Permit vorr
CITY OF TIGARD MECHANICAL PERMIT
, };� r +r DEVELOPMENT SERVICES PERMIT #: MEC2002 -00435
��' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/02
PARCEL: 2S110CB -02200
SITE ADDRESS: 12180 SW PAR 4 DR
SUBDIVISION: KING CITY NO. 16 ZONING: ?
BLOCK: LOT: 010 JURISDICTION: KIN
CLASS OF WORK: ALT 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Installation of furnace.
Owner: FEES
GAVIN, FRANCIS & GLADYS Description Date Amount
12180 SW PAR 4 DRIVE [MECH] Permit Fee 10/4/02 $72.50
KING CITY, OR 97224 [MECH] Permit Fee 10/4/02 $0.00
[TAX] 8% StateTax 10/4/02 $5.80
Phone: 503- 620 -6131 [TAX] 8% StateTax 10/4/02 $0.00
Contractor: Total $78.30
OWNER
REQUIRED INSPECTIONS
Mechanical Insp
Phone: Final Inspection
Reg #:
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: .67V .4, le -- 770,1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
5036393771 CITY OF KING CITY PAGE 02
' SERVICE t_, narncal Pe mit Application OFFICE USE ONLY
* ' '2 � City of King Cit v - _a Date received: /D /02 4,2� Permit no.: N3 S
r `-':" -, ! �tl -fit. .
40 . 13125 SW Hall Blvd. 0 i��,r� V Project/appl. no.: Expire date:
Clackamas Tigard' OR 97223 639 Date issued: By: Receipt no.:
Multnomah Phone: (50 4 1 7 1, P • t: (503) , :; T7297 20 02
Case file no.: Payment type:
Washington
coy. • t E 5 Land use approval: Cri 1 `" L. - , : -, ', -.1 . 1 .) B u i lding permit no.: •
--• -1''''''Y'
TYPE OF PERMIT
I & 2 family dwelling or accessory ❑ Commercialindustrial 0 Multi - family CI Tenant improvement
❑ New construction 0 • ddition/alteration/replacement Cl Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: • •
d' A MillniMill Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite o.: value of all mechanical materials, equipment, labor, overhead, .
Tax map/tax lot/account no.: profit. Value $ -
Lot: I Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: W r. c )` ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
Fee (ea.) Total
Est. date of completion/inspection: Description . Qty. Res. oily Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? CI Yes 0 No Mr handling unit CF
Is cxisdng space insulated? 0 Yes ❑ Air conditioning (site plan required)
Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: y. ,, e G I State boiler permit no.:
Address: HP Tons BTU/H
Fire/smoke dam • rs/ i smoke detectors
::iry: it A • t ELIIM ZIP: _ g ` at pump (site pan required)
Phone: 6 zD , a i ) Fa , 1 - ail: stall /replace furnace/burner BTU/H
2CB no. Including ductwork/vent liners Cl No 1
Install/replace/relocate heaters ,- suspended,
2ity /metro lic. no.: wall, or floor mounted
lathe (please print): Vent for appliance other titan furnace
CONTACT PERSON
Refrigeration:
Absorption units BTU/H
Name: G i / Chillers HP •
Com . ressors HP
address: l n I g S • W m G Y 1) .r 1/ 'e Environmental exhaust and ventilation:
•
:ity: �` t Stately , a ZIP: s' A..liance vent
'hone: M b 2/FinillMIIIEZEMIIIIIMIE Dryer exhaust
OWNER Hoods, Type I/ fres. kitchert/hazmat
hood fire suppression system
lame: fae: r in e: fan with single duct (bath fans)
failing address: ; i - xhaust system apart from heating or A
ity: .. c r r . y . Fuel piping and distribution (up to 4 outlets)
` - T .: LPG NG Oil •
hone :. Z 111.11Zr, ; Fuel P� R i to each additional over 4 outlets
P
ENGINEER Process piping (schematic requ
ame: Number of outlets •
ame: : Other [sled appliance or eq lu pmene
Decorative fireplace
fry: I State: I ZIP: Insert - type
tone: ( i E- ail: Woodstove/pellet stove
• •_..
;plicant's signatu 4 • ,• .� . . �, is, A J Date: D - - D 7 O ther:
true (print):
all jurisdictions accept Credit cards. please cal juribdiCVUn fur • information.
Permit fee $ �. .I''6
Asa 0 MasterCard Nonce! This permit application Minimum fee $
i card number. _ expires (fa permit is notobtained Plan review (at %) $
spires within 180 days after it has been State surcharge (8%) 7r �S
Name of cardholder as 6howa on credit card — accepted as complete, , l
!J
Cardholder signature 5 TOTAL ........................ -7$- 3 tJ
mount
440617 f6P00/COMt
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 __
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ■
/ BUP
Received Date Requested / b// / AM PM BUP
Location id- � i Suite MEC — 0 0 L[3
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner L'la —n L �� �- ELC
Footing lD a — (� / 3/
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
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 /
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
as in
• a Dampers
PART FAIL
■' TRICAL
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 El Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / ( 1 0 1 — inspector 1M Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•