Permit C1TY TIGARD MECHANICAL PERMIT
;t r DEVELOPMENT SERVICES PERMIT #: MEC2000 -00059
.,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 02/28/2000
PARCEL: 25111 DC -05100
SITE ADDRESS: 15683 SW SUMMERFIELD LN .
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 351 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:
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: Add gas piping for conversion to gas water heater.
Owner: FEES
LAMAE BATES Type By Date Amount Receipt
15683 SW SUMMERFIELD LANE PRMT KJP 02/28/20( $50.00 00- 321865
TIGARD, OR 97224 5PCT KJP 02/28/20( $4.00 00- 321865
Total $54.00
Phone:
Contractor:
CROUCHLEY PLUMBING
8717 N LOMBARD STREET
PORTLAND, OR 97203 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 286 -4431 Final Inspection
Reg #: LIC 1184
, ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Code 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 t ip . of these rules or direct questions to OUNC b _ - 303)246 -9189.
Issue By: Permittee Signature: . 1
Call (503) 639 -4175 by 7:00 P.M: for inspections needed the next business day
Plan Che
°CiTYF TIGARD Mechanical Permit Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit # i72G 2o�` 430 57
Incomplete or illegible applications will not be accepted Called
•
Name of Development/Project Description
v r�\ P, �1� Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fee 16.00
Address /,3 4* r t / Sa --, » , i =.s «1 I including to ducts & 0 BTU
S Including ducts vents see footnote 1,2 9.65
Bldg# City /State Zip ) � 2) Furnace 100,000 BTU+
7 o 7) a 'it S y y including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner / ct /11 4 .e _ / . it /,3 p including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
or floor mounted heater see footnote 1,2 9.65
50 5) Vent not included in appliance permit 4.75
City/State Zip Phone Check all that apply: *Boiler Heat Air
5 SY pi c 5 -_ For Items 6 -10, see or Pump Cond Qty Price Amt
Name (or name of business) footnotes 1,2 Comp
6) <3HP;absorb unit to
a 1 .� 100K BTU 9.65
Occupant Mailing Address /� V ' "*. 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
N ame 9) 30 -50 HP; absorb
Contractor unit 1 -1.75 mil BTU 36.00
Ci ?o l. /..r y ALci +-n. h r " p 10) >50HP; absorb unit
Prior to permit Mailing Address >1.75 mil BTU 60.15
O
issuance, a copy 7 / 7 X/ 1.d w. h O ✓ 11 Air handling unit to 10,000 CFM
of all licenses City /State Zip Phone 5 e 3. 7.00
are required if / Ti-I) C`2 277 J ,"te(- 747 / 1 2) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date f ,J 11.75
database 11 f6 / - 26.- a t , J 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
4.75
Or Mailing Address
15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip Phone 16) Hood served by mechanical exhaust
7.00 -
Describe work to be done: 17) Domestic incinerators
12.00
New 0
air 0 Replace with like kind: Ye No O
, 18) Commercial or industrial type incinerator
Resident Commercial 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove /gas FP /other units /clothe dryer /etc.
7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas 0 LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee 550.00 SUBTOTAL 5o' do
I hereby acknowledge that I have read this application, that the information y} /r° /a SURCHARGE 4
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
Signatu�Owner /Agent Date S ce
• G Other Inspections and Fees:
> - �.�, 22_ I 7 1. Inspections outside of normal business hours (mininum charge -two
Contact Person Name Phone hours) 550.00 per hour
3
, 0-1/-7 / 2. Inspections for which no fee is specifically indicated (minimum
charge -half hour) $50.00 per hour
Foonotes for commercial 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
2. Provide drawings to scale showing existing and proposed mechanical
units. "State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
I:lrnechperm.doc rev 02/4/99
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171
BUP
Date Requested ,3/;2/0 AM PM BLD
Location I 56 A 3 5 I it f 2 MEC 2x66 -000 S'
Contact Person (4 Li ) / Z f. Ph ' I PLM 2 �
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
Insulation
Drywall Nailing eotd � G P y ect Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post& Beam
Under Slab
•p Out
Wa er Service
Sanitary Sewer
Rain Drains
Fin -
M 'ART FAIL
ECHANICA
Post & Beam
Smoke Dampers
Fi..
PART FAIL
ELECTRICAL
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 •
[ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date 2./0 0 Inspector ( Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.