Permit MECHANICAL ~~�
PERMIT
,�'� -� ��� OF � PERMIT # ^ M52 �mm�'� � �
DATE ISSUED: 05/1�/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 9722308199 (503) 639-4171 PARCEL: 25102BD-01503
SITE ADDRESS...: 12760 SW PACIFIC HWY
SUBDIVISION. ... : FREWINGS ORCHARD TRACTS ZONING: C—G
BLOCK. . . . . . . .. . : LOT. . . . . . . . . . . . . :1
.
CLASS OF WORK..:ALT FLOOR FURN....: 0 EVAP COOLERS: 0
TYPE OF USE ^COM UNIT HEATERS..: 0 VENT FANS...: 0 •
OCCUPANCY GRP..:B2 VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES ^ 0 BOILERS/COMPRESSORS HOODS.......: 0
FUEL TYPES • 0-3 HP....: 1 DOMES. INCIN: 0
:/GAS/ / / 3-15 HP....: 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP....: 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30-50 HP....: 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP ~ 0 CLO DRYERS. . : 0
NO. OF UNITS --- AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 100K BTU: 1 <= 10000 cfm: GAS OUTLETS. : 1
FURN >=100K BTU: 0 > 10000 cfm 0
Remarks: Replace fixtures
Owner: — — FEES
ROSE GOSPODINOVIC type amount by date recpt
12770 SW PACIFIC HWY PRMT $ 25.00 JSD 12/07/95 95-273536
5PCT $ 1.25 JSD 12/07/95 95-273536
TIGARD OR 97223 PLCK $ 6.25 JSD 12/07/95 95-273536
Phone #: 620-5524
Contractor: — — --
JACOBS HEATING & A/C
1421 SE HOLGATEBLVD
PORTLAND OR 97202
Phone #: 503-234-7331 $ 32.50 TOTAL
Reg #..: 001441
------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Heating Unt Insp __ ____ __
applicable laws. All work will be done in accordance with Final Inspection ___
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 18N days.
---� —
Permittee Signature: �� ---
Issued By: /
Call for inspection — 639-4175
•
City of Tigard g�� MECHANICAL PERMIT Planck/Rec. # i � 1(?C
13125 SW Hall Blv . 1 "'� ' e , APPLICATION Permit # n-ticgc (4Z(
Tigard, OR 972 1y
t
(503) 639 -4171 e
Name of Develo m,t Descnption
Table 3A Mechanical Code QTY PRICE AMT
Metes'
Job / 2-'74 0 g W J. ?Arcs - , - C j 1) Permit Fee -0- -0- 10.00
Address +"''°
120 og 4 7 22;3 2) Supplemental Permit 3.00
Name for name of bosoms) Furnace to 100,000 BTU
r ?-405e dS P� P i ^� C V t hone 1 9 1) incl. ducts & vents 6.00 6, v0
Wilma Address Pt1O1° Furnace 100,000 BTU +
• Owner s 277 ° 5, aj • p er' i '. L. da 2) incl. ducts & vents 7.50
cd•Slate LP Floor Furnance
L . a 14'te-p O e q 72-2-3 3) incl. vent 6.00
me for name of anal Suspended heater, wall heater
'/; / i'21 -e 5..._..9.-‘4- 4) or floor mounted heater 6.00
Occupant 'Arden) �` 6 ,ors Vent not incl. in
L T / ff� 5) appliance permit 3.00
carfstate +o Repair of heating, refrig.
6) cooling, absorption unit 6.00
Name a 7 Y _ Boiler or comp, heat pump, air cond.
J4 o RS' iirt 4 /.4/c- // 7 33/ 7) to 3 HP; absorp unit to 100K BTU l 6.00 00
Mamg Addfeei Pt1O Boiler or comp, heat pump, air cond.
(6? Contractor / i - 2 . - / / 3g. / L ' Gigue 8) 3-15 HP; absorp unit to 500K BTU 11.00
✓'t' Boiler or comp, heat pump, air cond.
PA Arvla OR 6 152- 02 - 9) 15 -30 HP; absorp unit .5-1 mil BTU 15.00 •
Sta1O Negomaann Na. "t'' Ws. ,aa No. Boller or comp, heat pump, air cond.
4 /1447 . / 246" 10) 30-50 HP; absorp unit 1 -1.75 mil BTU 22.50
I hereby acknowledge that I have read this application, that the Boiler or comp, heat pump, air cond.
information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with Air handling unit to
State laws, that I am registered with the Construction Contractors 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State Air handling unit
registration, please give reason below.) 13) 10,000 CTM + 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected
15) to a single duct 3.00
�� _ Q� Ventilation system not
�� 16) included in appliance permit 4.50
Swarm (owner m age Date Hood served by
17) mechanical exhaust 4.50
Describe work new U addition U alteration repair U Commercial or industrial
to be done residential 0 non - residential 0 18) type incinerator 30.00
Existing use of Other i.e., woodstove, water
building or property 19) heater, solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets / 2.00 2. DO
building or property I
21) More than 4 -per outlet (each) 2.00
Type of fuel - oil 0 natural gas LPG 0 electric Q
. j -
NOTICE ��,
Minimum Fee $25.00 SUBTOTAL G
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE / L S
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL 4. 2-
AFTER WORK IS COMMENCED.
TOTAL 32. $o
Special Conditions W��'�
Date issued by 5
HILOOIMDSTSSMECHPMT
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 3 - A.M. /V - 7 i / / /� P.M. MST:
r, Location: 1. a 0 4W P T ` /w BUP:
Tenant: F -4g C W Q P L Z) Suite: Bldg: MEC: 95 )W,„11
Contractor: 5 ietztr e r t 4 jece. Phone: 1 �5
- 5. PLM:
Owner: Phone: •il !20 . / ' C:
• " /`/,_ 4 / ELR:
A / / Sa . �_L j_/ / I i / i i1� � SIT:
BUILDING BLDG (con't) PLUMBING ME • ' • ELE TRIC • SITE
Site Post/Beam Post/Beam Pow Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved ed Not Approved Not Approved
FINAL FINAL (' ") FINAL FINAL
,
Cl Call for re' ..,,. Cl Reinspection fee of $ required before ext inspection O Unable to inspect
1 Inspector: j Date: ✓ J, f.5" Page of
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4/19/00 Activities for Case #: MEC95 -00421
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5:52:32 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. -Level By Updated Notes
MECC007 Application received 12/5/95 JSD PASS JD 12/7/95
MECC010 Plan check by 12/6/95 12/6/95 JHF PASS JD 1217/95
MECC799 Final Inspection 3/10/98 TLP PASS J'H 3/12/98 •
MECC710 Mechanical Insp 12/7/95 3/9/98 TLP FAIL TLP 3/10/98 No one has a clue about this
insepction. Was told owner had -
a heart attack - Joe above said
he will tell contractor to
straighten out any undone
inspections.
MECC715 Heating Unt Insp 12/7/95 3/10/98 TLP PASS J'H 3/12/98
MECCO50 (F) Ready to issue 12/7/95 JSD PASS JD 12/7/95
MECC090 (F) Issue permit 5/10/96 CJS PASS • CJS 5/10/96
MECC095 (F) Reprint Permit 5/10/96 - CJS 5/10/96
MECC800 Case Finaled 3/10/98 TLP PASS J'H 3/12/98
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