Permit CITY OF T MECHANICAL
' n �'ap i �,� DEVELOPMENT SERVICES PERMIT ., ., ..... - �T1F {'1 47!!` 7
A.61 ' � 13125 SW HaII Blvd., T i g a r d , OR 9 7 2 2 3 ( 5 0 3 ) 639 - 4171 D AT : F . SSL?; =D a 0 2 / 0 9 / 9 S
PARCEL: 15135CD -0480
SITE ADDRESS... 09785 SW LONDON CT
SUBDIVISION....: LONDON SQUARE NO., 1. ZONING: R-25
BLOCK..........: LOT............. :001 JURISDICTION: TIG
CLASS OF WORK.. oO•TR FLOOR FURN.. , .:, !i"t EVAP COOLERS: !Z!
TYPE OF USE..., ,SF UNIT HEATERS..; +c"t VENT FANS...: 0
OCCUPANCY CRP, , a R3 VENTS W/O AP'P'L o 0 VENT SYSTEMS: !
STORIES. , ....... 0 BOILERS /COMPRESSORS HOODS. , ...... 0
FUEL TY PEA_._.._..... __._...__._.._.._.__.. _. 0-3 HP, . , . o 0 DOMES. I NC. I N ; 0
:GAS 3 -15 HP....: 0 COMML. I NC I N a 0
M AX INPUT: 0 BTU 15..._30 H#='.....: 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30 -50 HP„ ... „ 0 WOODSTOVES.. p 0
GAS PRESSURE...: 540•- HP....: 0 OLD DRYERS..:
NO. OF UNITS---------- AIR R HANDL_ I NG UNITS OTHER UNITS.: 1
FURN ( 100K BTU: 0 (= 10000 c f m u G7! GAS OUTLETS.: 1
FURN )=100K BTU: 0 ? 10000 cfm a 0
Remark p Installation of gas fireplace and gas piping.
CHRIS GROVER t ype amount by date recpt
9785 SW LONDON CT PKIYI T v 25.00 DER OP:'09: 9`:9 99-312739
TIGARD OR 97223 5PCT $ 1.25 DEB 02./09/99 99-312789
Phone *e 824 ----- +Z+3BB
Contractors -----------------------
JOHN 0 BRANCH FIREPLACES &:• NOR
JOHN OSCAR BRANCH -----------------------------------
PO BOX 23898 26.25 TOTAL
TIGARD OR 97281
Phone
�'
. . 620-0255 620-0255
Rea 1f... 003958
------- REQUIRED INSPECTIONS - _.__....__.._. _._
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp _
applicable laws. All work will be done in accordance with Misc. Inspection _ _______________
approved plans. This peroit will expire if work is not started Final Inspect i on
within 180 days of issuance, or if work is suspended for more
than 1•'!" days. ATTENTION: Oregon law requires you to follow rules ______________ _ __. _ .._.___.__._._._._._.._._._._ ..__._..
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 001 -08i8 through OAR 952 - 001 -0O80. You say
obtain copies of these rules or direct questions to OUNC by calling
15003146 -9187.
00 e2.44*Ascu i t
Issue 'Drwmittee Signature:
! i } h ! }••4° h i l ? F f + ++ 1 ++ r t °! r l } ! .E !.._�.y.. ._}... }..t.._�_ - }.4 -'r-t--F-h-l- +-!-..t...�...! ±i r i--}--!....}..}...t...!--} -r +-! ±- !.•- . --}. °F I i } ! ! F F !
Call. 639-4175 by 7: °.00 p.m. for inspections needed the next business day
l ..h i ..... !- + +..�........}.�....}..i..{...} . }• ! } 1 F i h.. }._} ..t...s.�.j i E !.�••-r..f f- h+ ! F•- }• }• 1 ! •+ }+ F t + F.�.... }. {.. I }••! 1 I i ! •i.•-i 6 I i +-t i....!
r ... vnc -
CITY OF TIGARD Mechanical Permit Application Recd e
13125 SW HALL BLVD. Commercial and Residential Date Recd A. --Q-9. f
TIGARD, OR 97223 Date to P.E.
(503) 639 - 4171, x304 Date to DsT
Print or Type Permit# il Ce.W - crs - 7
Called
Incomplete or illegible applications will not be accepted
Name of Development/Project Description
Table 1A Mechanical Code QTY PRICE AMT
Job Street Address Suite# A) Permit Fee -0- -0- 10.00
Address
Bldg# City /State Zip 1.) Furnace to 100,000 BTU 6.00
including ducts & vents
Name (or name of business) 2.) Furnace 100,000 BTU+ 7.50
Owner C`l \ t'\ S U \.re including ducts & vents
Mailing Address 3.) Floor Furnace
Sw � 6.00
9 Ii ° S
l�`r1 � � • including vent
City/State ZIE / Ph - o � ney 4.) Suspended heater, wall heater 6.00
1- G -c 1, (t4-0 or floor mounted heater
Name ( name of business) 5.) Vent not included in appliance permit 3.00
Occupant Mailing Address \ )\-S2, 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorb unit to 100K BUT*
City/State Zip Phone 7.) Boiler or comp, heat pump, air cond. 11.00
3-15 HP; absorb unit to 500K BTU"
Contractor Name 8.) Boiler or comp, heat pump, air cond. 15.00
j 0 \\ in 0 - Bcanc Y\ 15-30 HP; absorb unit.5 -1 mil BTU"
Prior to permit Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50
issuance, a copy _ o `. mac, ,9. l ` E 30-50 HP; absorb unit 1- 1.75mi1 BTU"
of all licenses City /State Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
are required if - 1 - i c \0.-r A 9i &i boo- O S > 50 HP; absorb unit 1.75 mil BTU"
expired in COT Orego onst Exp. Date 11.) Air handling unit to 10,000 CFM 4.50
database V onbb S i-1--sr?
Architect Name 13.) Non - portable evaporate cooler 4.50
Or Mailing Address 14.) Vent fan connected to a single duct 3.00
Engineer City /State Zip Phone 15.) Ventilation system not included in 4.50
appliance permit
Describe work New 0 Addition 0 Alteration 0 Repair 0 16.) Hood served by mechanical exhaust 4.50
to be done Residential 0 Non - residential 0
Additional cription of ork: 17.) Domestic incinerators 7.50
V� O ` °r pt„?..),--- `
18.) Commercial or industrial type 30.00
Incinerator
Existing use of 19.) Repair units 4.50
building or property
20.) Wood stove 4.50
Proposed use of 21.) Clothes dryer, etc. 4.50
building or property
22 Other units a „ , i � serf- / j 4.5 z4 .5o
Type of fuel - oil 0 natural gas ' LPG 0 electric 0 23.) Gas piping one to four outlets / 2.00
•
I hereby acknowledge that I have read this application, that the 24.) More than 4 -per outlets (each) .50 ,
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL 06
laws. _
Signature of Owner /Agent Date *SUBTOTAL /.?-.C-
2 . ---,-- / ' 7 5% SURCHARGE
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
TOTAL 6
iArnechpmt.doc (rev 9 *Minimum permit fee is $25 + 5% surcharge
'"Residential NC requires site plan showing placement of unit.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• BUP
&'L/ / Date Requested J ��6/9f AM PM J>< D
Location 97 Suite MEC 99- 7 /
Contact Person Ph PLM ,
i
Contractor Ph SWR
1r
BUILDING „ , .; Tenant/Owner (Y ,,11.4711 oaf, ELC
Retaining Wall e;a: .5� — ELR
Footing Access:
Foundation — 78? ° FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: _ � •
Slab i / • SIT
Post & Beam /
Ext Sheath /Shear
Int Sheath /Shear �� - � / 7
Framing -
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING " .._°
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
HANICAP:.
Post & eam
Rough In
<tZt
e Dampers
S/ PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 6 / O Date Inspector 9 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.