Permit _ n*
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT DEVELOPMENT SERVICES PERMIT #: MEC2004 -00046
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/4/04
PARCEL: 2S111 BD -02400
SITE ADDRESS: 09720 SW PEMBROOK ST
SUBDIVISION: CLOUD CAP ZONING: R -3.5
BLOCK: LOT: 006 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: 1 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
DON LAWRENCE Description Date Amount
9720 SW PEMBROOK ST [MECH] Permit Fee 2/4/04 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 2/4/04 $5.80
Phone: 503 684 - 6451 Total $78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 62196
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 N ► • " ca • Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952-R01-0100. Y• . ma obtain copies of these rules or direct questions to OUNC by calling
(5 1 : )246 -6699. •
Is ued By: „ ��• i Permittee Signature:
- .39-4175 by 7:00 P.M. for inspections needed the n • xt business day
Feb 03 04 02:O1p climate control 503 968 7224 p.1
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M. €cgo� y- ov-o1/(0
Mechanical ation OFFICE USE ONLY
0 4 004, Date received: Permit no.:
.,�61 r1i1I City of Tigard f E D J Project/appl. no.: Expire date:
A ddress: 13125 SW Hall Blvd, Tigard
City of Tigard Address:
. Phone: (503) 639 -4171 G1 OF �g1014 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 gV11.D1N Dt, Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERl1
p • I & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement 0 Other:
JOR SITE INFORMATION COMMERCIAL VALUATION SCII.EDULE
Job address: 91 ._c S(j Pew, p1, Si - Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: prcfit. Value $ •
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: gdy.p I a, - L,ctkot'e,u_a_ jurisdiction's fee schedule for residential permit fee.
City /county: - ri c I ZIP: '17 i.._1 & 2 FAMILY DWELLING PERMIT FEE SCHE)ULE
Description and Ibf:ation of work on premises: 1 COMMERICAL/INDUSTRIAL EQU1PM ENT SChiEDUL IR
1 fvf [c,.L1 Arm Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
Is existing space insulated? ❑Yes ❑ No Air conditioning (site plan required) I H .°45 1'1 - 66
Alteration of existing HVAC system .
MECHANICAL CONTRACTOR Boiler /compressors
Business name: State boiler permit no.:
11`Mc L O�n QY __ HP Tons BTU /H
Address: 1v-.CX] �,,_)1 a Ytd Al/t_ Fire /smoke dampers/duct smoke detectors
City: -1.(0.unCA I State:OR I ZIP: ' ?7 aaL.1 — Flat pump (site plan required)
Phone: 5 , -452,- E0ax:96Z-7 o I E -mail: Install /replace furnace /burner BTU/1-1
CCB no.: Including ductwork/vent liner 1=1 Yes O No
� I Install /replace/relocate heaters - suspended,
City /metro lit. no.: 1'- t 9 wall, or floor mounted
Name (please print): Aryl Gyj eR Vert for appliance other than furnace
CONTACT PERSON . Refrigeration:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP -•
Ci[ Ensironmental exhaust and ventilation:
Y: (State: (ZIP: Appliance vent
Phone: Fax: E -mail: Dry :r exhaust
Hods, Type i/ It /res. kitchen /haznat
hood fire suppression system
Name: D cNl V (Yl Q. Ut - lva .) r,e �� Exhaust fan with single duct (bath fans)
Mailing address: df la-C„) St/ f Li - oropic:, $ Exhaust system apart from heating or AC
Cit f C I ZIP: 97 � Fuel piping and distribution (up to 4 outlets)
Y �I State:
� , Type: LPG NG Oil
Phone: 513 - (251.4 - (o Fax: E -mail: duel piping each additional over 4 outlets _
ENGINEER ' rocess piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Inse:1 - type
Phone: I Fax: I E -mail: Woodstove/peltet stove
Applicant's signature: I Date: a- ?)-0' pe .
Name (print): iorvt.t_. E1,{,
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Permit fee $ ly • efl'
0 Visa 0 MasterCard Notice: This permit applicatio $ Minimum fee - 73.. Go
• Credit card number. expires if a pentt:t is not obtained
_ Plan review (at %) $
Ezpires within ISO days tiller it has been State surcharge (8 %) .... $ r7 -• 117 •
Name of cardholder us shown on credit curd as complete.
$ TOTAL $ MK,
Cardholder signature Amount
440.4617 (6/(XVCOMI
Feb 03 04 02:O1p climate control 503 968 7224 p.3
Home Layout
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Windows Windows ' Doors Walls Roof Floors
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP , /
Location q 7 a O P �-E % / L.f' Suite MEC d ° `'�"
Contact Person �j C Z Ph ( ) 1 1S - 3 - 7 S 2, 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 i n /k - A G -] f / „ koc
Framing 1,' v ` l_ W ((/
Insulation f1914
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
PA FAIL
CHANICA
eam
Rough -In
Gas Line
A e Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line ,.
ADA /I/
Approach/Sidewalk • Date -- /(ter- b Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL