10240 SW CENTURY OAK DRIVE r
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10240 SW CENTURY OAK DR _
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r CITY OF T I G A R D _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2004-00295
1315 SW Hall Blvd., Tigard, OR 97223 (503) 639 4171 DATE ISSUED: 5/19/2004
PARCEL: 2S111 CC-03500
SITE ADDRESS: 10240 SW CENTURY OAK E)R
SUBDIVISION: SUMMERFIELD ZONING: R-7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APDL: VENT SYSTEMS:
STOR;cS: 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:
CAS PRESSURE: 5( + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANGLING UNITS OTHER UNITS 1
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: I �tcrior A%('.cim nmt install citlni, ih i �i ne�l ,aback,
Owner: — FEES _
DONNA JOHNSON Description Date Amount
10240 SW CENTURY OAK OR I nil t l l I Permit Pee 5/19/200 $72.50
TIGARD, OR 972.23 11 AX W',State Surcbart 5/19/2001 $5.80
Phone: 503-084-x952 Total—
$78.30
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97002 REQUIRED INSPECTIONS
Phone: 503-692-5563 Final Inspection
Reg#: LIC 126881
This permit is issued subject to the reoulatic,ns contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All wort, will be done in accordance with approved plans. This permit will expire F ,ork is
not started within 180 days of issuance, or if work is slispended for more than 180 days. ATTENTION: Oregon law
requires you to'ollow rules adopted in the Oregon Utility Notification Center. Thosn rules are set Orth 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 fay: _L yyL ;�Ck— Permittee Sic nature: �7�
Call (51)3) 639-4175 by 7:00 !'.M. for inspections needed the nex business day
- 11111114111111111
May I `I rl4 1 P: A(la Fit-at t ng 503-691 -6855 P. 1
of 19"
Mechanicril Permit Application
/ x.. Datereceived: Permit
City of Tigar4-1r.k_. Prokxtlappl.no.: Expiredate:
f
Cir o /'i b-urd Address: 13125 SW Hall Blvd,Tigard.(lit )7223
y Phone: (503) 639-4171 bate issued: By: Rccoiptno.:
Fax: (503) 598-1960 Cuse file no.: Payment type:
Lard use approval: Building permit no.:
wr-1 &2 fam.ly dwelling or accessory U CommerciaUindustrial U Multi-family O Tenant improvement
I_► New c.mstruction D Addition/alteration/mplacement O Other:
Jr:!,adnc�,_ss. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suitc no.: value of all mechanical materials,equipment,labor,overhead.
Tax mup/tax Io(/account no.: profit. Value S
Lot: Block: Subdivision: *See checklist for important application information :Ind
Project name: '—__ jurisdiction's fee.schedule for residential pr_rmit lec.
City/county: T1 d zIP: y q _ 31111 11 1
Description and Tocation of work on premise,;. Rallmlillatill1 l
_ Fee(es.) Total
Est.date of completion/inspection: . - r y-p t/ Dt�scn on _ Ra.only Res.only
Tenant improt anent or change of use:
Is exi:.tiug space heated or conditional?0'i es U No Airhandling unit —..CFM--
trcnn ttomn a 1e,p an rrqu re, ) CL
IS existing space insulated?U Yes U N.I 1e_r_a -o,-of air I�sti'n`g IIIAU sys tcm
PollEf COI 7pressors
State boil)r lsermil no.:
Business nat::c�! �,mtj�� �.fZ/��%� LLG _
HP Tons BTU/Ii
Address: irdsmo a dampers/duct smoke detectors
City) Swtc: /L Z1P: �J ;AG t pump(site�7iiin iequ ro1�
P.aoue:je92-551x3 I-ax: /_ E-mail:_ TnStrallTrepTi urnac urner i3TQ71T
CCB no.: Including ductwork/vent liner U Yes U No
/ZUdf'8� nsta 1 rep acelre ocatc cater --suspended,
City/metro lic.no.: ��� wall,or floor mounted
Name(please print): p --vent forappliance oterthan furnace
1 e einu on:
Absorptionunits,__,��T h'u'll/11
N;une:�CeJ7j _�•�11;�{j�'= - -- _ Chillers_ _, Fill
Address:VIfI'Yl/ S Corn m%sors._— Hf'
��� st menta a rust a vent too:
City: Slate: I`1I'. Appliancevent _
Phone Fax: 1_bj5 E-mail: erex taus!T
s.Type res. .le en azmat
hood rim suppression system
Name: _ �� �c,hn-_��In _ Exhaust fan with single duct(bath falls) _
Mallin address:/p;/yp C e� tea l3xhaust s sterna art rrom7reat n-I g or AC
tx pl � ttA v u to outlets)
City: State: oit_ ZIP: y Z T _1-I'Ci NG p Oil
YPc� —
Phone: ;� Fax F.-mail ucl i ringcac additionalover outlets
crmpiping(schematicregn1r )
Numhcr of outlets
Name:- _. —� Otherg.s�1e�i appi a�nce or equTpneot:
Address: Decorative fireplace
City: State: ZIP: _ Y nserl-ty:ie
Phone: I E-mail: Woo I i pelletsilove _
Applicant's signuture: Date:
Not all iI rtadknan snepl credit cards.pirate,call Irrisdicdn,An mom Information. Permit fee.....................
_
tom— U MasterCard Notice:iris permit application Minimum fee................3 •yti
expires ira permit is not obtained Plan review(at %) $ _
Credit card number,._-- ---_ _
_�__-
.x res within 180 days xner it has been Slate surcharge(8%)....$
`—N�cmdhnlder u abrwn on credit earl � accepted as comple a. TOTAL ............ .........S
Cardhutdet sigoauim --- _Amount 4404617(&M/COM)
May 19 04 12: 30a Shambur6 Heating 503-691 -6855 P, 2
P
9hamburg HaaUrvj U.,:
PO Boot 829
TuWalln,OR 9706 •0829 (Y _
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f
CITY OF TIGARD 2JH
BUILDING Inn Line: (503) 639-4175
INSPECTION DIVISION BLine: (503) 639-4171 MST
BLIP
Received __--- - ;late Requested _ AM --.__-_ PM _--_- BUPLocation _—� _C _Ce-� `� '' _ ✓quite ---- -- - EC ;200 - oo2g5
Contact Person 10% Ph PLM
Contractor_ _ ___. __-_ Ph
SWR _ ---------
BUILDINGTenant/Owner -_ - -__ -____ _� ELC -
Footing
ELC
Foundation _
Access: D� � �+�� �d--,T�- ,•�.
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �� f SIT
Post&Beam -- `►_'_�, _-�f�'nG !h __
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear --
Framing
Insulation �,� ,�/Z -�� � _
Drywall Nailing ----
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - -
Root
Other:
Final
PASS PART FAIL ---------- - -- -- -- ----- -- -
PLUMBING
Post& Beam — -- -�-�--- ----- ----
Under Slab _ _—`—
Rough-In ----------- - ---
Water Service --- - ---_-
Sanitary Sewer
Rain Drains —
Catch Basin/Manhole
04009
Storm Drain - -- -
Shower Pan
Other: - ------- - - --
Final —
P FAIL _ ------— -- -- --4E-CHANICAV
m y
Rough In e"�' - ---�. _ ---- - ---
- -
Gas Line �0.) +0 ye
Smoke Da"$erst,_SQt ---
A_SS i PART FAIL -
TRICAL
Service -- -- ------- _ --.
Rough-In __...------- ------ — - -- -- - -
UG/Slab
Low Voltage - —- ----_� - �_`--- -- --
Fire Alarm
Final Reinspection fee of required before next inspection. P at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE _ Please call for reinspection RE: Unable to inspect-no access
Fire Supply—:in—e'
ADA Date �, / Inspector `��
Approach/Sidewalk -- "'�---�
Other
F f . I DO NOT REMOVE this Inspection ecord from the job site.
PASS PART FAIL