Permit ti
CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2002 - 00090
:. I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/4/02
PARCEL: 1S134CD-03600
SITE ADDRESS: 11950 SW KATHERINE ST
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 063 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:
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:
Remarks: Installation of NC. Unit cannot be placed in the required set backs.
Owner: FEES
FRANKI BACCELLIERI Type By Date Amount Receipt
11950 SW KATHERINE PRMT CTR 3/4/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 3/4/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 692 -1565 Cooling Lint Insp
Reg #: LIC 5193 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 -0080. You may obtain copies of these rules or direct - questio to OUN •y calla
r�n�»aF_ca� Ra
Issue By: fay J am„ , 1 v Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
w,, ♦ m
Mechanical Permit Applica ' I n • . . . •
Date receiv • ' : 6 2 Permit no.: b , -pp , - 0 090
• i1 City of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR ' Date issued: By: G j Receipt no.: •
. Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: • . Payment type:
• Land use approva Buitdingpermitno
TYP. OE PERMIT "'
40 1 & 2 family dwelling or accessory ❑ Commercial/industrial • . ❑ Multi- family , ❑ Tenant improvement
_ ew construction, . .,. Addition/alteration/replacement ❑ Other: „ • _ .
• -- Y;:.' - ; JOB SITE INFORMATION _ . - M *7 ,.. -m , ,, , COMMERCIAL VALUATION SCHEDULE'. "
Job address: i `g _ C W Ka ki\tr; r C. 3 . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ -
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 7 , ZIP: • 9 7-12 =1 & 2 FAMILY DWELLING :PERMIT FEE,SCH-EDULE
Description and location of work on premises: ' ' <– AND COMMERICAIJINDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: ■-�
Air handling unit CFM
Is existing space heated or conditioned ?'es ❑ No
Air conditioning (site plan required) MI
Is existing space insulated ?,.'es ❑ No Alteration of existing HVAC system -
„ l 'J' ECHANICAL'CONTRACTOR : k , , Boiler /compressors
u n ess name i' 1DI II
Business State boiler permit no.:
f''�v �'���'� =� HP Tons BTU /H
Address: 16 3 Q 14 Tv as , W / Fire/smoke dampers/duct smoke detectors -
IEMINER State: oQ ZIP: '' )06 Z Heat pump (site plan required) —
Phone: 6Lj(- ! Faxee d L -fl6 MENIMMIEME Install/replacefurnace/burner BTU /H -
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: cj , Install/replace/relocate heaters – suspended, ■--
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace —_—
CONTACT PERSON Refrigeration _ _
Absorption units BTU /H I
Name: S�04- Chillers HP -
�'` Compressors HP I=
Address: ■--
Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Ile - 1 Fax: E -mail: Dryer exhaust -
OWNER Hoods, Type U IUres. kitchen /hazmat ■
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) -__
Mailing address: Exhaust system apart from heating or AC —
City: State: ZIP: Fuel piping and distribution (up to 4 outlets) ■--
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
04 ; ENGINEER',„- h. Process piping (schematic required) M ��
Name: • Number of outlets
Other listed appliance or equipment: ■ -
Address: Decorative fireplace
City: El= ZIP: Insert – type —
Phone: IIMMIHNIZEIII Woodstove/pellet stove -
Applicant's signature: , ,,,M Date: Other:
3"� � Z Other: -
Name (print): O 1( -
Not all jurisdictions accept credit cards, pleas, call jurisdiction for more information. Permit fee $ 7(9 • c6
ID Visa U MasterCard Notice: This permit application Minimum fee $ •
Credit card number: ! / expires if a permit is not obtained - Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ ""e)
$ Cardholder signature Amount 440 -4617 (6/00 /COM)
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CITY OF TIGARD 24 -Hour,
BUILDING - Inspecti Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
g BUP
Received Date Request d 3 �� AM PM BUP
Location / ( '.5 - 0 A a Suite MEC a/ 0O0
Contact Person 6 Ph ( ) - f4pPLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LC
z -Cx/ I
Footing _ _ ELC
Foundation J �
g Cess : �J 2j ELR 0004
Ft Drain �� � �
Crawl Drain
Slab Inspe tion Notes: , , SIT
Post & Beam L_
Shear Anchors
Ext Sheath/Shear 1 v J
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
P mar FAIL
^ �HANI �.
*! ro,ram
Rough -In
-
Gas Line
S oke Dampers
- ', P A -' FAIL
Rough -In
UG /Slab -
Low Voltage
e Alarm
. Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Ili Unable to inspect — no ass
Fire Supply Line • ,,
Vit
ADA Date ? / 2 S I U Approach/Sidewalk Inspecto Ext'
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL