Permit y ✓as
� - CITY OF TIGARD MECHANICAL PERMIT
► PERMIT #: MEC2004 -00753
TAU - Ail. DATE DEVELOPMENT SERVICES DATE ISSUED: 11/17/2004
13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 PARCEL: 1S134BD-03400
SITE ADDRESS: 12010 SW SPRINGWOOD DR
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R -4.5
BLOCK: LOT: 122 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: 1 VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 2
> 10000 cfm:
Remarks: Gas furnace change -out, AC add -on, gas fireplace insert and gas WH change -out.
•
Owner: FEES
MOHR, STEVEN C CYNTHIA D Description Date Amount
12010 SW SPRINGWOOD DR [MECH] Permit Fee 11/17/20( $83.40
TIGARD, OR 97223 [TAX] 8% State Surchart 11/17/20( $6.67
Phone: 503 266 - 1249 Total $90.07
Contractor:
ROTH HEATING & COOLING
P.O. BOX 1265
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical Insp
Reg #: LIC 14008 Heating Unt Insp
Cooling Unt Insp
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By:
ALi
Permittee Signature: (01 c Gam,, 14-,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
! 04/09/2000 07:12 15032632513 ROTH MECHANICAL PAGE 02
MethaiieaIPerniit ' a a • e a : n . /-4 r I: a 111 u I I i e t; 1, i•: )NI .,
City of Tigard • fil0 Received o N / Permit No.: , ., I /2 n
r e AM Date/B /► 7 i'
13225 3W Hall Blvd., Tigard, OR 97223 ;: 1. 20U Plan Review
Phone: 503.639.4171 Fax: 503.598.196Q r.,,• + � C r' ��g Other Permit; Inspection Line: 503.639.4175 UTY OF rIGAR ,� II
Jntctnet: wWw.ci,tygatrrl onus 0-101q57 Date > dy/By! WI Sea Page 2 for
,GGI 51 1 N ad/Me �d: Supplemental Information
r W.v ,a� r:,�•: t
x,: p ra'''r'T + "ai ",- ..,�, - �!- �� .t t
•i•,'W��fjY't .L. t � n � : I.I�.l..ir �. �rG'I'.i:'I .Iii ;i �'Y : I :i.�;I.}'h �12,. a4h., �:�.1 �':1 .'� ,.;
;� �_........ -p +.• :. ....I,. .... ..... � .� •.r' .e ..r..,.• � .....if�i'.'+L:`.�'.`;�il��,, ;�x,..,) < :'' <Tl�: r'1' �.S',d�i�A{� ��1� 'l�lY•�++�.�ww 1�1W Vi4i;Cr-�•;�� Sit � ... ,. .
Mechanical permit fees" are based on the value of rho work
ID New construction ddition /alteration /replaeetnent
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Othcr: me materials • m labor overhead and
'" wl diete )n� J' i l b >' '•'' �:ei t i(S , t� 'n it it .'1• M{,...h,- T`•,,-t:;,',r. Value: $
' �C' r ." u°iq n� Pi�f1E (�r�t�6#�;��.d�'l�i?ig':LL�I � �'m �r�f
'a nwv., ,. •�.• • !'�.. ... . •..: ol��.y .ik,� ,.I•�:,- tae• ►1�+
Qi'r,':�Ijti c 111051I�`NfT.!f.65!Si11? . 1.17,,��>c.y�i 1;
1 - and 2 dwelling .
y $ [� Co CotntnerciaU 0 building For special in ornradon use checklist
• Multi - family 0 Master builder
t 'i�;E' ,1 �, L.,�' `1R "+, 9139e? ,r;•;'r'•r';i' t ;c a"'' Qty.
...,... Other: Description y
„si i n t,�,1 A '��,, 013x113 L o j f !# )l 1 i �f t,' a 4.. Total
,..� ....�., , - '4'i'F.,,., . , �,... �..., �...., ...•.�:.; .... _...�..'. � . }. a' i .l. ;y �j.!"i 1 � l�01)IfR
1 r `'y �eatlnPf IIa.
