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7961 SW CHUk('II[L[.WAY
�� ru CIT OF TIGAR D MECHANICAL PERM!'f
DEVELOPMENT SERVICES PERMIT#. MEC2004-00099
13125 S%V Hall Blvd.,Tigard, OR 97123 (503) (339-4171 DATE ISSUED: 3/4/04
PARCEL: 2S1 12CD-06600
SITE ADDRESS: 07961 SW CHURCHILL WAY
SUBDiVISION: BOND PARK NO. 2 ZONING: R-12
BLOCK: LOT: 046 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: S1 UNIT HEATERS: VENT FANS.
OCCUPANCY GRP: VENTS WIO APPL. VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 3 HP: DOMES. INCIN:
— 3 - 15 HP: COMh"L. INCIN:
MAX INPUT: BTU 15 - 30 HP'
R
FIRE DAI"±PERS?: 30 - 50 HP: O . UNITS:
DS
OTOVES:
GAS PRESSURE: 50 + HP-
C ODSL.O DRYERS
FURN < 100K BTU: 1 AIR H1 NDLING UN115
OTHER UNITS::
F'IRN 100'C BTU: <= 10000 cfm: GAS OU-1 LE I S.
> 10000 cfm:
Ramarks: Replace gas furnace l
Owner: --- — -- _ _FEES
GARY DESA Description Date Amount
7961 SW CHURCHILL WAY 1'%Il?('III I'crmit I'l'l' 3/4/04 — — $72.50
TIGARD, OR 97224
\I '8",.State 314104 $5.80
Phone: 503-970-8534 Total $78.30
Contractor:
COLUMBIA HEATING+ COOLING INC
P.O. BOX 2.30397
8900 SW BURNHAM#E1110 _ REQUIRED INSPECTIONS _
TIGAF2D, OR 97223
Phone: 503-624-2704 Mechanical
Line Insp
echanicGl Insp
Reg #: LIC 76359
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. ATTFNTION. Oregun law requires you to follovv ,�Jes 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 callir q
(503)246-6699.__
Issuad By: _�'1 ilk_- Permittee Signature:
Call 03) 639.4175 by 7:00 P.M for inspections needed the nex Iness day
Mar 114 04 10: 02a PAM DALBY 503-598-0270 P. 2
Medianlcal PermitApplicaation r t
Received Mechanical
RECEIVED
DatelH Permit Norl_�U, L/-pa0
City of Tigard Planning A ru.a! Auildtng
13125 SW Hall Blvd. Dare'L.v Permit No.:
11� Plan Resew
i nthcr
Tigard,Oregon 9223 MAR 4 2Pu4 Date s
_y_ _ Permit No.:
Phone: 503-639.4171 Faax,�Tr503_�9��q(�U Post-Review — Land Use
Inttrnet: WWW.ei.tigard.or. T U I' A 1 L�ete/Hy: " Case No- t
24-hour tnspe,:timt RequfiUIONIlljCAIj %V 510 Contact Juris.: see Paer 2 ter—
`Nam/Method: Su Irmentsl Inforo:xtion,
TYPE OF WORK COMMERCIAL FEE+SCHEDULE-USE CHECKLIST
New construction Demolition Mechanical permit fees*are based on the total value of the work
ddition/alteratioWre P1acement Other: performed. Indicate the value(rounded to the nearest dollar)of all
CATI'sCORX OI CONSTRUCTION mechanical materials,equipment, labor,overhead and profit.
I & 2-FamilCommercial/Industrial Value: S See Page 2 for Fee Schedule
Accesso I3uildin* Multi-Farre - RESIDENTIAL E(�UFYMIENTlSYSTEhtS FEE•SCHEDULE
Master Builder Otter: 4escriptton tv Fee ea. Total
JOB SITE INFORMATION and LOCATION_ HeatintJCooun
Job site address: -� Furnace-add-on air conditionin *• 14,00
fie.' L- _ �1ftdLc • Gas heat pump 14.00
Suite #: I Bldg./A_ptfi: Duct work 14.00
Pro'(;:t Name: _ — H dronic hot waters stem 14.00
Cross streeMrectio- tojob site: Residential boiler
for radiator of h ronic system 14.1110
Unit heaters(fuel,not electric)
(in wall,in-duct,suspended,etc.L _ 14. L
Ftue/vent(for any of above) 10.00
-Lot #:
Subdivision: LRe air units 12.15
Tax map/p arc fl /#: her Fuel A liances
DESCRIPTION OF WORK Water heater Ot__ 10.00
Gas fire lace --' 10.00
Flue vent(water heater/Btu fireplace) I a.ou
Lo li hler as _ IU.OU
Wood/Pellet stove 10.00 _
—` —--- -- Wood fire laceiinsert 10.00
_ _Chimney/linerr(lue/venr ►0.00
PROPERTX OWNER TENANT Other:
10.00 _
Name: �� S.� Environmental Exhaust dr Ventilation
AddreSS: I — - Range hood/other kitchen +uipment 10.00
Cit /State/Zip; Clothes dryer exhaust � 10.00
v
Phone: -1? —f Single duct exhaust
Fah' (bathrooms,toilet compartments,
11
APPLICANT _ CONTACT PERSON utilityrooms
Name: __ 6.80
_ Attic/crawl s ace fans 1000
Address:_ Other:
10.00
City/State/"Lip• — _ Fu _piping -
-- '"S5.4Q for First 4,SI.00 each additiona
I
Phone: Fax: Futnace,etc. ••
E mail: Gas heatpump •• —'
CO�iIIRACTOR _ WalVsus nded/unit heater ••
Business NWater heater - .• -
ame: ��M6Fire lace .• "' ---
Address:_ A P_-- -.._ D �1 Ran e -
iIf�' B--rt
PhO11E:
- Clothes dryer
� hone: Fax: o3 �t_t2s� Other: �" •• -
_CCB Li C. #: _ i'otal:
Authorized �{ D Mac is ieal Permit Fees•
Signature: Q,�r, � _ Date: — Subtotal: $
Minimum Permit Fee E72 SO S
Plan Review Fee t25%of Permit Feet
IPlease print nary cY State Surcharge O,-ofPemiit Fce S
�'oticr: I'+Is permit application expires i(a perndt i.+rut obtain+d within -- TOTAL PERMrr FEF. $ ---
IAT da%s arh r Ir has been accepted as complete. Si methodology set by xterl oanry Bails. Industry Ser•..,e Bos
rd.
t'Dsts\Permit+-nrmsNecPeratitApp doe 01103 ' Site plan required for cr tenor,Vt'units.
E
(CITY OF TIGARD 24-Hour
BUILDING Inspection Linc:-: (503)639 4175
INSPECTION DI'JISION Business Line: (503) 639-4171 MST
Bt1P - --------
//.,,, l�'r
Re^e�ived __ - -_-_- Date Requested Z/,— �,3 �_ ._ ! AM.. _ PM _ _ ____ - BUP
Location G M1=c — Z�_�_�.
Contact Person _ -- Ph(— ) _ i�! JkM .__----------
Contractor_ - Ph( ) — -_- _- -- SWR -_-_
BUILDING Tenant/Owner _ -_ _ _-_ ELC
Footing
ELC
un Access:
Ft Drain ELR
Crawl Drain
Slab Inspection Nates: / - SIT
f'ost&Beam - - - - �➢ 1 �S /,
9,hear Anchors —--
i:xt Sheath/Shear
Int Sheath/Shear ^
F-amin9 - --- —_
lm ulation
Drywall Nailing ----- - — ---- —
Firewall
Fire Sprinkler 09= — —
Fire Alarm
Susp'd Ceiling 1-
Roof
Other: —
Final
PASS PART FAIL
PLUMBING
Post&Beam i — ------ _ ---
Under Slab — - ------ — "-
Rou;h In
Wetnr Service ----- 411 —
Sai,,tary Sewer
Rain Drains 7,,'- ' - --
1-71
Catch Basin/Manhole
Storm Drain ---- -
1,71
Shower Pan
Other: —�-
Final ---^---
P RT FAIL
ECH_NICA
Pos i'8t39Trr
Rough-In
Gase QarnDers � f.� }
Fi al
PART FAIL ---- -- --- ----
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltae
Fire Alarm' ~
Final SS Reins required before next in.+Reinspection tee of$
ASS t?AHT - a peCtion. Pay at City Hall, 13125 SW Hall Blvd.
— - F-1 Please call for reinspect ^ RE:_ —� Unable to inspect-no access
Fire Supply Line
ADA Ext
Approach/Sidewalk Date ` _ Inspect ar _C`~ -
Other..
Final - �^ DO NOT REMOVE this inspection recor from the job site,
PASS PART FAIL r