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11945 SW CARMEN ST
CITE( OF
TIGA.RD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00561
13125 SW Hall Blvd., Tigird, OR 97223 (503) 639-4171 DATE ISSUED: 9/12/03
PARCEL: 2S 103BD-01700
SITE ADDRESS: 11945 SW CARMEN ST
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: 014 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: BOILERSICOMPRESSOR3 _ HOODS:
FUEL TYPES 0 - 3 HP: !^ DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPU r: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 _ _AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Remarks: Replace gas furnace.
Owner: FEES _
JOHNSON, WARREN A& MARGARET F Description Date Amount
11945 SW CARMEN STy/11/03 $72.50~
T{GARD, OR 97223 [MGCHJ f ertnit i
[TAX]80/o State] 1)/12i0 i $5.80
Phone: 503-590-3705 — ---Total $78.30- ---
Contractor: _
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS__ _
Mechanical Insp
Phone: 284-2173
Final Inspection
Reg #: LIC 222
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 it work is
not started within 130 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 fort{t in OAR 952-001-00
Issued By: /^� Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
.Mijechanical Permit Application ' Mechanical
Datc/13y // 0.j, Pe mit No.:/`fee- r
�-- �'i L.. Planning Approval Building
City of Tigard Daic/By: Permit No.:
13125 SW Hall Blvd. ^)� �) 1 2�(1? Plan Review Other
'Tigard,Oregon 97223 oost-R Permit Use
Phone: 503-639-4171 Fax: 503598-1960'` iP Uate/ y: [And Ute
GateBy: __ Case No.:
Internet: www.ci.tigard.or.us Contact See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method. Sup lemental Information.
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
N
ew construction Dernolitior Mechanical permit fees*are based on the total value of the work
Other: performed. Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 &2-Famil dwellin CommerciaUlndustrial value: S _See Page 2 for Fee Schedule
Accessory Building Multi-Family RESIDENTIAL E-t�UIPMENT/SYSTEMS FEE*SCHEDULE
Description Fee ea. Total
Master Builder Other: _ - Heatin Coouo
JOB SITE INFORMATION and LOCATION Fumace-add-on air conditionin •• 14.00 C'G'
Job site address: \ c\ \, c AN Sr Gas heat puMp 14.00
Suite#: Bld ./A t.#: Duct work 14.00
Project Name: C-,C��� V e f H tunic hot waters stem 14.00
Residential boiler
Cross street/Directions to job site: for radiator or hydvanics stem 14.00
Fj� Unit heaters(fuel,not electric)
\ C: in wall in-duct su nded etc.) 14.00
Flue/vent for any of above) 10.00
Repair units 12.15
Subdivision: Lot#: _ Other Fuel Apt illsinces
Tax map/parcel#: _ Water heater 10.00
DESCRIPTION OF WORK _ Gas fireplace 10.00
\U\ A Ct l C `a �"L,-Y X\('LtR Flue ventwater heater/gas fireplace) 10.00
Log lighter(gas) 10.00
Wood/Pellet stove r 10.00 ^
Woodfire lace/insert 10.00
Chimne /liner/flue/vent 10.00
[tOPERTY OWNER TENANT Other: 10.00
Envirounsental Exhaust&Ventilation
Name: \� `�L� ('t y P� JL%\!\1f�SC^(� Range hood/other kitchen equipment 10.00
Address: c
Clothes dryer exhaust 10.00
t /State/Zi . 1- o k 4� l:' "1 t l Single duct exhaust
Phone:1711'ic -1 L---Is Fax: (bathrooms,toilet compartments,
APPLICANT CONTACT PERSON utility rooms) — 6.80
Attic/crewl space fans IO.UO
Name: — Other: Y1 10.00
Address: — - Fuel PI In
Cit /State/Zl : _**(S5.40 for first 4,51.,00 each addiuonal
-�- Furnace,etc.
Phone: I rax: Y Gas heat
E-mail: _ _ Wall/suspended/unit heater _ ••
CONTRACTOR Water heater
Business Name: 0-VAti=1 !-\-QL1N"' 4 Cczleh. Fire lace
—� Range "
Address: V'St- -J`C �\, BB - ••
Cit /State/Zl : - ' i !L 1\-C( Clothes dryer as
Phone: �g L - \-1 Fax: L�- \t�C, _ Other: _ •'
Total:
CCB L1c. #: t�C�Z 1-Z_ Mechanical Pertnit Fen' _
AuthorizedSubtotal: I S •V V
Signature: ��� �-- \C �lQ Date:�_��� � Minimum Permit Fee 572. 0_ S 5
v_( — Plan Review Fee 251/6 of Permit Fee S
(Please print name) __.__State Surcharrge(8'/•of Permit Fee S
- TOTAL PERMIT FEE S
Notice: 'Phis permit application expires if a permit 1.riot obtainer:within *Fee methodobgy set by Tri-County Building Industry Service Board.
180 days after It has been accepted as complete. "Site plan required for exterior A/C units.
i4l1stsTermit FormatMecPermitApp.doc 01/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP _.
Received ------ Date Requested -_- 1�'.�:7_ __ AM___.___-_ PM—_ BUP
Location �Q"'.,-,ems, 5� - - - ---Suite r _ (EE7c) 3 0 o 5-61
Contact Person _ yiao-r;a _. Ph (-- --) —�g4 - PLM -- -- _—
Contractor - Ph ( .._ ) __
_ SWR ._._- -------_-.—
BUILDING TenanVOwner _- _--- _- _._ ELC
Footing
ELC - --- --
Foundation Access:
Ftg Drain rn kl_v� 4 ELF! ---- - - - -
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors - --�------
Ext Sheath/Shear
Int Sheath/Shear
Framing (�` �:L. rt Z GO L Gtt�•�.��� /L 1��L�# _ _G�` i--
Insulation _---
Drywall Nailing
Firewall
Fira Sprinkler _ - -- -- -- ---
Fire Alarm
Susp'd Ceiling ----
Roof
Other: _-- - ----
Final -Y -'---
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
_ FAIL --- -
ECHANIC
Post& Beam
Rough-In - -- -
Gas Line
S oke Dampers -- --
�ina;
S PART FAIL
CTRICAL _
Service
Rough-In
UG/Slab _ _—.- ---_- --- _-----_..
Low Voltage
Fire Alarm
Final
PART FAIL C Reinspection tee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
SITE _ Please call for reinspection RE: _ [� Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date - _T �� Inspoetor_ Ext
Other: _
Final DO NOT REMOVE this Inspection record from the Jofh site.
PASS PART FAIL