Permit CITY OF TIGARD (9/
MECHANICAL PERMIT
Az DEVELOPMENT SERVICES PERMIT #: MEC2000 -00486
-� ), II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/01
PARCEL: 25101 DD -00401
SITE ADDRESS: 06955 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: I -P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 DOMES. INCIN:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Remove and replace (2) 7.5T gas packs on roof top.
Owner: FEES
NORTHWEST MEDICAL TEAMS Type By Date Amount Receipt
INTERNATIONAL, INC PRMT CTR 2/13/01 $287.10 2720010000
PO BOX 10 PLCK CTR 2/13/01 $71.78 2720010000
PORTLAND, OR 97207 5PCT CTR 2/13/01 $22.97 2720010000
Phone: Total $381.85
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 234 -7331 Mechanical Insp
Reg #: LIC 1441 S.D. Shut -down inspection
Final Inspection
EXPIRED
( M
su
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. T
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 O
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC b ;.Ili • - ! -,? 46 -9189.
Issue By: 1 D Permittee Signature: j / _ /
Call ( ) 639 -4175 by 7:00 P.M. for inspections needed the next business day
BUP - Building Permit EL C - Electrical Permit
1 Inspection Description Date Passed By J Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing sI Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing erg O o— o T f6
MFG - Structure set -up C hanical ermit
Insulation Inspection Description Date Passed By
Drywall nailing Post/beam mechanical
Suspended ceiling Gas line
Engineered soils - /11 ` }'
Mechanical rou l h -in !•
Welding Lab Final Fire damser
Concrete Lab Final • "� ,,-I `` --,
Bolting Lab Final Duct work
11 1 WIE111
Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils _ 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
� , CITY OF T I GA R D MECHANICAL PERMIT
�YIA DEVELOPMENT SERVICES PERMIT #: MEC2000 -00486
'� �!
DATE ISSUED: 2/13/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101DD -00401
SITE ADDRESS: 06955 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: I -P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 2 DOMES. INCIN:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Remove and replace (2) 7.5T gas packs on roof top.
Owner: FEES
NORTHWEST MEDICAL TEAMS Type By Date Amount Receipt
INTERNATIONAL, INC PRMT CTR 2/13/01 $287.10 2720010000
PO BOX 10 PLCK CTR 2/13/01 $71.78 2720010000
PORTLAND, OR 97207 5PCT CTR 2/13/01 $22.97 2720010000
Phone: Total $381.85
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503- 234 -7331 Mechanical Insp
Reg #: LIC 1441 S.D. Shut -down inspection
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 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC b Ili •- -! - %46 -9189.
Issue By: D _ Permittee Signature: /f'
5 03 639 -4175 by 7:00 P.M. for inspections needed the next business da
( )
Call Y p day
t
Mechanical Permit Appl'cation
Datereceived: / 42. D/ Permit no.• to ZOO --OQ yer4
:1.:I i! City of Tigard _ , „ �, 6 , ,,,,
Address: 13125 SW Hall Blvd, TWO, OR 9 i ProjecVappl. no.: Expire date:
CityofTigard 6R 97223
Phone: (503) 639 -4171 Date issued: /2 /. By 'I cccipt
Fax: (503) 598 -1960 FEB r(7 'inn Case file no.: Payment type:
Land use approval: Building permit no.:
COi1MUNIT',. UC , .. ,,.
O 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi- family ❑ Tenant improvement
O New construction ❑ Addition/alteration/replacement O Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1, :JIA) i c,b(AA Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: 3.--. value of all v mec nical mat rials, equipment, labor, overhead,
Tax map /tax lot/account no.: Zo>Sp ,a 1eS�J 5 profit. Value $ ! a a )0
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: , () , .. `7 yt,a, jurisdiction's fee schedule for residential permit fee.
City /countyopd � 8„, I ZIP: 6 37 22'x. I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description an(Nocati n of work on premises: �/1 Ev►±ei�Q Q AND CONRIERICALIINDUSTRIAL EQUIP'S ENTSCIIEDULE
� aa -p �► — 1 lti_2a t
Est. date of completion inspection: - Fee (ea.) Total
Description Qty. Res. only Res. only
Tenant improvement or change of use: IIVAC:
Is existing space heated or co d'tioned es U No Airhandling unit CFM
Is existing space insulated? •- s
El
Is (site plan required)
— Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
Business name: M - 44, ,, � , d L St ate boiler permit no.:
Address: 1.1,41 6 / • 1:, • HP Tons BTU /H
Cit Fire/smoke dampers/duct smoke detectors
• I State:I ZIP: q- Z02 Heat pump (site plan required)
Phone: 2M. 3 2 ( I Fax: 7)13• .9Z5ej E - mail: 1 i- 7 R/replacefurnace/burner BTU /H
CCB no.: yy ( Including ductwork/vent liner ❑ Yes O No
•
City /metro tic. no.: Z Install /replace/relocate heaters - suspended,
( LP wall, or floor mounted
Name (please print): Vent for appliance other than furnace
Refrigeration:
V n Absorption units BTU/'{
Name: .
Chillers HP
Address: Ai Q Compressors HP
City: Y I Stat ZIP: Environmental exhaust and ventilation:
Appliance vent
Phone:
Fax: E -mail: - Dryer exhaust
Hoo s, Type I/ II res. kitchen /hazmat
n /l, ^ hood fire suppression system
Name:
f ' Ita) Exhaust fan with single duct (bath fans)
Mailing address: , p, 1 ( Exhausts stem a r art from heating or AC
City:�bik . State: ZIP: 419ZQ1- ue p p ng an sl ut o t.. , out ets)
Phone: (QN. ( Fax: E -mail: Type: LPG Oil t
Fuel piping each additiona 9 er 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: arc. - ,E - mail: - Woodstove/pel let stove
Applicant's signature: 11 / /! -�!
�l Date: : ��iM� Other:
Oth er Name (print): r - � r ®�/�1� / i 6(i
'Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ Zr) 1
O Visa ❑MasterCard Notice: This permit application Minimum fee $
Credit card number: expires if a permit is not obtained
Expires within 180 days after it has been Plan review (at %) $ - 7"( 7 +9)
Name of cardholder as shown on credit card accepted as complete. State surcharge (8 %) .... $ 1Z Pi +-
$ TOTAL $ f 3 _
Cardholder signature Amount
r
440 -4617 (6l00 /COM)
- r
( 1-2,1 (0 -S
e5il CITY OF OF TIGARD
Approved 0'
Conditionally Approved. . .. ( ):
North west Medical Teams HVAC Roof Plan For only the wortas described In
6955 S A 8to
VV Sandburg Road PERMIT NO. 'VW. . 1000 ' eV
..
See Utter to: Follow ( ):
Tigard, OR 97223
Job fress: Atti Sckl ' 111 $ 3.6P b 12 .4
B y e2 Date: 7
IN11.11111111111.1111111111.111111111mm
Lennox
....--- Lennox
Lennox
Lennox
MIN-GCS3-953 MN-GCS3-953
MN-GCS3-953
M/7-GC:S3-953
7.5 Ton 7.5 Ton
7.5 Ton
7.5 Ton
Yr. 1974 Yr. 1974
Yr. 1974
Yr. i 974
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7 WN-CHA9-311
2 s Ton
Yr. 1974 WN-GCS4-311
2.50 Ton
Y. 1974 WN-GCS3-633
5.0 Ton
Yr 1974
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