Permit CITY TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2004 -00767
f.411 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/22/2004
PARCEL: 1S125DD-04400
SITE ADDRESS: 09805 SW VENTURA CT
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.2 ZONING: R -4.5
BLOCK: LOT: 052 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:
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: Gas line to range.
Owner: FEES
ROBIN CASSIDY Description Date Amount
9805 SW VENTURA CT. [MECH] Permit Fee 11/22/20( $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 11/22/20( $5.80
Phone: 503 720 - 9836 Total $78.30
Contractor:
SUBURBAN @ HOME
6014 NE 112TH AVE.
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Final Inspection
Reg #: LIC 143335
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: All/ T_ /' Permittee Signature: O1- - t 1 ��
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
t
• nl al Permit Applic ® FOR OFFICE USE ONLY
City Tigard Received ty ` Mee _ `, g g o � ..,„ Date/By ii pt , 6' d Permit No : ry`� ✓f// -- Ojf 7 7
13125 SW Hall Blvd., Tigard, OR 972
Plan Revte
Phone: 503.639.4171 Fax 503 54. ' 31 Cl ♦ t " ^' fk • Other Permit Ins
Inspection Line: 503.639 4175 (� 5 . x ''. Date/Bf y g
P `\ _ - n Date Ready/By lulls 0 See Page 2 for
Internet: www ci.tigard.or us �OV / `O �' Notified/Method -' I(� Supplemental Information
- ,� ; fc; �; : . y .. TYPE° �97iK; ,° - - . - "COMMERCI:A.F SCHEDULE - USE CHECKLIST
❑ New construction Addihof� alteration /replacement' <' Mechanical permit fees* are based on the value of the work
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical matenals, equipment, labor, overhead, and profit
I.)e - _'i.p,A? ,- , 10 , <iv'dATEGOR' -0F` ,: '= _ - Value $
R 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ; RESIDENTIAI EQUIPMENT / SYSTEMS FEES*
Master builder For special information use checklist
Multi - famil
❑ Multi ❑ 0 Description Qty Ea Total
w `.;' s JOB� SITE IIYF,ORMATIU N;ANID�:-LO _' '
::.�„ ')';�,:v�t`4x�:. '•',.;.� __.:a...,:.... ,�„ �., � .. Y,._.._ r,::<.._°_ 01V;
,. ..�..,.��r- �...,';..;:�jr -,- .,i , Heatin
Job site address: \ allo Air conditioning or heat pump
A (requires site plan showing placement) 14 00
City/State /ZIP: \ 0 c:>i-A2.,1-- J Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg./apt. no.: Project name: Fumace 100,000+ BTU (ducts /vents) 17 90
Gas heat pump 14 00
Cross street/dtrections to job site: Duct work 14 00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10 00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10 00
Tax map /parcel no.: Other fuel appliances
Nrg •R,:L 4 "Y s:;- r Y ,, st. r*z- ...,,y... -rr,..v � t. <... ,
. ,.� X ik7 . P '-'`z�' li'S '' ,��DES .O� W RK.' ? "-a 4, a ra " i.: ' ''; 't' ^;+ Water heater 10.00
• =-'° y - sin.,, = �,,.;- 3j.�:'D6. r' - .....,, ' ...°w� + 'i:a.. � ,., .7 . ' 3�: .
- '.i'r,s:.�o-�,na-r+.: �.., .,.. ;s:�:rse.'�a ai'sM. -- �-..ai &�;, a" y: ^ '�
�7-� Gas fireplace 10 00
0 ()) t tI Flue vent for water heater or gas
fireplace 10 00
Log lighter (gas) 10.00
Wood/pellet stove 10 00
Wood fireplace/insert 10 00
i , ,., f _. , . - a �,1 -r =,, ;•.� .), -,; ,,, � -r 4 _ : . < - Chimney/liner /flue/vent 10 00
,; r ROPE TY:` 1141.�,s'' :ikrt, /A ". : *,,N Ai Sai ` - di.i^
.Su "s"3?:.k�?` �. .--ic° laen.;�, °_ a^.; °,r,'¢- °t,an =i`_. :, S` z. urr }I'n�°,d;.Y�:.'�' . '� _.,. ..B, �rc �s�e6i',':��,:.^`a,,:Y,
Other: 10 00
Name: \ �\�..) C1`A Environmental exhaust and ventilation
Address: (7\ �."...._.) V Range hood /other kitchen
equipment 10 00
City/State/ZIP: -- "V‘ ‘ ) C"(A-2,2 ) Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( b Fax: ( ) toilet compartments, utility rooms) 6.80
rz >e!t;-° :r.-c9 , t- i`%rcq.. s i: ' 1 -. ; .. , e{_. br' r r° �• E ;: jrM1
e '-'�, � �;�:�:_ �,� t ��t"nc�, xY:�, x �`+ Amc /crawls ace fans 10.00
,3N u APPI;ICAIVIY i;, -, p I ®. CONTACT_`PERSOb!1? t }�� 4,1 , ,: P
,�... iP.� "_ s7as � :. .. n �K�,n::�Fi�., `f�' -..:. :''^erva'.';' �;.�5..�1-�# 41,._ \i �, . ,�i,� ..£s, c,�-.. � _ . -s � �.. >•.`1M G �...
Business name• �r �COe_ Other 10 00
�/ Fuel piping
Contact name . $5.40 for first four; $1.00 for each additional
Address: C.--- IMF \1/4.--\ s(\ \\ "tr on ��\7/�-
t -e Furnace, etc
- -\-\ �.I`�� (.J� 1 \ 1 � J / T) / FuGas Wall/suspended/unit � WalUsus ended unit heater
j�j� ∎� 3 a1
Phone: �X� Fax:: /�� ` Water heater `.!\. J
Fireplace
E -mail: Range �j - 1s::)°
vU'4 .,T.,?:., { l- ' -n. it R }fi'°4 ' G • ara.,r. 114 y 11,7 r
-- r ti :1 7' +°.. 5 '- s. `7 a :;
P z r - . 4 ; =�:. �° =- 3' �' '. 44 ' CONTRAC R :». . .: Y , i ? •Nr2 - : 3;: v /,, / "`: := 'j ' Barbecue
. .. " �- ��'�'�iC:��:.: ?'ta �r_-�_e�3.v�6 �Fd'.»•„ w *Y?'.. 2 },':;`Sty, p� y ?' ��3�s?'r - ;.`t�x�: _, _r ,
Business nam —D,�),(D Q \-\(1/4AryN `) ) Clothes dryer (gas)
` Other -
Address: \� J \\ -^s 1 0,0e >,1,(7 a r= , " 4= ` ;? "±':: MEGHANICALPERMIT'F ES *``
City/State/Z : � C }� CA � � Subtotal
Phont 3 . �`--, Fax: "D- _.)"L� Minimum permit fee ($72 50) �Z ,�t 1
� Plan review (25% of permit fee)
CCB lic.: \�� State surcharge (8% of permit fee) CI. SQ
TOTAL PERMIT FEE ( A - p .
Authorized sign
atui � ►`C This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print nat�e: I , Date. \` / \ C.J / • Fee methodology set by Tn- County Building Industry Service Board
I \Building\Pcmats \MEC- PetmitApp doc 12/03 440.4617T (I 1 /02/COM/WEB1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503 - :175 MST
INSPECTION DIVISION Business Liner (5f± : 171 3
Received Date Re nested f PM UP
Location Location l g I) ') Azte Suite EC „;OD 4-/- 00 7<' 7
Contact Person Ph ( ) PLM
Contractor Ph ( ) 7 — Y3 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
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 RT FAIL
kfigo AN AL
Post eam Kam"
Rough -I
"Gig
o e Dampers
411 PART FAIL
- TRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA \ /t
Approach/Sidewalk Date Z �/ In spector " `z': 1 Est
Other:'
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL