14780 SW 91ST AVENUE-3 14780 SW 91`' Avenue
CITY OF TIG,ARD MECHANICAL PERMIT
PERMIT#: MEC2002-00592
DEVELOPMENT' SERVICES DATE ISSUED: 12/19/02
13125 SW Hall B:vd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S1 1 1AD-14901
SITE ADDRESS: 14780 SW 91ST AVE ZONING: R-4.5
SUBDIVISION: MALLARD LAKES JURISDICTION: TIG
BLOCK: LOT: i)15 _ —
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.TYPES0 - 3 HP: DOMES. INCIN:
—--~
I IDG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 1.5 - 30 I-IP: REPAIR UNITS:
FIRE DAMPERS'?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: — GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas insert and gas piping.
FEES
Owner: —
DON BRADLEY Description Date Amount
14780 SW 91 ST AVE til l'I I I'rrmit Fcc 12/19/02 $72.50
TIGARD, OR 97224 I ` statcTax 12/19/02 $5.80
Total $78.30
Phone: 501-634-1919
Contractor: --
GAS CONCEPTS & CONSTRUCTION
P.O. BOX 86232 REQUIRED INSPECTIONS
PORTLAND, OR 97286 _
Gas Line Insp
Phone: 50.1-098-4996 Mechanical Insp
Reg#: LIC 133149 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or it work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: :�•i. / ; i Permittee Signature: C , !,� 1 l lt✓{ t
Cali (503) 639-4175 by 7:00 P.M.for inspections needed the next business day
Mechanical Permit Application
IDatcreceivedv.14 /i '! rmitno.:!> +5
^ City of Tigard Project/appl,no.: Exp c date:
City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE-OF PERMIT
❑ 1 &2 family dwelli.-g or accessory U Commercial/industrial ❑Multi-family U Tenant improvement
❑New construction J Additiolt/alteration/replacement J Odic? _
O; SITE INFORMATIONaSCIIEDULE
Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tux map/tax lot/account no.: profit.Value$
Lot: IBlock: Subdivision: *See checklist for important application information and
Project name: ,jurisdiction's fee schedule for residential permit lcc.
City/countyi-v vin7l •LIP: al
Description and I ation of work on premises: 1 111 Est.date of completion/inspection: IN-wription " Res.onlyRe
Tenant improvement or change of use: q1IVAC:
Is existingspace heated or conditioned?U Yes U No Air handling unit CFM
•P Air conitloning(sire Vlan required)
Is existing space insulated?U Yes U No Alteration o existing HVAC system
o cr compressors
c , _ State boiler permit no.:
Business name:
FIP Tons BTU/H
Address: 0,C), y90,CD Z�_) rc smo c amper uct smo a etectors
City State ( ZIP: C-) 2 cal pump(site plan require )
Phone: Fax: I E-mail: Installfreplace furnace/burner—
Including ductwork/vcnt liner U Yes U No
CCB no.: -� ` � nsta rep ac re ocate heaters—suspendc
City/metro lic.no.: _ __ wall,or floor mounted _—
Name(please print): -, 1 ; I 11 ' ' 1 ent for] r lanceot erthan furnace
Refrigeration:
1 Absorption units-_ HTU/I I
Name: ) 1 _ 1 r l Chillers --- HP -
Address: �" t( l�y Com ressors�
Environmental exhaust an ventilation:HP
City: State: '1.11': Appliancevent
Phone: Fax: E-mail: hycrex aA
0o s, ype rex. itc en azmat
hood fire suppression system
klm r I A cu Exhaust fan with single duct(bath fans)
Mailing address: C' ( x taust system a art from heating or
AC
city: State W I ZIP: Q _2: Fuel piping an str ut on(up to 4 outlets)
Type. _ LI'G _. I NO Oil
Pltonc - < I-ax: E-mail: uc i in i each additional over 4 outlets
roces�p
ping(scematicrequire )
Number of outlets
Name: _ ter listed appliance or equipment:
Address: Decorative fireplace •
City: state: IIP: Insert-type —`
Phone: I E-mail: oo stov pc stove
UI lcr:.-
Applicant's signator 1 I I i lt' A1e _ ter;
Name(print): —
Nnt d))udr6cnadl nccep etedil cads,plena ce11 IuNAdklian it*mare Infnrm..on Permit fee.....................$ 5 0
U Visa U Maotetcor.l Natice:This permit application Minimum fee................$
expires If a permit is not obtained Plan review(aly — %) $
credl card number: _ ——� 1 -- within ISO days alter it has been -- c —
'plrc' State surcharge(896)....$
--Name of cuhoid r�r uew
3hn on c cw3--_ s accepted as complete. TOTAL $
Amount 1104617(WOOCOM)
CITY Cr. - -aARD 24-Hour '
BUILDING Inspection Line: (503) 639-4175 MST --
INSPECTION DIVISION Business Line: (503) 639-4171 BLIP
Received .—__ __—, .— Date Requested__ 1 3 AM—- —PM BLIP BUP
l �1 `�—Suite
Location _� f
Contact Person -
'hC.— — Ph PLM - —
(
Contractor
Ph —) SWR
Tenant/Owner ELC -
BUILDING --
Footing - ELC -
Foundation Access: EL R
Ftg Drain
Crawl Drain — SIT -
Slab Inspection Notes:
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:—
Final _
PASS PART FAIL
PLUMDrNG — - -
Post&Beam
Under Slab -
Rough-In — -- --
Water Service
Sanitary Sewer - -
Rain Drains -- - - -
Catch Basin/Manhole
Storm Drain
Shower Pan —
Other:----_..------
Final
PAS RT FAIL_
MECHANICqA
Post& -n — --- ---- ---
Rough-In
SmFars �� —----.---. -------- ---- - -------
P/+RT =AIL — - —- -
ELECTRICAL ---- ---—
Service —
Rough-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 Unable to inspect-no access
SITE E] Please call for reinspection RE: — ❑
Fire Supply Line
ADA Dg% -� �? -- Inspector Ext _
Approach/Sidewalk
Other: .__
f=inal DO NOT REMOVE this Inspection record from the jab site.
PASS PART FAIL