Permit CITY TIGARD MECHANICAL PERMIT
,� IA DEVELOPMENT SERVICES PERMIT #: MEC2003 -00488
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/12/03
PARCEL: 2S1 14 B D -00400
SITE ADDRESS: 09915 SW RIVERWOOD LN
SUBDIVISION: PICKS LANDING ZONING: R -4.5
BLOCK: LOT: 078 JURISDICTION: TIG
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: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace furnace and water heater.
Owner: FEES
ADEN, VERNON L JR + Description Date Amount •
AGNES H
9915 SW RIVERWOOD LN [MECH] Permit Fee 8/12/03 $72.50
TIGARD, OR 97224 [TAX] 8% StateTax 8/12/03 $5.80
Phone: 503 620 - 6655 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Heating Unt Insp
Reg #: LIC 76359 Final Inspection
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 -00
Issued By: ' � AP _ ` _ Y Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business d
•
Mechanical Permit Application
Datereceived:�- ' '3 Permitno.: 7 1J 6
t r.ti?,t k i it.
1 `.��.. City of Tigard RECEIVED Project/appl. no.: Expire date:
City 8 o f Ti and Addregs: 13125 SW Hall Blvd, Tigard, OR 97223
Date issued: By: $60 Receipt no.:
Phone: (503) 639 -4171 AUG 12 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TItAPD 1:/ Building permit no.:
T YPE OF PERMIT . .
0 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction Addition/alteration/replacement ❑ Other:
• JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE ''°
Job address: 4 7 / 5 $7 I 1 �, ,, j,, / Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 7;72 �/;,�/ ZIP: 1 & 2 FAMILY DWELLING PERMIT.FEE•SCHEDULE 1 "'
et
Description and locion of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
/-0 J a� , ✓et41' Fee(ea.) Total
Est. to of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
Is existing space insulated? 0 Yes ❑ No Air conditioning (site plan required)
g P Alteration of existing HVAC system
• MECHANICAL CONTRACTOR Boiler /compressors
Business name: ]U 6Ps 4; AA, K- Gdl how. =NG State boiler permit no.:
H HP Tons BTU /H
Address: ! Q0 OK 303 7 Fire/smoke dampers/duct smoke detectors
City: �*/ G rR 44 State: t7Q ZIP: 97 /.yCI Heat pump (site plan required)
Phone: (, 2e%,2 7 4 q Faxsejg 0 2,71 E -mail: Install/replace furnace/burner 'BTl l/H
CCB no.: �` +� Including ductwork/vent liner ❑ Yes o '
9 Install/replace /relocate heaters–suspended,
City /metro lie. no.: /a 7 a wall, or floor mounted
Name (please print): m, G A p L / p XS e,2.■ Vent for appliance other than furnace
' CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: PAM OA /6 y Digit) noatpeilly Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: .2 0 Fax:$ E -mail: Dryer exhaust
Hoods, Type 1/I res. kitchen/hazmat
hood fire suppression system
Name: t ,/n Exhaust fan with single duct (bath fans)
Mailing address: 99/s J•t•J ,,, vc„o d W Exhaust system apart from heating or AC
City: �s e1/ I Stater . ZIP: et2 Fuel piping and distribution (up to 4 outlets)
/ Type: LPG NG Oil
Phone' O Fax: E -mail: Fuel i ing each additional over 4 outlets .
rocess p pmg (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert – type
Phone: I Fax: I E -mail: Woodstove/pelletstove
A Applicant's signature: Date: 'Z.' 3 Other:
PP g ��� I � � Oth er:
Name (print): ,Q ,9 4,,-/,
Not all jurisdictions accept credit cards, please call jurisdiction for more information.' Permit fee $
CD Visa l] MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at — %) $
Expires . within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $
Cardholder signature Amount 440-0617 (6/00lCOM)
•
•
CITY OF TIGARD - l ' - ' 24 -Hour - ' F
BUILDING Inspection Liner (503) 639 -4175
DIVISION Business Line: (503) 639 -4171 MST BUP
‚ SPECTION
eived �'F X Date Requested �®� l AM PM BUP
Location of g/ s S 'RI t, cv- 1.„ .1, 4 2 Gov Suite MEC -: — e= 2?
Contact Person la \---- Ph ( ) 6 Z y 74 9 PLM 00 I EP
Contractor Ph ( ) SWR ,
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain , ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
hit Sheath /Shear i
Framing / `rethai C� !.%�i2.� /4-c
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 'Ice 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: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk •
Date ! Inspector Ext
Other: .
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL