Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2004 -00210
11 WI* DEVELOPMENT SERVICES DATE ISSUED: 4/22/2004
=--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S 133RD -12500
SITE ADDRESS: 11334 SW SUMMER LAKE DR
SUBDIVISION: SUMMER LAKE ZONING: R -7
BLOCK: LOT: 006 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:
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: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Gas furnace replacement.
Owner: FEES
RAGER, CAROL Description Date Amount
11334 SW SUMMER LAKE DRIVE [MECH] Permit Fee 4/22/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 4/22/200 $5.80
Phone: 503 - 524 - 3301 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS
TIGARD, OR 97223 Cooling Unt Insp
Phone: 503 624 - 2704 Final Inspection
Reg #: LIC 76359
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: Permittee Signature: f2 a ., 72fa i t *e_ 0 7- 7
�.,
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Apr 20 04 01:15p PAM DALBY 503- 598 -0270 p.2
It clianiclifErMtiVEgication Received . .Mechanical
r
Date/By: 3 01 Permit No.: o�/
City of Tigard Planning A prova7 f Building i
�� �; 20 Date/By: Permit No.:
13 125 SW HaII Blvd. Plan Review Other 1
Tigard, Oregon 97223 r oF flGAD Date/By: Permit No.:
Phone: 503- 639 -4171 ��� � li. LON , Post- Review Land Use
Internet: www.c:.ti ard. �.1 ' 1' DateBy: Case No.:
g -a�'i :`/�� Contact Juris.: tg See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Tic_\_ Supplemental Information.
• TYPE OF WORK • . COMMERCIAJ JirFEE+.SCHEDULE: -1JSE CHECKLIST •
Q New construction 0 Demolition I Mechanical permit fees* are based on the total value of the work
1, r Additiort , alteration/replacement [J Other: performed. Indicate the value (rounded to the nearest dollar) of all
.CATEGORY OF ':::'' ?. mechanical materials, equipment, labor, overhead and profit.
1 & 2 Family dwelling Commercial/Industrial
I 0 value: 5 See Page 2 for Fee Schedule
• Accessory Building I Multi Family �t 1ue: 5 SUtE.1ti1EN'I'ISY.S EMSiE f or:i� S c hed
Master Builder I Other: Description j Qty I Fee(ea.) j Total
Heating/Cooling
JOB SITE INFORMA•TIONand••LOCATION . Furnace - add -on air conditioning** / 14.00
• Job site address: // 334-/ Six/ ,f /,,v, jf,/ Gas heat pump 14.00
Suite R'. • Bldg. /Apt. #: Duct work ' 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) I 10.00
Subdivision: I Lot #: Repair units. I 12.15 _
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00 I
DESCRIPTION OF WORK Gas fireplace 10.00 I 1
ii—ti0 tot 745 tew wMAf1 ' Flue vent (water heater /gas fireplace) 10.00 1
/ Log lighter (gas) 10.00 I
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
P ROPERTY OWNER ' I D.TENANT• - . •. Other: I 10.00 ,
me: C,94, / ,,q-e., e /!/ • -Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 1 0.00
Address: //.3, 3 y f,J$, /a Ze tla,4-1
City/State/Zip: AA ',IL_ Clothes dryer exhaust 10.00
97ap..."74 Single duct exhaust
Phone: ,?y 3,3 / Fax: (bathrooms, toilet compartments, .
ID APPL ® 'CONTACT:PERSON.• • utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: other: Fuel Piping moo
City/State/Zip: ••(55.40 for first 4, 51.00 each additional)
Phone: I Fax: Furnace, etc. I ••
Gas heat pump • •
E - mail: I WalUsuspended/unit heater ••
CONTRACTOR .. • ' • ' Water heater ••
Business Name: /unh1a AL- n, .. COoizA<eo Fireplace ••
Address: g0 Range ••
BBQ • •
Ci ty /State /Zip: ' - -. -' a Tvay4a Clothesdryer(gas) ••
P i, sky ,p...3 . si I Fax: ,1 o .7 '7 0 • Other: ' •.
CCB Lie. •: Total:
Authorized Mechanical Permit Fees*
Signature: Qtr ., ,.L.r_1) ac_l d_.� Date: n5/ Subtotal: S
Minimum Permit Fee $72.50 S 7c?—._ 57)
Pi M s LI A /)A / b y/ - Plan Review Fee (25% of Permit Fee) S
(Please print name)" State Surcharge (8% of Permit Fee) S `✓ .. W
TOTAL PERMIT FEE S 7 S. 3_0
Notice: This permit application expires if a permit is not obtained within 'Fee methodology set by Trl -County Building Industry Service Board.
180 days after it has been accepted as complete. ••Site plan required for exterior A/C units.
i:\Dsts \Permit Forrns\MecPermitApp.doc 01/03
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — AM PM BUP
Location /1 3 , r� �J' P %-f ite
ontact Pr `�/r/7/? Ph ( ) 2 a - 2 7 LM
Contractor 1. / 4 Fa. ) 5 LPL - 3 36 / SWR
BUILDING Tenant/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
Framing �� 7�= /�/1CF %,u Al. s �rL_.- �;�lIC��L /.ts <��a/y l�,�Fl <2" 4543.E
Insulation
Drywall Nailing e'-`C
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
e.
Final 7
- ART FAIL
I BING
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
mpers
Final
PASS PART 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 Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 5 7 - - a 5 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL