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CITY OF TIGARID BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line, 339-4175 Business Line: 639-4171 — —
BUP _
.-------..---Date Requested AM_ PM BLD
Location &LZ( G },<� rc ' 1� Suite -- --- MEC
�.
Contact Person Ph PLM
Contractor! Ph SWR
BUILDING --- Tenant/Owner ELC
Retaining Wall -- - - ELR
Footing Access. y�
Foundation !1 1 C(C� FPS -
F'g Drain
Crawl Drain In, Not Requested _ SGN
Slab -- Found During Research -- SIT
Post 8 Beam -
Ext Sheath/Shear No Insnectim►(s) In vile
Int Sheath/Shear
Frarong A-
Insulation -
Drywall Nailing
Firewall - -
Fire Sprinkler
Fire Alarm —
Susp'd Ceiling -
Roof -- -
Misc:
Final - - -
PASS PART FAIL
PLUMBING _
Post& Beam M --- -
Under Slab
Top Out -
Water Service
Sanitary Sewer - -
Rain Drains
Final --� ----
PASS PART FAIL
MECHANICAL --------- ------------------ ---
Post& Beam - -- - - --- -- - -----
Rough i
Gas Line -- _ . ..--- ------- --___-.-_. -- ---
Smoke Dampers
Final --- -- -• �__ _
PASS PART FAIL
ELECTRICAL -
Service _
Rough In - - -- -
UG/Slab
Low Voltage - - --
Fire Alarm
Final -
PASS PART FAIL
SITE -
Backfill/Grading -- - ----
Sanitary Sewer
Storrs Drain [ ] Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply I the ` )Please calx for reinspection RE _ _ — — [ J Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date --__ Insnc-ctor Ext
Final � ----v---
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD MECHANICAL_
DEVELOPMENTSERVICES PERMIT
ESUMM 13125 SN Hall Blvd., Tigard, OR 97223 (503)639.4171 PERMIT #. . . . . . . : MEC916-0360-7'
DATE ISSUED: 10122196
PAr_-EL: 2SI1IZIDD-01500
SITF. ADDRESS- - 1.0405 SW CENTtr.RY OAK DR
c RF ZONTNG: R-7
I V.1 S I uN. �"UMMF- I E L.1)
BLOCK. LUT. . . . . . . . . . . . . :122
CLASS OF WORK. . : REP FLOOR I`URN. . . . : 0 E:-VAP COOLERS- 0
TYPE OF' USE. SF LR\111' HF-ATFRG. . : 0 VENT FANS. 0
OCCUPANCY GRP. . -Al VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 1301L.ERS/COMPIRESSORS l.-JOODS. . . . . . 71
FUEL. 0-3 HP. 0 DOMES. INCINz 0
3-15 HP. . . . : 0 COMML. INCIN: 0
MAX I NPU T- izi B TU 15-30 1 it . . . . : 0 REPAIR UNITS: 0
FIRE DAMPIERS% . . 30--50 HPI. . . . .. 0 WOODSTOVES. . : 0
GAI." PRESSURE. . . 504 HP. . . . : 0 CI.._0 DRY1.-RS. . : 0
E
NO. OF UNITS--._.__-.-._..___.. AIR HAt.DL_TNG UNITS OTHER UNITS. - 0
TURN ( 1001J, BTLJ- 1 1.0000 (--fill : it) GAS (:OUTLETS. : 0
FURN ) =10CAK BTU: 0 > 1Q7.100�A cfln : 0
Remarks : WORT! Ohl FURNOCF
Owner,: FEES
BETTY K'NGSBURY type amoi..tnt by date r-ecpt
10405 SW CENTURY OAK DR PRMT $ 25. 00 TAT 96-285481
5PCT $ 1. 25 TAT !O/C-2/96, 96---.P5481
i'TCARD OR 97224
Phone it:
ontt-actat-:
CONTRACTOR NOT ON FILE
1:11-ione #: 26. 25 TOTAL..
Reg #. . .- REDUIRFD INSPECTIONS
This permit is issued subject to the regulations coi,tained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within 184 days of issuance, or if work is suspended for tore
than 180 days.
I lev-m itt ee Si gr�Ai 1V)F1
issi.ted By :
_41
;all for insppction 639-4175
Plan Check 0 _
CITY OF TIGARD Mechanical Permit Application Rec'd By_ —
13125 SW HALL BLVD. Commercial and Residential Date Recd _
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Permit
Print or Type Called
Incomplete or illegible applications will not be accepted
— —�— Name of Development/Prured Description —
f ---- Table 1A Mechanical Code CITY PRICE AMI
iJoh Street Address sutte0 A) Permit Fee -0- -o- 10.90
Address 11- 105 SW Cent.ury O I3hld I'I _
stdgp CtryrStata zip B) Supplemental Permit 3.00
_ ard Or 97224 _ --
-- Name(or name of buttress) 1.) Furnace to 100,000 BTU 600
Own
Vaallriincl.duds&vents , Loo
oo
r �� i n�raht��/ -- —
Maibng MCreu 2.) Furnace 100,(109 STU+ 7.50
t 1 incl.ducts&vents
rttylstete ziP Phone 3.) Floor Furnace 6.00
Ind.vent
r
— ►�raIM41 r11 u�business) a) Suspended heater,wall heater 6.f10
Same floor mounted heater __—
Occupant Mal"AddAddress 5) Vent not Ind.in 3.00
ctyrstme I-P 6) Boiler or comp,heat pump,air cond 6.00
—� - to 3 HP;absorp unit to 100_K BTU _
_-- Nrne --�-- 7.) Boiler o•comp,heat pump,air cond. 11.00
2VT(. IM': 3.15 H-';absorp unit to 500K BTU
Contractor Maw'g Address 8) Boiler or comp,heat pump,air Gond. 15.00
LV SSV 1 9 )1 e1 15-30 HP;absor unit.5.1 mil BTU
Attach copy of Cty1su to zip Phone °.) Boiler or comp.heat pump,air Bond. 22.50
Current Licenses $eaYeX} Dn (lR 'a 117--h--7241 30-50 HP;absorp unft 1-1.75 mil BTU --
Oregon ronst.Unt.Board Lk 0 Exp Dale 10.) Boiler or Tromp,heat pump,air coed. F4,
on file 91104 14111 7 >50HP;absor_unit1 75roilBTU
COT INninssa Tax or Metro 0 Earp Dare 11 ) Air handling unit to 10,000 CFM
Architect Name 12.) Air handling unit
_10_000 CTM
or Me"Address � 13) Non portable 4.50
evaporate cwler
Engineer
ClrylStme zip Pnorm 14,) Vent fan connected 3.00
to a single dud
Describe work New O AdI O Alteration Repair O �- 15) Ventilation system not -yv 4.50
to be done Residential p� Non-residential O included in appliance permit
Additional Description of work -- 16.) Hood served by
mechanical exhaust 450
17) Domestic incinerators 750 --
Residential _ _r
F�n9 use of R 10) Conxrlerdal oindustrial 30 00
building or r-operty_iie,cLidpi1 i a 1 -- type incinerator --_ 4 5O
19) Clothes dryers,etc —
Proposed use of 20) Other units 4 50
building or property -�
Type of fuel-oil Q natural gas 0' LPG O electric O 21) Gas piping one to four outlets 2.00
1 hereby acknowledge that I have read this applkmtion,that the — 22) More than 4-per outlet (each) .50
information given is correct,that I am the owner or authorized agent of _
the owner,that plans submitted are in compliance with Oregon State QTY.SUBTOTAL
Lows
signature of ownerdAgerlt Dabs / .SUBTOTAL ba
6%SURCHARGE
aj
Contact person Name PLAN REVIEW 259E OF SUBTOTAL
( a x t �i4 i yt►�„) / _TOTALr-
CIAD
t doc "Minimum permit fee is$25+5%surcharge
Rev 7 �I_
U 1'r Y (jf- i 1 UpIRI) — 1.1 s.+ 11--,1 (it Pf� t YMI•_N I kF_C.k:I I"I NO.
CHECK AMOUN t'
NNMF. x B R r (':)AS Sh RV i l;E frit"' CASH AMOUNT
EIM?l�Rk 6i !8 SW 14 H (AVS I'i'Y'MN N I DA I E.
{ SL13itIVIr.,I1NN r
BF..AV>T P I ON, OR 971007—
pt it 6-'(ISE. Uh PA YMF N I AMOUN I PAID PUkP0-,1: OF PAYMk-.N 1 FaMC�►.IN I 4!Ga l l�
M (^,EIF1fJ1f;t�Lr.F��. __._..__. �nQ► �+l . RUI:t_D PLP
I
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{
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t04&5 SW 1=,LN'IIJRY ►JHK OR
{ 1 (Irt I'ERMY I 0 MVC96•-001P
I
ro'1•Al. AMULIN I r'NI I)
4
\\ CITY OF T I G A R D —. PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003-00640
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-41 i1 DATE ISSUED: 12/31/03
SITE ADDRESS: 10405 SW CENTURY OAK DR PARCEL: 2S110DD-01500
SUBDIVISION: SUMMERFIELD ZONING: R-7
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair water main.
FEES _
Owner: -
Description Date Amount
FISH, JOSEPH F + ANNIE M — --- --
10405 SW CENTURY OAK DR III MliI Permit I-ce 12/31/03 $72.50
TIGARD, OR 97224 1 A 1 8" �State 12/31/03 $5.80
Total $73.30
Phone
Contractor:
SYMMETRY CONST SERV
19468 NV'J CORNELL
9-7(ay
REQUIRED INSPECTIONS
Phone : :)i0 X1)1+ Water Line Insp
Water Service Insp
Reg #: 1 Ic 1 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR
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 by the Oregon Utility
Noti`cation Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100.
Yo-1 may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699.
' � f
Issued B ` l-mac ��c=--- 9 1
By:
,f L i Permittee Si nature: 1
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
s
.y.
DEG-31-2003 10 :03 AM GENCO MECHANIAL 503 722 4389 P. O2
Bonding Fiztareit 'A :')' i'i 3PIRU
➢lirbibige Per 1l ARD k, DIVI&ON
1lv oYTi�td aw a Mrntittvt.: l lr1�tY OrL 4
119.11w 3(a, at-4,TIpM.DX 9971 W
Phone $03.1SUA171 4■. 503,1P1.11MD t�utwParrtltNa.:
24-l"r bwpaYee l.}na+ 501.004175 Dw Radyf Y rwre It ihi pop for
111irnell ww�+d,1VYdOnw 1Nd lu pkntatalt■r■nratYrr
�r+�1, I 1,�i�i II—�• �II.�_-L�.hll,.i I�I �I�'i,,� � 1. � qr►��_
Ci Ncvr r�MIC111 1 {�DerwliEloet I TOW
■► w oAtt4r4w
L]wJJIUon/attasdoNnyfu+went ❑(AIN. Maw 1.2-faitpNyAlwUf.p(trtelude IM ft.Nell&USIRYor leoeen)
f ,FR(1)batt,
No 1•A11*dwdlltw (3 Ccttamtead/feeutttrfd SPR(1)6aU) 50.01) -
❑ANDY bass - p�1ufn.f+aatfly SFR(>)b.d, 199.00
--- r,,zb additional h■OrArf ob" 45.00
K111tM bu��llde rJ od►.r: (( rhe tQrUtldsr(__oq ft.)
T
Sitrmotlea
Job d'e 1ddrW Vt4n`•-� � �_� Catch tsatn or Ina&'ft'
Drrwn,ta■un unq IN thnch dA:: -
�— -- —L -- FuOn1 drtaln no.11ne.r ft. 1 Part 1
Bit�VbidgJt4+t nD.. �Ptojeet t __ -
,.^_ ---- -- - Aimuaoarrntt>'ctste udlftlw t 10.00 __
Piola4Du:t/ditardoastnlubSUM t7C11G�� _— MAY00)u - T� 1e.60
R1dn Qrdn ettrtnaatar_ 6.40
-- -- Smlftil'Y w wm h+a,IlInW R; hfpe 2 -
- storm e■ww(no.lfnmr Mt J Pop 1 _
TettmopVtodno.
r tion�rlvM lib0 �J
yut'l ` I x. �. ..'. .. I��94 p}' Ci.•1Y j4:1TFt 1.rry,i
L !'vl+� t D.C)r irnvprcvwrta -- Psp i I -
__�1,�,� Balk me,wrd 16,40
G'IDGtaa w►i ar 16.60 _
—.__ _�. ---- -- Dllhwtuh■r .f. �- � Ia40 .�.--�
PAnkm�[bonbon t4•CO _
LAd —
Nuuo t'1 �,-� symomIsr u^L 16 w
P1awd_Mwa a■P
Arirheir w r _
�uty/9utcJziPr - — Flwr dtutdpuci dl>k/tub l6 tF0
I ) Gorhap dioml l6•�
I Fbnac,— ) a-
Q
Ha.bibtun.
BfAlneat tyyt btett+raiptm/crr.a�neU - IQdD
Camuct twtra: 4EL _ Medloal pw MIS !—1 y Pop Z M -
Addrele: Fnmvr
1\`'11L1��v� hoof ttrafn(ertmnwcid) 16.60
9tnlJbvin/Iavatery 16.60
l bum irk rot:i J U 1.) - - —
TuWv%cwv/a)w%w pro )660
3lree1llt
t"61 - .....__,. -15.60
+ ; yl •rtil tE ._._ "(• • Wab closet --16.d0
BeRlren>aCtw Web lt■atrt .� � t0 d0
AdO.hw
rin+IR --
_.
n >f' _ — M4itnum permtc Rx. !'rl,
Pham.( -) -- Pax ( ) Reslde■tu11>edtt «rnnfertu�t_,-�umtt ke hE1! � _
rte• Plan mviow (1114 6(Pe ntft fM)
L()C•D L„ �-jt — Pluu6wd Lie fir.: — --
4t.'c a.mturrj(tM Or=12ft
�Attthoti±M (t•-_ Nh �— �-- _TOTAi-iFA;ITF!!H �1J
Print nitnc^ r llak: f parmR apNlla'!on e:pl,yr It i pirMle letebtalnad within
M
-----_ �1 �.�-- 110 d.yr■ItK h has leen■cogt■d at ssel IM&
•Rac motltodo',ofy.m(by Tri Courtly Itt,tldinj 1?14uatty bervtq
u.nanwr,KorPt,vn+....+.+c-'M. •,r, Ye 441milln'tOww")
11N�"JIL 0 �.iIJ 096tesozoo IVA Prel Cit0E-0C gal
CITY OF TIGD RD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPEC71ON DIVISION Business Line: (503)639-4171
BUN
ReceivedZ— _ &•f-Date Requested.__ le )ASM PM -__—_ _ _ BUP --_
Location _ ;uite ___- MEC _
Contact Person21-- Ph( y71 M 00
��
Contractor __ --- Ph(--) SWR - _ --
BUILDING TenanVOwner _ _. -_ - -_ EL.0 -___ -
Footing EL C
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: - // SIT -- ---- -___
Post& Beam
Shear Anchors -
Ext Sheath/Sheaf
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 Diains - --- -- -- -
Catch Basin/Manhole ,
Storm Drain -
Shower Pan
Final -
PART FAIL
_CHANICAL
Post& Beam ---
Rough-In - ------
Gas Line
Smoke Dampers -------- - -----------__-_-_ —
Final
PASS PART FAIL -------- ---_-----....--_____-- - -_---
ELECTRICAL
Service
Rc::;h-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 f Please call for reinspection RE:___ _ Unable to inspect-no access
Fire Supply Line
ADAr-
`
Approach/Sidewalk Date �� Ins ►ectoT _P._ ---Ext---
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL