Permit C ITY OF TIGARD MECHANICAL PERMIT
,r ilj DEVELOPMENT SERVICES PERMIT #: MEC1999 -00446
I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/19/1999
PARCEL: 1S133DA-01200
SITE ADDRESS: 11115 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 034 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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES: 1
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of a gas insert and gas piping.
Owner: FEES
ANNANIE, DONNA M Type By Date Amount Receipt
HANSEN, HELEN L PRMT GEO 10/19/19E $50.00 99- 319189
11115 SW SUMMER LAKE DR 5PCT GEO 10/19/19E $4.00 99- 319189
TIGARD, OR 97223
Total $54.00
Phone:
Contractor:
T + K MECHANICAL
TIMOTHY S WYNNE
11525 SW CANYON REQUIRED INSPECTIONS
BEAVERTON, OR 97005 Gas Line Insp
Phone: 626 -4652 Misc. Inspection
Reg #: LIC 00121165 Final Inspection
ORIGINAL
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 by
calling (503)246 - 9189.
�// Issue By: ` � � ,��� Permittee Signature: _
Call (503) 639 175 by 7:00 P.M. for inspections needed the next business day
•
CITY OF TIGARD Mechanical Permit Application PlanChedc#
pp - Read By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGP RD, OR 97223 �� 3g Date to P.E.
(503) 639 -4171, x304 ri4, Cook " D to DST
Print or Type Pemmit -r/9G
• •
I Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description -
Table 1A Mechanical Code Qty price Amt
Job Street Address SOW/ A) Permit Fee 16.00
( 1) Furnace to 100,000 BTU •
Address / 4/5 S (-z-) -=t ; Mil/ e v [ ? K D.'' Including ducts & vents see footnote 1,2 . 9.65
iiw City/State Zip 2) Furnace 100,000 BTU+ ,
including ducts & vents see footnote 1,2 12.00
Name (or name of business 3) Floor Furnace
Owner '' `1 ( including vent see footnote 1,2 9.65 ,
I � a ' r 'n y� 4) Suspended heater, wall heater
or floor mounted heater see footnote 1,2 9.65
1\ i 5 5■- +- c onlyi E [L'(ic (2. . 1) r"" 5) Vent not included in a?pliance permit 4.75
City/State Zip Phone Check all that apply: . Heat Air
c
( i et✓J U r `77 z c;?y- , se For items 6-10, see or Pump Cond Qty Price Amt
Name { ( 1 r name of business) footnotes 1,2 Comp
,.1.- n 6) <3HP;absorb unit to
3-1 BTU • 9.65
Occupant Mailing Address 7)
7) 3-15 HP;absorb unit
100k to 500k BTU 17.65
City/State Zip - Phone 8) 15-30 HP; absorb .
unit .5.1 mil BTU 24.15
•
9) 30-50 HP; absorb
Contractor Name . t unit 1 -1.75 mil BTU • 36.00
t
• l< 1 `'�L' C. 1(1 IA (c J / /'t,� .J 1 d i hoe N Ued1D) >50HP; absorb unit .
Prior to permit Mailing Address < <i >1.75 mil BTU 60.15
CO
issuance, a COPY //...5,2.7,' JL.v C� L'i lit . C: Vl., 11 Air handling unit to 10,000 CFM
of all are required licenses
.. Ci e . d C V1 Li v `1" (.- ( <h ,. > i F 7.00
�( �� 12 ) Air handling unit 10,000 CFM+
expired in COT Oregon Cant. Cont. Board Lb./ Exp. Date 11.75
database /,g / /6 c _ 3/ /7 /J 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct .
or Mailing Address 4.75
15) Ventilation system not Included in
appliance permit Engineer ( Ctly/State Zip Phone 16) by Hood served b mechanical exhaust 7
7.00
Describe work to be done: 17) Domestic incinerators
12.00 ... -
New 0 it 0 Replace with like kind: Yes 0 No 0 18) Commercial or industrial type incinerator ;; y
Residential Commercial 0
48.2 : , [:; '
19) Repair units : :
Additional information or description of work: 8.40x ' . . rr
20) Wood stove/gas FP/other units/clothe dryer/etc.'' ' ;•..
/A/5.6-se- 7 1 .7.0 :,_ ,.T
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets _ • ' . • ; ' '' j : I#
structural gas calcs. . See footnote 1 1 3.75 : . j3 ` :, g;
Type of fuel: oil 0 natural gas LPG 0 electric O 22) More than 4 -per outlet (each) .75 ;
/ Minimum Permit Fee $50.00 SUBTOTAL c0.42t: .
I hereby acknowledge that I have read this application, that the information 14% SURCHARGE c%DC;
given Is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only •
TOTAL
Signature of Owned/kgent Date ' (X) i
reon me
7� /( � . ne < � Other Inspections and Fees: . . . rm • n
� '
7 1. Inspections outside of normal business hours ( mininum charge -tWo'• '
Na Phone hours) $50.00 per hour • •
' I 7 �� 2. Inspections for which no fee is specifically Indicated (minimum t
-iscte l U,11v1 SIP t L' 9� --'')-- charge -half hour) $50.00 per hour
Fowt for cQttmerclal projects only: 3. Additional plan review required by changes, additions or revisions to ' '
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge-one-half hour) $50.00 per hour ,
charge-one-half -
2. Provide drawings to scale showing existing and proposed mechanical .
units. *State Contractor Boiler Certification required .
"Residential NC requires site plan showing placement of unit : • '
e:
.
lamechpern.doc rev 02/4/99 a *' " ``
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested/6 - Z../ — AM LPM BLD
Location / / //s Sum- 114irc - Lager. Suite MEC /fly a0 Ve,/ (,
Contact Person --r— K Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing 57 CA-77 04. Q/1 1. /1C� l / AI D S 7 - S
Insulation
Drywall Nailing /,YJA.S7oAe `> . ��/� 1�.� {��� /hL �c�5�/ Y2.- s-n o L45'7=>
Firewall
C
Fire Sprinkler Q4S .. P ,-r S Y i Ma.5 =
Susp' Alarm
Ceiling ./A4 �,�rv7 CZ 0004--
Susp'd Ce .
Roof
Misc:
Final ,L.4'? L ��
PASS PART FAIL r." ` 1 —
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ipCHANtr_A'
Post & Beam
Iu
(Gas Lines
Smoke Dampers
Final
e_1■151 PART FAIL
ELECTRICAL
( 27
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date ,1 — 2/ — 'S' Inspector . Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.