Permit CITY TIGARD MECHANICAL PERMIT
IA DEVELOPMENT SERVICES PERMIT #: MEC2004-00463
DATE ISSUED: 7/15/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BD-08700
SITE ADDRESS: 11626 SW WOODLAWN CT
SUBDIVISION: PENN LAWN ESTATES NO.2 ZONING: R -4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
3 - 15 HP: COMML.INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace and AC unit install.
Owner: FEES
BARTKOWSKI, JOHN C AND Description Date Amount
CHERYL L [MECH] Permit Fee 7/15/200 $72.50
11626 SW WOODLAWN COURT [TAX] 8% State Surchari 7/15/200 $5.80
TIGARD, OR 97223
Phone: Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 640 - 3607
Reg #: LIC 66578
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:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
, ... . •
Mechanical Permit AP liCRICV_:, / FOR OFFICE USE ONLY
,
City of Tigard ._, ..--
......7
Date/By: -,..)- .1 ) Permit No
13125 SW Hall Blvd , Tigard, OR 7742 Plan Review
Phone 503.63c Fax 503.598 19601 IV:Is Attop...4tY; I Date/By: Other Permit-
Inspection Line 503 c 39.4.175 sig t• - • :i it'
Date Ready/By. Ends' El See Page 2 for
Internet WWW.:i.tigat d or us Notified/Method. - 1 G . Supplemental Information
,,..L . ,.. A. ____,.I.% ^ ‘D r '
1 " - R'1. -1 ' . l:: N ‘..,',.' "o'S•Y,!Ff z .r. .' .:. COM:MiiiCIAL BEE* 'SCHEDULE USE'CHECICLIST
Mechanical permit fees" are based on the value of the work
El New cons :ructic n 0 Addition/alteration/replacement performed. Indicate the value (rounded :o the nearest dollar) of all
0 Demolition 0 Other' mechanical materials, equipment, labor, overhead, and profit.
' - "=. ''' ■ - ' • • :::* ' ';'%':': •
CATEGORY OF '60.iiaticriori - ..'-' 3 .---, .- ' . • ..,:f"...., , ‘• - Value 3
.. . ,
RESAIENTL4L,EQUIPMENT / SYSTEMS FEES*
I: I - and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist
0 Multi-family 0 Master builder 0 Other. Descnption 1 Qty. I Ea. 1 Total
JOB..SITErINFOIRINIION - .1•k u LOCATI(* . .,., . _. ''..; ,-. •,.., Heating/cooling
c c c e..i...,.. j . 0.4 ._ Air conditioning or heat pump
Job site addrc :1 1 L, 2 la , i,)
, L ()C.) (requires site plan showing placement) 14 00
City/State/Z1P' 1AL, .C5 t . it 2:2.-.? Furnace 100,000 BTU (ducts/vents) I 14.00
Furnace 100,000+ BTU (ducts/vents) i 17 90
Suite/bldg e ./apt. no • - Project name: Gas heat pump I 14 00
Cross streetidirectio is to job site' Duct work I 14.00
Hydro= not water system _ 1-1 00
Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel-type, not electric), 1
in-wall, in-duct, suspended, etc 1 10.00 ..
Flue/vent for any of above ' 10 00
Subdivision: Lot no :
Other 10 00 1
Tax map/parcel no. Other fuel appliances
• . -,,, _
_ —.. - ..:•t"-'" DESCRIPTIOSI, Olk1VOtiK. , ,,,.•'•:'*: - • ' • ,-' --.- Water heater I _ 10 00
Gas fireplace 1 10 00
. ,4 %II .0 i Arl--' Flue vent for water heater or gas -,
IIIIIII I___ fireplace
10 00
Log lighter (gas)
10 00
Wood/pellet stove , 10.00
Wood fireplace/insert I 10.00
Chimney/liner/flue/vent I 40 00
" ' ' - - : ty OWROC ,• of'''''' -,", -. . ,.. : "AN ' • ' .- , . : • I 10 00 " Other
Name: - 16 1 -41 64,,v 0 iJr .
Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment - 10 00
City/State/ZIP: Clothes dryer exhaust 10 00
,- Single-duct exhaust (bathrooms,
Phone: ( ) CI Z) -,3 I (0 L .A Fax: ( ) toilet compartments, utility rooms) 6 80
12
''''''',:::.----..•.- itatAm4.fi:: 7 .... 7.7.,,..,:: L oNixoi .PEA(*,;; :.:.',`", Artie Other crawlspace fans 10.00
___:..._ • - I 10 00
,
Business name' _ 3 j .)_t, L :._ CI l i I (' C 1 1 I -1 5 Fuel piping
,
Contact name: 1 1
LI 6 1 S c K 1 . - fr r — 12 rti . S5.40 for first four; S1.00 for each additional
Furnace, etc.
Address' 4 :- ) ,--- Li 1 _f C. \ '
Gas heat pump
City/State/21P: 1+ t.:-.2 . c . eLy / L 3 Wall/sended/unit heater
Water heater
Phone: (St S ) l (., ( 0 - 3 (e . 6 4- r- Fc: ( .st ) t jt i _ 0 } -if
Fircplacc
E-mail: Range
,4 . • --, 3 ; ?-; . , • :r.r:t..61;;I kA3*.e '4V 0
. .7,7,1.4t1- - ,.';: .,„: Barbecue
.,....);- ,„.•-, ..,,, • ., , i--cz y - yi,,---w.,--,,,,r,..... ...,;., -. , _:•0;i4i.i,„ si. -•.-. ,[14. • .....we_ .
Business name:
Clothes dryer (gas)
Other. ‘ I
Address: li, 1:.' - ,MECHANICAL,PERNIIT - FEES *
City/State/UP: Subtotal
Minimum permit fee (S72.50) . -• ?
.
Phone ( ) Fax. ( ) Plan review (25% of permit fee)
CCB lic.: 4.. . .
{, c 1 k- State surcharge (3% of Derma fee) A A.)
' ..._ . I
C:
Authorized sign': ture: r■k i %.. („S....4;. s'...-
( Q-.-- This permit appticarion er PERMIT FEE ' S',
if a permit is not obtained
days 3fter it has been accepted as complete. within 150
Pnnt nanw. ,-- i la i. -- c r , __C 1 (' e , L 7 Date' Mit° Li' • Fee methodology set by Tn-County Budcing Indusrry Service Board
'
■ \Building\Perturs■ME;-PernutApp doe 12/03 440—.617r (I I /02/COM/WeB)
2 - d BTLO B6G EOS 2 ur4.eaH R.4.TeToads dLE:20 .T.0 21 Inc
SITE PLAN
•
30
.? -= ; PL
--'
I �
i ;
I i
7(
STREET
Specialty Heating & Cooling, Inc.
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.60-3607 0 -3607 Fax X03.681.0 _ 93
E'd BILO B6S EOS 2uT4eaH RlietaadS dBE :20 b0 Zi Inc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested g — `P AM v PM BUP
Location ft co - 2,f. (t) e`er- .C.v'v► Suite f • Xbei-e
Contact Person Ph ( ) 6 ({d-3e 0 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain a- (, ELR
Crawl Drain
Slab Inspection Notes: C y , ®� . 1 $ . �-o W SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear A NC/ , t ' Q
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm C7 g t.� L I 1 6 9 4 ('
Susp'd Ceiling
Roof
Other: •
Final - - t���11L 1 /0■9 N•illi
PASS PART FAIL
PLUMBING
Post & Beam L. ` �� )Cr- 1
Under Slab o �c�,� r� }�
Rough -In %)V-7, \�`_''` VIV \� l� �( 'R 5")
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
•
Storm Drain
Shower Pan / Other:
Final j.--
/
PASS PART FAIL
MECHANICAL 40 6
Rot & Beam ‘144 ,..
Rough-In
Gas Line
Smoke Dampers
•ART FAIL
LECT' •.L
Servic-
Rough-In
UG /Slab \
Low Voltage
Fire Alarm
C 4. PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line / /
Approach /Sidewalk Date A G Inspector � 7 • / t..i _ Ext
Other:
Final DO NOT REMOVE this inspection record fr the Job < ite.
PASS PART FAIL