Permit - A, CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00006
P. l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/04
PARCEL: 2S1 14 B B -10900
SITE ADDRESS: 10414 SW KERI CT
SUBDIVISION: SWANSONS GLEN ZONING: R -
BLOCK: LOT: 050 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install furnace
Owner: FEES
LARRY WEISGERBER Description Date Amount
10414 SW KERI CT [MECH] Permit Fee 1/8/04 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 1/8/04 $5.80
Phone: 503- 234 -7331 Total $78.30
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503-234-7331 Heating Unt Insp
Final Inspection
Reg #: LIC 1441
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 O_UNC by calling
(503)246�6G99-,
Issued �� yy k � " / ' Permittee Signature: ,,.Q�,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Ilk
-06 -04 10 :34A P.0
FOR OFFICE USE ONLY
euanicai Per 4_: ' [ol ',y `: on Received ecahnical �/
Date/By: /7 P /7C 0i/ t - 'CJ�
0 Planning Approval ' Building
City of Tigard !JAN 0 6 2001- Date/By - - Permit No.:
Plan Review Other
13125 SW Hall Blvd. Plan Permit No.: „
Tigard, Oregon 97223 CITY OF TI A Post - Review land. Usc
Phone: 503- 639 -4171 Fax: dak1 Case No.:
S� •�s "'�� c �� Date/By: - � ® See Page 2 for
Internet www.ci.tigard.or.us Contact
" Nam e/Method , 7'� Supplemental Information.
24 -hour Inspection Request: 503 -639 -4175 '
,; n:CO IrTE1H #rSC 1IEDUT.F -USE. Ci1ECiCI,TST
Ne TYPF (IF.WORK - ' MMERCIA
n w construction Demolition Mechanical permit fees' are based on the total value of the work
❑ Addition/alteration/replacement ❑ Otber: performed. indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead and profit.
.'CATEGORY Ob ". CONS'1'Ruc-rION See Page 2 for Fee Schedule
Family dwelling Li C.o lt ail /lndusl.rial -
Accessory alue: S_, . h'
„RESIDENTIAL I QUI1'ME1V "1' /` YS'I'I.-MS FEE* SC'IiEDULG;
Building Multi Pamil
ry g . _ ❑ Y ... bescriptiUtt I � i Fee(ca.) Total
❑ Master Builder . Other H ea rt t
r .;oohn
',.1,....301i SITE INFORMATION 911d LOCATION Furnace - add -on air conditioning** 14.00
Job site address: l _ Gas heat pump 14.00
1
Llrt - la -a0 _
B l > /A t #: Duct work
Suite if: p ' Hydronic hot water system 14,00 _
Project N ame: ( .
`� -er' Residential boiler
Cross street/Directions to j h site: (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
Repair •
units __ 12.15 _
Lot #: Other Fuel Appliances
Subdivision: - Pp
Tax map/parcel
D S
/parcel #: Water heater _ 10.00 •
el WORtC "r'. ;ltc'a`` ;`? ' Gas fireplace 10.00
Flue vent (water heater /gas fireplace) - 10.00
Lo li ( 10.40
- - Wood/Pellet stove _ 10,00
Wood fireplace/insert __ - 1 0. 00
Chimney/liner/flue/vent _ 10.00
CL ',12' •
„R'Q t.TY 'WNEii 'llii T NVANIt: i� it'... Ot her. t & Ventilation . _
,,�„ ; r;; � ; .a:, � 1 1000 .
”" ' ' i Environmental Fxh.au3
ii dre r t _ / �.. Range hood /other kitchen equipment 10.00
' f
,Address: I w . t j r . Pte_ Clothes dryer exhaust 1(1 -00
Cit IS ate _Zi ; / J .. • ( _ Single duct exhaust
P e 1- ~' 0 S or, Fax: (bathrooms, toilet compartments,
IP L' . . .. • CONTACT PERSON : - utility rooms) .. _ 6.80
PPIaCANT ;
Attic/crawl space fans 10.00
/ , l__ `�,,. _� Other: ... 10.00
Name: �(:.. K-1,. ?`:.
Address; _ __L. t - Fuel i�i�in,; ,
• City /State/Zip: ` - ) . (---4.._:., , -- ) t -1 _ "($5.40 for first 4, $1.00 each additional)
Phone: 1 Fax: etc. ”" •
G heat purpp _ • •
. �
F mall: _Wall/suspended/unit heater -
:• 4 .. i '.12,. ' „ .1:C N.R.A. TOR . ,.' Wate heater *4
O T
11 1 c Fireplace s -
Business Name: C; (.� 0;� v t_t (�'_'��i -, .._ - .s
Range
Address: 4- -i `-1 �`c. v °' t ,.,_> -',. 1,_ � Range "�
,� �� - 1 ,,2. C3 Clot d dryer CtCity/State/Zip: l- t Ida .�, . rr. (gas) .
Phone: D. 3 3 Fax , . - 1 �S oilier: _ — -
y 1 L� I 2 Total;
CCB Llc. tf: i - Me chanical Permit Fees! -
Authorized II Subtotal; $
Signature: . `'� �" Uatr.�, Minimum Permit Fee $72.50 $
Plan Review Fee t25% of Permit Fee) $• (
— State Surcharge (S% of Permit Foe) $ J
(Please print name) - TOTAI, PERMIT PEE $ "Fee methodology ��
- set b Trl -Count 1 Blinding ard. - -
Notice: This permit application expires if It permit is not obtained within *Fee
plan required for exterior Alt"' units.
180 days after It has been accepted as eo • �� � V
i_\Dsts\Pcrmit Forms\Nta PermitAPP -dctc 01/03
l/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received .2 SV Date Requested 2/3/ AM PM BUP •
Location ! 4 c /?,0 07 Suite �MEC Arc/
Contact Person / . �! 'RCi ( ) PLM
�
..„...„ Contractor ' .L_�: � ' Ph (mil, 3 Z 3 y J
23 5 SWR
BUILDING Tenant/Owner ELC -e..-
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain \-) . / &" 0 L— i °
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 C
PLUMBING _ �
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS _At T FAIL (�
Post & Beam (Y
Rough -In
Gas Line
Sm • ° - Dampers
4* PART FAIL
ELECT AL
Service
Rough -In
UG /Slab • •
Low Voltage EA c =
Fire Alarm
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date. O Inspect r _ _ _ - __ i AL ' Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo r - -ite.
PASS PART FAIL