Job site address: / Zo 10 5 S P�� NG,�O600 .. b . L' Air conditioning or beat pump
(m aims aim plan showimplacement) l 14.00 PA '00
City /State/ZIP: 73 (. ka-t. L o-R_ q -72.-7 3 Pomace 100.000 BTU (ducts/vents) 1 14.00 , 1+4,d o
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg. /apt. no.: I Project name: irlg, 9 9 -7 Clew brat pomp 14,00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronlc) 14.00
Unit beaters (fuel -type, not electric),
in -wall, is -duct, suspended etc, _ 10.00
Subdivision: J Lot no.: Flue/vent for any of above j 10.00 ] d.OQ
Other. 1 10.00
Tax map/parcel. no.: Other fuel appliances
`� I s ] ML3' 3. G *'1> 0: 0000. { �}�'�Y'� 7ara'"S. t•l: � .,,�j Water heater 1 10.00 10.00
r r x 0 41 •if=J u'ti, c w ..,.r. , v t: �Ie,,.• � 1 •' �- Z"j` ����3/;` �A1 1�'c)fi:f`��meS,;+�i..: {j1:�jd
Gas fireplace _ / 10,00 t a' Oe
1 - .:i. /.. 1 ;.. A 6 • A tl Flue vent for water heater or gas
fireplace 1 10.00 1
CHAS F i R &PL ACr /A s e -T 1 t, (AS LLI AT crz Log lighter (gas) 10.00
• j 1 A D 7 2 . C M r s - CLAY. Wood/pellet grove 10.00
Wood fireplace/ insert I 10.00 Jt
giiN . ,.. : . n vi rp 9,,„'1, . r, p .
R �: .5� :t•; e ° + ,; •i I S 90:4,104,v .. a Ir' - c ts:u . � E t4� { G Other
10,00
Name + S.' Eli E. MO t- .Yt_ Environmental exhaust and ventilation
Range hood/other kitchen •
Address: Sft1Z& - _equipment 10.40
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (SO ) 70 ,. -214 ( �F ( � j ) toilet compartments, utility moms) 6.80
R' t'i'��t ° ''::q `•;ir r 1113 F°1 1 ' 1,.ivr.r , � V,:i.1 : i i 7s �,� , J1f tg Fd,'�4'i' "yp: Atlic/crawlspace fans 10.00
Other f 10.00
Business itmsae: Fuel piping
Contact name: 1 $5.40 for first four; $1.00 for each additional
Address' Furnace, etc.
Gas heat primp
City/StatelZIP: ep
Wall/anended/unit heater
Phone: ( ) ru ! Fax:: ( ) Water hater
13 - ed: F 'Place
I N, "' i I [yi ,4.',/... , -41:q "3 "iS� ti,Sj`e `. "t`''" t Y �5 j��J- ��' Range i g. i60
w
' 'id.tn7:t.vla7rt Is , 1t ° : �" . ,y a ,,�l •.."}, 'ir~ ;k�9.' , Barbecue __ F----
Business name: # � Clothes dryer (gas)
Address: D 2-lO � Other ^...:. _
T O lip-4..__/ aMtral . 1\Ti I G`Y1XT' . $r `„db` 4. a ; l T'
Cit subtotal . TD -
(5) lip - 2� L 1 [ Fax: (�6 2h - _ 4 minimum permit fee ($72.50)
-
Phone: Plan review (25% of permit fee)
CCB lie.: / State surcharge (S% of permit fee) �
L f Der . (2 r
TOTAL PERMIT FEE }
Authorized signature:
j I ` ' , A -
Thla permit appltmtton expires If a permit is not obtained � a e 0'
hm 18 - days alter It has linen Dampted ere complete.
Print name: n''�i��/ mot- Date: 117 • Fee methodology act by Tri- County BuIiding Industry service Board
04/09/2000 07:13 15032632513
ROTH MECHANICAL PAGE 03
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STREET Sen,41
AD E Sg.; / 3
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Reid S '� Date Requested / 7 AM PM BUP
Location ation _ 0 9 .I�: L Artriel, . I Suite icac3 71D - 0675
Contact Person Ph ( ) PLM
Contractor Ph ( ) a' 7 - S// SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: < O \ k2:c : k:z%. Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:
GI/C/2004 O 0.7(0 SIT
Post & Beam
Shear Anchors 1+
t i4. G -i'
. ' � i_ ' lx cam. Li
Ext Sheath/Shear G Q 1
Int Sheath/Shear L n P
Framing ► r , W� f Li\ 3 Mir l O O�
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 • - ' FAIL
L
—
Pos Beam
I - . . '1St:`
- e Dampers
PASS.. PART FAIL
RICAL
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 fo reins =ction RE: I
Approach/Sidewalk LI Unable to inspect – no access
Fire Supply Line
ADA / /
A alk Date v Inspector ' 11 Ext
ew
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL