6 Susp'd Ceiling '`�`T /� _i .
Roof ► CC.ui,1 n -1 6 0A3) .s,S
Other:
Final WV----,.... \ C.„4---1 ,'
PASS PART FAIL
PLUMBING /� l
/� 4
; � .i......, '�— w'.
Post & Beam ,� - 2
Under Slab , " q v `4( — `�' L 6
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
4---(4e
Shower Pan . ��
Other: /
Final Le Q ,
P PART FAIL o tt11 \L
ECHANIC . . k �
P
V ,;(3 ) L ' &i
Rough In ; Q�/ (�
Gas Line Ir , 1 r
Smoke Dampers
A ir / z / z ,„
Anal
PASS OUP FAIL
ELECTRI . AL
Service '
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply
ADA Date `� ' n � ■ v ✓ C
` /e ' c °?
Approach /Sidewalk 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
Received Date Requested eeb AM, PM
Location / �' ( "50 6, Suite 4t 0
-3.Z�
Contact Person Ph ( ) &40 -- 36 0 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Shleath /Shear i - �1
Insulation NS,
Drywall Nailing .) f I /V �`
Firewall 7 Ver‘f (Ce,N)
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
P FAIL
ECHANICA
am
Rough -In
Gas Line
S oke Dampers
4111P
PART FAIL
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: ❑ Unable to inspect - no access
Fire Supply Line -
ADA �j
(6 � �
Approach /Sidewalk Date Inspector � ' �/ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL