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Permit CITY OF TIGARD MECHANICAL PERMIT I DEVELOPMENT SERVICES PERMIT #: MEC2004-00137 i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 3/23/04 PARCEL: 2S111 DB -12700 SITE ADDRESS: 09420 SW LAKE SIDE DR SUBDIVISION: SUMMERFIELD NO.12 ZONING: R - BLOCK: LOT: 678 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: 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: Replace gas furnace Owner: FEES BURGESS, MARY B TRUSTEE Description Date Amount 9420 SW LAKESIDE DR TIGARD, OR 97224 [MECH] Permit Fee 3/23/04 $72.50 [TAX] 8% State Surchaq 3/23/04 $5.80 Phone: 503- 639 -9629 Total $78.30 Contractor: COLUMBIA HEATING + COOLING INC P.O. BOX 230397 8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS TIGARD, OR 97223 Phone: 503 Gas Line Insp Mechanical Insp 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 9.52101_010.0 You_ may_ obtain _copies_of irect questions to OUN_Cby (503)246-6699. Issued By: / Permittee Signature: ,,4)/2 Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business day r Mar 22 04 10:5,P. PAM DALBY 503- 598 -0270 p.2 A y f . , Mechanical Permit Application FOR OFFICE USE O L.Y pp n Received as • Mechanical RECEIVED ate/B : / Permit N./ - - Cit of Tigaard ED Planning Approval Building y b Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 MAR z 2004 Date/By: Permit No.: Phone: 503 -639 -4171 Fax: 503 -598 -1960 Post - Review Land Use N7 } �� Date/By: Case No,: Internet: www.ct.tigard.or . us CITY OF TI J. • Contact Juris.: lEl See Page 2 for 24 -hour Inspection Request: NALa'•k6 - Name/Method: Supplemental Information, TYPE OF WORK .', COMMERCIAI IFEE *iSGHEDUL;E.= 'USE :CHECKLIST ❑ New construction 011111 Demolition Mechanical permit fees* are based on the total value of the work ddition/alteration/replacement 101 Other: performed. Indicate the value (rounded to the nearest dollar) of all CATEGORY OF CONSTRUCTION• :i', • .. mechanical materials, equipment, labor, overhead and profit. ( 1 & 2- Family dwelling ❑ Commercial/Industrial Value: S See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi Family -. °RESIDlE1 I T: EQU. T1? MENNTIS'Y;STEMS.iFEE *::SOHEDULE • ❑ Master Builder ❑ Other: Description } try I Fee(ea.) Total Heating/CootinP JOB SITE INFORMATION and•LOCATION . - Furnace - add -on air conditioning ** / 14.00 Job site address: Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.0 Residential boiler Cross street/Directions to job site: (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) 1 0.00 Subdivision: i Lot , #: Repair units 12.15 Tax map/parcel r: Other Fuel Appliances Water heater 10.00 DESCRIPTION OF WORK ' • Gas fireplace 10.00 1 / J 7e Azr i . �� , 7 4 � e7,/ Flue vent (water heater /gas Fireplace) 1 1 0.00 " 1 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace/insert 10.00 1 Chimney/liner /flue/vent 10.00 I PROPERTY.OWNER ' "1** D.:TENANT...•'r. . Other: 10.00 Name: . • ._ .Envlrohmental Exhaust & Ventilation R a hood/other j /1 T Qum Cr S Range hd/other kitchen equipment 10.00 Address: 92--e, , C(- ) (- I'' 4,44, ,(), City, C lothes dryer exhaust 1 0.00 p 4( 97z z.' I / State /Zip: -7 Single duct exhaust Phone: ,,7yi� / 9, , Fax: (bathrooms, toilet compartments, . 0 APPLICANT '❑:•CONTACT PERSON..' • utility rooms) 6.80 Name: Attic /crawl space fans 10.00 I Address: - Other: ` 10.00 Fuel Piping City/State/Zip; * *(55.40 for first 4, 51.00 each additional) Phone: Fax: Furnace, etc. 1 ** Gas heat pump 1 ** E -mail: Wall/suspended/unit heater "" 1 CONTRACTOR . : • ' Water heater Business Name: ( 1 4 -f- . COG /,A /6 Fireplace *" Address: /0 D (3 e Range J.4, . � , 3 d -� q `> BBQ 1 .. 1 City /State /Zip: ---7-76. ,4 n 45 4) 97 3 *, �7+ Clothes drye (,gas) I Phone:S03 L 8 y ez'7,a/ I Fax: .5o3.SpP 0.7 7 Other: •• CCB Lic. #: i Total: i Authonzt d Mechanical Permit Fees* Signature: C2l ,? _ Date: -Dal Subtotal: S Minimum Permit Fee 572.50 S PA , e fd A 'ci / by Plan Review Fee (25% of Permit Fee) S (Please print - name/ State- Surcharge- (8- %- of- P- ersnit -Fee)- -5 TOTAL PERMIT FEE S Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Boa rd. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:Dsts`Permil Forms , ,Mcc PemlitApp.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST a , • BUP Received ` X Date Re�estted — 7 /� y` AM BUP Location e' Z-0 c:Z- l ?nom -L_ ' A -CJ Suite ( a -= ` �? Contact Person o '�iYY� /� Ph ( ) (o Z < — Z7 J5Z 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 Int Sheath/Shear Framing - �.rl.� ✓�.cf./�C .r r���� /.C9C� G il ����°A-- 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 PASS PART FAIL MECHANICAL` Post: & Beam Rough -In Gas Line S ke Dampers F' aI PART FAIL _ LECTRICAL - 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 Please call for reinspection RE: ❑ Unable to inspect - no access - Fire Supply Line ADA 1 j � O „ Approach/Sidewalk Date inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL