Permit •
. CITY O TIGARD MECHANICAL PERMIT
�. I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00668
0.414 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004
PARCEL: 2S111 CB -02800
SITE ADDRESS: 1.0023 SW LADY MARION DR
SUBDIVISION: MARION ESTATES ZONING: R -3.5
BLOCK: LOT: 001 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace.
Owner: FEES
GARDNER, JOHN & DENISE Description Date Amount
10023 SW LADY MARION DR [MECH] Permit Fee 10/6/200 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchart 10/6/200 $5.80
Phone: 503 670 - 7961 Total $78.30
Contractor:
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 76359
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: Permittee Signature: e l-A/ �/�GIC'�j -r'70N
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Oct 04 04 02:16p ' R E C E I V E D 503 -5 -98 -0270 p. 2
Mechanic, 'el - mit Application OCT 4'2001 . FOR OFFICE USE ONLY
C in' of Tigarq.
Received Permit No.: MEraO1 l� b 6.:,
T t RecDale/BY: ive L� q o� : Qr
l32 : SW Hall Blvd., Tigard, OR 97223 CITY JF - 1 !GAR Plan Review Other Permit
?hone 503.639 F. Fax 503.598.1960 BUILrldss' t, °s;\ 1SI o.'te/By:
inspection Lice 503.639.4175 III Date Ready/By' 'uric I 0 See Page 2 for
TIC I Supplemental Information I
;r www.ci.:igard.or.us ZVw.cl. ::gard.or.us Notified/Methed: /
..s:- ..: •(�.yt • t'ir s `�'LR� iFEE""rSC'HED'GtL ( S T I
tm�„ 5..,: "s.. r• : ?. ;E — USE, '
- i .: }_ _ - 1� :•[ :i •i(>.a • . • .t17_ tf.t� : : ..: + � , . •�t.,,'., : ..
t,. : :'.. { based the value o the Mechanical permit ees • are asc on .e work °
❑ Nuys construction (= Addition/alteration/replaeement performed. Indicate the value (rounded to the nearest Solar) of a1.
❑, Demolition ❑ Other: mechanical materials, ecuioment, labor, overhead, and pro/it. .
,, ,. ;,. 'r
F . _ ,.. it f , . � .,.: . 'oilac&Wifi �J :. ' 'SON: ' iii r'''''' < - s:.. • • Value: '-ii Ji t � : + '
' ."' ,; mot= x-''' 31' ! Q� OYt.� r.....,. «• .....,.�• , . -..... S. / SYSTEMS FEES'
�, t :<•,t�, `. ;. ; .. : D;Ei`l AL �EQ
and 2-family dwellin¢ ❑ Commercial /industrial ❑Accessory building For special information use checklist
❑ Mul:i- family ❑ Master builder ❑ Other: Description I Qty I , Ea ! Total
TO.B SITE ;Nks..ORVtAFi;SOi : ;A;: ` LOCATION ' . . : '1 , _ (E ieatinp/cooling a
i Air con ditioning or hea pum
!So S. ;e address: 1 OC'
l �� �l / �i I ( re q uires sit plan s acenicat)
/e)6 2 3 5 d /./ 0 showing P 111 Cir : /State/ZIP: 1
Furnace 100,000 BTU (duets(duets/vents) / 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90 !
Suitel;ldg: apt no.: i Project name: Gas heat pump 14'00 •
Duct work 14.00 1
Cross s ;reevdirections to job site: 1 4 00 '
Hydronic hot water system
•
f Residential boiler (radiatoror •
hydronic) 14.00 _•
Unit heaters (fuel -type, not electric), :
: in -wall, in -duct, suspended, etc. 10 00
Flue/vent for any of above 10 00
Subdissio Lot no.: Other: f I 10.00 j
Tax map /parcel no I Other fuel appliances I
i n -,.� • , y -, -q t °ra•. . + 'limit, ...,.,= - . ter ►; ", .::
:.r f• `.• •''ii'' .- tr•i 'r wl • rn't7c • K•t7a.. : .
` .C' i "� ` i ,.,:!trial:- :: •.
Water heater I C.00
y ;: az x,n S I0 Q �!ORIC ' ' ,'rianr• i 00
��� ?...,_...1•iy`i ,+( +� ' ..SJ!Kaii:.''A .f+ J•ARk. + .: F. � a w. ».- +f•+..'? '{ :
' ' °" Gas fireplace .
/ / I 7!1 .e�z./7 .e.—..., Flue vent for water heater or gas
fireplace .
'.0 00 ' •
1 ! Log lighter (gas) I l 10,00 !
Wood /pellet stove ` 10 00
I Chi
- Wood fireplace /insert 1 . 10.00
` • ,,, �t. ,rr . p r • !. y x.. - v -. is Y"t:S
{ rnne}' /liner /flue /vent f 10 00
• pi? 'r . fv47 . » 4,' �' -T +'i /` .tit. :�,I
{. ; , i;iopR7x 4R ::r!� ;. a�vT , , .s 10.00 t...:.•,.f').. :��f :`� t >��: �(�tT_ �..,...- ,�,. y�, � / �p Environmental exhaust and ventilation Other:
)\amt G/4 /``i 5.I .,
. �Q ��� S L' ' � / � � e �y /� Range hood/other kitchen I I I
Address.
/De-9,,3 SSeel Gal— J /LLetM 4.4. � coutpment I 1'0.00
� Clothes dryer exhaust I I I ,
C :y: 5tate,Z{P. 10 00 / e �J Sing -duct exhaust (bathrooms, l r
Phone. 3) 4..70 ? �4 I Fax: ( ) toilet comoartrnents, utility rooms) I 1 6 10 i •
r �,. -.a• :..:r.., Y, �, At ic;craWlspace fans l O.JO
, tai ., 4 :yri.: l ;.. '...i, Sr,+,i j,. t:v, r.: { :,;. -i' , `s'.' t
.' ,- _... :.' ®.'t 1 4,� ti:'' t .: r ��'(��,, �+Q !t?3 �`. iii ;� { I
I � . "�, :. :. a"�.'sYl . .- 1 .. 'r-a tih't {a"`•! : :. ;,N ' L , e.Plerr`yr'!`= "'^'.rh: S•"�, :..:' ,'Y'6A19hr: . :�E :,. i I t !C 10.00 1 I
.
Other:
Business name: Fuel pip!nR
•
J
Contact name: Aq/h( 0/i- /t y I 55.40 for first four; 51.00 for each additional
1 Furnace, etc. I
ll Address: Gas heat pump
CIty!Sta :c /ZIP' . Wall /suspended /unit heater `
I f \k'ater heater it
1 Phone ( ) . Fax:: ( . ? O .�(��1 I -
�, 7 ( y �'� (J I Fireplace
l �' Range 1
E - mail
, s ta<']ki'.. 'r r• '• :r: y °'i
7 , ,,.... .,,1,t.° e �, •:, arc. ; :.. ' i e {, �i' : r;fl` Barbecue
II �£ ; :` :-�}.q ,�: ; {,Ar�r : .,li �'.COI`T , :- ., r.S :,.''.
ne r :''.` : ;'.,.., . • Clothes dryer (gas) I
Business name: r� / (� /et..., '�GA "~ { �o e, t, it/ Other: Other: I I
1 : \ ddress: D ,a,o k c a b ..3 % 7 ''t.' a i$ ' , IN P,ERI4IIT :FEES
ti - •� - � - Subtotal � 712,5 CiryfState ZL°: ! / li�_,2t7 0!J �'r 013.
tvlimmum permit i e ($72.50)
Phone: {�� ) G a cL! �1 t? .eTC Fax:(5 ) .�9 8' G oZ 7,5 1 Plan review (25% of permit fee)
CCB lie -. -: -- _ I State surcharge (8% of permit fee) I .5', �(�
fir .� TOTAL—PERMIT—FEE - i pi. - t?
Authorized signature: &2/J'7-2- ""G.,--"'"'��. a , �� This permit application expires if a permit is not obtained ,thin ISO
/ days after it has been accepted as complete.
C � I Da GG 1 - Fee methodology set by Tri- Cowity Buiiding Industry Service Board
_ Print game: ��� �� ^7 _ Q � /� ` � v / •_ , -D
: •17_ildin s'' crmnslM.EC•PermitAppdoe 12.03 440.46i 7T f I IM2:COM'WEB'
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63 1175
INSPECTION DIVISION Business Line: (503 171 , MST
`C BUP
Received Date Re • uested / — LZ-- AM PM BU
0
Location I I. ,� __% _ I/ /' A Suite E A00 V---Da (
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ ner / ELC
Footing 7a-- - 7 t' 1 ELC
Foundation Access: e A '
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam I
Shear Anchors
Ext Sheath/Shear \
Int Sheath/Shear ' ^„ �
Framing Y V ` `_� —
7
Insulation
Drywall Nailing
(... jrze._"„,1/4..ra.....
Firewall \PV(r. / --:-.-----deC
Fire Sprinkler
Fire Alarm ) -Q 0 .L v f C___
Susp'd Ceiling
Roof
Other:
Final 4, g_, '- C--ev1/1 fe'l -4
PASS PART FAIL % �/
PLUMBING
..; s ,
Post &Beam �� /
Under Slab 0 -� / ...16-.... �-v
Rough -In v 7 ® l� a/ ei6 G( ,
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: `
Final / ■ 4 ,
PASS PART FAIL
CH L ,._ , , A •∎
Post &Beam �; ffirAIIPIPAIM
Rough -In .-- "`
Gas Line
Smoke Dampers '
PART FAIL
TRICAL W ,:
• Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ` _ - -' ❑ Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line 1,� citt
ADA Date Y 1 2 � b q Inspector F i Ext
Approach/Sidewalk P p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL