11120 SW 109TH AVENUE n.+
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1112 SW 109"" AVFNUE
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CITU' OFTICARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST
INSPECTION DIVkSION Business Line: (503)639-4.171 BUP ---
` Date Re nested-- / I'Sr --AM-_ -PM _--_._--_ BUP _
Received ___ q _ L.-
`
Location . MEC�' --L-b-�- -
Contact Person
_ Ph( ) - -------- PLM
Ph ) ----- SWR -
lontrar.',or
Tenant/0
_ ��! 7 7eELC _
' rBUIl.DING r - - _
Footing ELC
r;lrndation I Access:M� ELS -
Ftg Drain
Crawl Drain - SIT
Slab Inspection Notes:
Past&Beam �---_ -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear -
Framing
Insulation
Drywall Nailing -
Firewall ~
Fire Sprinkler J
Fire Alarm --.--- - -
Susp'd Ceiling
Roof
Other
Final
PASS PART FAIL
PLUMBING _ -- -- -
Post&BPjm— �.-_ --- -
Under Slab -
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole - -
Storm Drain _
Shower Pan -
Other-
Final _ ___-`---
Final
PASS PART FAIL
--
Rough-in --' -
Gas Line -
sTq,e Dampers
PART FAIL
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 FAILUnable to inspect - no access
SITE ,� Please call for reinspection RE: -__-- r--
Fire Supply Line
ADA Date
ApproacYSidewalk
Other: _
Final DO NOT REMOVE this Insp,ectioli record from the��site.
PASS PART FAIL I
CITY OF TIGARD MECHANICAL PERMIT
®E v ELORN NT SERVICES PERMIT #: MEC2003-00382
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/9/03
PARCEL: 1 S134DB-04800
SITE ADDRESS: 11120 SW 109TH AVE
SUBDIVISION: CARNAHANS ADDITION ZONING: R-4 5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
T1'1 E OF USE: bF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: P.3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERSiCGM_PRE_SSORSHOODS:
FUEL. TYPES _ 0 3YHP: 1 DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU '15 -. 30 HP:
FIRE DAMPERS?: 30 - 50 HP: WOOD.
UNITS:
.:fOVES:
G,1%S PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K t3TU: --- AIR HANDLING UNITS
OTHER UNITS:
FURN x=1001K BTU: <= 10000 cfm:
>
GAS OUTLETS:
10000 cfm:
Remarks. Installation ofa c will
Owner: _ FEES ^v
KRISTEN CAREY Description Date _ Amount
11120 SW 109TH AVE N 11 (]111'crnut Pcc 7/8/03 '^ $72.50
TIGARD, OR 97223
7/8/03 $5.80
Phone: 503-908-5840 Total _ $78.30
Con'.ractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS __.___
Phone: 503-234-7331 Cooling Unt Ins[)
Final Inspection
Reg #: LIC 1441
This permit is issued subiect 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, ATTENTION. Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 thrcugh OAR
952-001-0100. You may obtain -,opies of these rules or direct questions to (,)UNC by calling 1
(503)246-6699. /
Issued By: �1 Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
.,Li4 - 03 - 03 09: 25A P .02
It I
ME'C!dlliCal TIeI .jit AppliCatiOD ReCC1ved Mcclienical ?8''9-
--- nata� . permit NO.:
1-
Planning Approval B.0ding
City of'Tigard patelDy: —_ Pemtit No.:
13125 SW hall Blvd. Plan Review Other
: Permit No,;
l)ute/B
Tigard,Oregon 97223 Y --_—_
Post-Rcvicw Land Use
Phonc: 503-639.4171 rax: 503-598-1960 r•■sc_No.:
1.Internet•. www.ci.tigard.orma Convect �r h See p■gc 22 T.r
1.4-hour Inspection Request: 503-639.4175 Nume/Mnthod — 'I i� Su Icmental Iurnnn■tiun.
TYPE OF WORK ',COMMEliC:1Al•..FEE°•SCIl MULE`='USE iC1HECKLIST
Ncw constructionDemolition Mechanical permit fees•tire based ort the total value of the work
Addiliot�/altt:ration/rcplacen�t:nt other: - performed. Indicalc the value(ruunicd to the nearest dollar)of all
'CATEGORY OF celiacCO I2UCTIOt mechanical materials,equipnment,labor,ovcnccud and profit.
Value: S See Page 2 for I�cc Sclu•dule
2 Famii dwcllinS Commercial/Industrial -
ArCesso Buildin Multi-erci ll -- RESIDENT1ALi:QIII PMh:NT/SYSMMS FEE`SCIICDULE
L__._ g ---� _Descrtptiun -C1ly Ncc(ta.) I Total
�] Mastcr Builder _ iC)thet: _—_ — ucAttrtg/t:oaul
3018 Sl E�LNFORMATION and LOCA' [-- Runtac� xdt!•on air cnnditlonin)++ 14.00
Job site address: ��yir�1— Cius hent pump -_ - 14.00
131d ./A t.#: Duct work -- 14.00 _
Shite;W; _ _�. �— --- H dror c hot water system _ 14.W —
Project Nalne: —__ --- Residential imilcr
Cross strceUDirccdoil 'v joh itc: for radiator or hydropic ttystcm�- 14.00
Unit heaters(fuel,not electric)
in wall in-duct nuspcnded,etc.), _ 14.00
Fluelvcn,(for M of above 10.00
Repair units 12.15
Subdivision: _-- - - - Lot ll: Other CIA Ilan fee
.------- - - — Water(seater +^ 10.00
Tax map/parcel# _ -_-. ---
+j!(�C : 97.1
S 1M'IC N'c)^t' (lR7C _ _� _�, Or+fire�lacc _ IA 00
flue vent(wfter he■tcrdeas nrcpl■ce) 10.00 _
-- --- --- --- - _
LoiL Uhler as 10.00
----_._- —.---.---.. —- WOod/Pelict stove 10.00
Wood tiro lacclinsert ._ 10.00
-'" J fV � Chimne /liner/(1ue/vent. 10.00
E F,R " a TENANT Other_ 10-M
_E
RE --� Kovirouutentel Lihoult&Ventllalloh -----
ame: • Q 11 Rengc hood/other kitchen equipment 10.00
Add-ass: 1 ...� L — C:lothcs Ar;rer exhatist 10.00
Cfly/'Sl8te/ZI ��_ � 1—.. Single duct crhwist
PlIgne. Fax: _ _ (bathrooms,toilet cc:mparrmenim.
T LIC T C' TACT PERSON uty roorrms�_ 6.80
Attic/cruwl Apace Mnr. I0 W
Nome:
Fuel riplatt
- �% (-'.�^'I!��\ —•-- - •• 3.If a Ont 4_51.00 each addlltonal
Cil /State/?
• I�aX: Furnace,etc.
Pharic: _ J_ _ ass heat pump
E-mail: _ Wnll/sugpendcd/unit heater
CO '!'Itf�"TUIi ' Water heater
I _- -
13uyincss Name: c ( _�� r , -• -�.` Fireplace -
Ran�
Address: L-I'-��i `t.. tom, .�J�.,.,� 1;• z aBt�_ --- .. _ —.
('.ity/State/Zip: � t l� �'� �'�'1 .��=� r� Clothes d r uy _ °°•-- •
Othcr:
"Co!al --
CC13 I_.1C. #: \ �.-�_ — Mechmlcil Pernilt F°n• � _
Aulho _ subtotal: s—
5igrtat - _ Minimum Permit l'cc 572.50 S
Plan Review Fee(2S%of Pemtit Fee) S
--" - (Please print panic r ---Q.,
_ _--- State Surchazge(8°�i of Permit Fee S _
TOTAL rE IT FLE _
Notrcc: This prrrttlt application expires H■prnnh Is nay ol�tr,lnrd n :F"methadolalp set by Trt-County Nutldrne tndu°t (1 —
Is0 days after 11 has born ateopled as csmplcle. •Site plea re�ulrrd for eeterlor A/C unite.
tDets\pemdtFowm\Mccpm*LApp.doc uirrtt
Jul -03-03 09: 25A P.03
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