Permit �� b y !1 Q ..
CI TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00703
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/10/03
PARCEL: 2S 114BD -01200
SITE ADDRESS: 09860 SW RIVERWOOD LN
SUBDIVISION: PICKS LANDING ZONING: R - 4.5
BLOCK: LOT: 073 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: 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: Replacement of gas furnace.
Owner: FEES
TORRENCE, EVELYN P K + Description Date Amount
STANLEY E TRUSTEES
9860 SW RIVERWOOD LANE [MECH] Permit Fee 12/10/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 12/10/03 $5.80
Total $78.30
Phone:
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 71878
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 -0 • • You may obtain copies of these rules or direct questions to OUNC by calling
(503)2.: - 6699. cd,,Q„,„.,47; Issued . ��� I ,1 Permittee Signature: OO i yfrei�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
DEC -10 - 2003 08 54 A TEMP HEATING 5035572990 P.02 /02
Permit No.:
• � � � ►A r,.n1�a■e ra � A
Mechanical Permt�+ 1 >�CatllUltl Received J o / Mechanical
' ;) - - a � ii 'V to a'• _ Datdi2¢: /2 // U3 0o N E€..0,3 -A0 703
Planning Approval ling
City of Tigard
DEC 10 X003 Date/By: _ Permit No.:
13125 SW Mall Blvd. Plan Review Other
Tigard, Oregon 97223 _l)atensy:. Permit No,:
Phone: 503 - 632 - 4171 Fax:G50 5A Post-Review Land Use
. ���(i r t) fly: Case No.:
Internet: www.ci- tigard,or.QuILD1NG DIv'' - ' ' t ■e,'ill Contact Ju„ ®
s,: see Page 2 for
24 -hot inspection Request: 03.639 - -4/ 4175 / j
COH- N+cIMcihod: — -770,,, Supplements! Information.
�` COMMERCIAL FEE* SCHEDULE - USE CBECKLIST.• ,
.i;9 TYPE OF YORK n+
New constr Demolition Mechanical permit fees' are based on the total value of the work
Addition/altera placemel la Other:. performed. Indicate the value (rounded to the nearest dollar) of all
't; ;'CATEGORY O1VSTRUCTION mechanical materials, equipment, labor, overhead and profit,
Value: S See Page 2 for Fee Schedule
)1V 1 & 2 -Famil dwellin_ U Commercial /Industrial •-
Multi -Tamil RESIDENTIAL EQUIPMENT/SYSTEMS FEEtSCFIED[ILE,
Accesso Building -
Y Descri lion 1 Qty 1 Fee(ex.) 1 Total
......
Master Builder II Other: . • nudist, coolin:
': JOB. SITE INFORMATION and LOCATION r 14.00 add -on air conditioning" ._ -
_to
Job s ite addr M(- d cA' Qj Vjjt1? pp,fl.Lei as heat pump 14,00
i Bld' /A it #: Duct work . — 14.00
Suite #: _ I b 1 -_ +..� Ilydronic hot water system 14.00
Project Name: 1 o r' ► ^ 1Cr-21 �. — Residential boiler •
Cross street/Directions to job site: (for radiator or hydronic system) 14.00 T
Unit heaters (fuel, not electric)
(in wall in -d suspeed„eta)__
nd • 14,00
Flue /vent (for any of above) . 10.00 •
Repair units 12.15
Subdivision: I.ot #: Other Fuel Appliances
Tax map /parcel #: , W ater heater - 10.00
' '' ; DE CRIPTION OF WORK Gas fireplace 10.00
V . 1 ' -a .
•
� L , Flue vent (water heater /gas fireplace) 10.00
. rt�ra4e - + Lo, li_htcr as 10.00
�.- Wood/Pellet stove .. 10.00
• _ �- Wood fireplace/insert 10.00
Chimney /liner /fludvcnt 10.00
>Siti.OPERTY OWNER I ❑ TENANT Other: 10.00
En•lranniental Exhaust & Ventilation
Name .r• — 1= Q c__-e, „ Range hood/other kitchen equipment J 10.00
Address: 98L S •. C.,1 t!• Xt,O 60 ,LY1 — Clothes dryer exhaust , 10.00
Cit /State/Zi' : -- Ft # e, • Q R -aa Single duct exhaust • • ' .
Phone: L 4•-- S - Fax: (bathrooms, toilet compartments,
'J APPLICANT gm CONTACT PER a N • utility rooms) • • 6.80
.4 - •p_� "(,,, ,.. gn .h Attie/crawl space fans 10.00
Name: 10.00
O t h er:
Address: , ” s2 - F Plnrnq
City/State /Zip•C.-I • a iki c l tD **MAO for. nrst 4, 5100 each additional)
L1r7tAQC etc. �
Phone 3 •(oS�UR (pp, .ax: D ....x. �• • Gas F heat • .um •.
E-mail: ' Wall /sus ended/unit heater .3
. ; . ;.,);1'•:' • i L RACTOR Water heater •`
. Business l Ntiin . ., _ • ._ a :, _ :.,� Fire .lace - io
R • • • Address: te' .• . %r Se • _ " �`
�•�
{-' BDQ s.
Cit /State /Zi : • . :./�!_ ,_ . ,v6! *" J Clothes dryer (gas) *3
5r ( r „. • • r: . ..
Pt>.onr;: � r � � ix = �� � - • !� other Total:
Authorize•
CCB Lic... - ! x" 78"' � - Mechanical Permit Fees° -- Subtotal' $
Signs e, ► .. .1��.17!" - 911 ..,_ i _... it° :_...__.,.� - Mini :'turn Permit Fee 572.50 5 /" ') -5t5 • dab. s , ��+ Plan Review Fec (23% of PCrtnit tt e) S C�
(Please print name) State Surcharge (8%° of Permit Fee S :� �i
. TOTAL PERMIT FEE 5 ••
Notice: This permit application expires If a permit is not obtained within • • Fee methodology set by Trl- County Building Industry Service Board.
IRO, days after !tiles been accepted as complete. "Site pian'required for exterior A/C units.
i : \sts\Pertnit Forms\MeePermitApp.doe 01/03 ' ' „ • • <' .
TOTAL P.02
Case Activity Listing 11/10/2004
12:12:45PM
TIDEMARK Case #: MEC2003 -00703
COMPUTER SYSTEMS, INC.
. ... a .. ,... .., � . . .,., w��i"
.,, .. , r ... : .<. s
escr bona , . .,,., ,,. ate. v.y,� . >. Uate��, ' ,,,, Date•.3 •;,, 'aid:: -rr , „ as .� rtes
D , � ; � � �' ..
.w,y .,w,,�P,,,,���., , ,, 3��i �� »,�,.� ti.. r� K .r...r�. w„ ��,_,,,, w , .,.. ,..._..,, P�� .:. ° ` . .Y "�,;'.
MECA007 Application received 12/10/2003 None RECD FAX 12/10/2003
DEB
MECA008 Create Permit 12/10/2003 None DONE DEB 12/10/2003
DEB
MECA725 Heating Unt Insp None 12/10/2003
DEB
MECA799 Final Inspection 12/15/2003 None PASS KBS 12/15/2003
KBS
MECA060 (F) Issue permit 12/10/2003 None DONE DEB 12/10/2003
DEB
MECA800 Case Finaled 12/15/2003 None PASS KBS 12/15/2003
KBS
Page 1 of 1 CaseActivity..rpt
CITY OF TIGAR-D 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received ( 2 - 3' -el/ Date Requested / 2 -/ AM PM BUP
Location __� � �S/6).S uite
Contact Person (Y1-- 5 Ph (S 03 62 V-2 66 PLM
Contractor Ph ( ) SWR
BUILDING Tenan 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 lJ /
Framing jit.c /7/
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 Dampers
Final
• RT FAIL
ELECTRICAL •
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 y ❑ Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk
Date / -2-- 7 /5— ' Inspector f Ext
Other: • _
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL