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11665 SW 114'�' Place
CITYOF TI GA R D _MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00438
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-41 71 DATE ISSUED: 12/5/01
SITE ADDRESS: 11665 SW 114TH PL PARCEL: 1 S134DC-01100
SUB;')IVISION: 114TH PLACE ZONING: R-4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT' FANS:
OCCUPANCY GRP: R3 VENTS W/O APDL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: COMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMMERS?: 30 - 50 HP: REPAIR UNITS.
GAS PRESSURE: 50 + ftp: WOODSTOVES:
FURN < 100K BTU: 1 _AIRHANDLING UNITS CI.O DRYERS:
FURN >=100K BTU: T _ <_ 10000 cfm: OTHER UNITS:
> 10000 Cfm. GAS OUTLETS:
Remarks: Replace gas furnace.
Owner. FEES
NESEN, MAURA S Type By Date Amount Receipt
11665 SW 114TH PL PRMT CTR 12/5/01 $72.50 272001000C
TIGARD, OR 97223 5PCT CTR 12/5/01 $5.80 272001000C
Phone: Total $78.30
Contractor:
FIRST CALL HEATING & COOLING
1650 NE LOMBARD
PORTLAND, OR 97211-4798 _ REQUIRED INSPECTIONS
Heating Unt Insp
Phone:231-3311 Final Inspection
Reg#:LIC 102030
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work Is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Noofieat+orn Center. Those roes are set forth in OAR J52-001-0010 through OAR
952-00 -0080. Ydu may obtin copies of these rules or direct questions to OUI�C by calling
f�if? .17
Issue �" /
y� � Permittee Signature-
Call
Call (503) 64-4175 by 7:00 P.M. for Inspections needed the next business day
Mechanical Permit Application
Y -- � --- �� Daterea�ived:/R ��' Permit
Cit ®f Ti ilrd Project/apol.no.: Expire date:
City oj7igard Address: 13125 S% Hall 31v Tigard,OR 97223 Date issued. By: Receipt no.:
Phone: (503)639-4171001
Fax: (503) 598-1960 ��� ` Case file no.: Payment typ::
Land use approval: CITY t�E'TIG AR� Building permit no.:
TYPE OF
0-1 8+ 2 family dwelling or accessory U Conimercial/indust ial U Mul;i-family U Tenaw improvement
U New construction 1 Additiordalteration/replaccment U Other
JOB SITE INFORMATIOON
.Job address: ji9l Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$ —
Lot: Block: Subdivision: 'See checklist for important applicatiin information and
Project name• jurisdiction's fee schedule for residential permit fee.
City/county:
Description and location of work on premises: 4- -L c/ tWt I010111kfol Ilaim
' , -- r= I-ee(ea.) TOW
list.date of compleUon/ins tion: Desciriptilm Q1y. Res.only Res.orth
Tenant improvement or change of use: '
Air handling unit --CFM--
Is existing space heated or conditioned?U Yes U No
Is existing space insulated?O Yes U No r conditioning exi(sue planCsrequired)
P i erauan o existing system
otr Tmpressors
Business nawmn : 'i , `c / ! r it< 7State boiler permit no.:
HP Tons__—BTU/H
Address: t �' ( k), C i smo a ampe duct smoke electors
City: , Stated ZIP:�r 1 eat pump(site plarequired)
—
Phone`_2 t r .�- l.4 • Fax:.? " E-mail: nste�repTacefurnace urner_ fi
OM
Including ductwork/vent linei es U No
CCB no.: /� r Hata rep a rc rxateheaters-suspen ,
City/metro lic.no.: /t g < wall,or floor mounted
Name(please print): i. ✓cni fur a i fiance other thun furnaceONTACT PERSON —
e en on:
Absorption units BTU/H
Name: Chillers._ _ ,___ HI' `
Address: Com ressors III'
Ay ronmenta ex atatts &W-Ventilation:
City: — —"- ate: ZIP: Apphance vcnt
Phone: Fax: E-mail: ryerex aust
Hoods,Type res. itc c azmat
hood fire suppression system
Name: / c - C �' , Exhaust fan with single duct(bath fans)
Mailing_address: i/G j, T :x ff
tems art rom eatin or A —
City: „ r , State: LIP: ---_� Fuel an str rut on(up to out ets)
TyLI'(; NG _, Oil
Phone: f.x: E-mail- uc t in each additional over out cls
rocets p p ng(whcmauc•required)
Name:
of oullels _
—.— _— — t erllstedipp ince or equ p1 ment:
Address: Decorative fireplace
City: State: ZIP:
Phone: F z: &mall.' «��stwr pe et stove Other:
_—
Applicant's signature Uate:
Name (print): L:i ,a .�� —__— _=._ 1=:L]
Not alt)uridictiow alto credit cads,pMane call)atdictiun for mae inffnmion
UV-ha U MasterCard Notice:This permit application '011nimum fee................S —.
Credit cad number_.........._.—_--- .—--- ,��_ expires if a permit is not obtained Plan review(at _ %) $
— ki%pire, within 180 days after it has been State surcharge(8%)....$
dro
—� N—�calder ru jl non cr till cad accepted as complete. ,
Cadhol��er i'trutae --- —Anmuoii—j 110-611(60WOM I
CITY OF TIGARD 24-Hour
JIUILDING Inspection Line: (503)639-4175
INSPEO TION DIVISION Business Line: (503)639-4171 MST -_
BLIP -
Received Date Requested- - AM- -PM_-_,-'" BLIP
Location . /�� i/7 ` Suite ___ MEt;
Contact Parson . l � -_ Ph(--) -2 Ll-7 S PLM -
Contractor - _ Ph(-) -- Swil -�
BUILDING Tenant/ wne,_1'}'1�s�1s � '�. ELC -�_- —
Footing �� 2G 5�! ���
Foundation C('e ELC
Ftg Drain ELR
Crawl Drain _
Slab Ins p ction Notes: SIT -_
Post&Beam
Shear Anchors ----
Ext Sheath/Shear
Int Sheath/Shear ----
Framing - - --- - ---- _ -- - `--- ----- ---- - -
Insulation
Drywall Nailing ---- - - - - -------- - ---- - ----- ----------
Firewal!
Fire Sprinkler - ------ ._. --. - ------- ---- - -_._ -- -----
Fire Alarm
Susp'd Ceiling -- - -- --- ---- --- ------ ----
Roof
Final
PASS PART _FAIL
PLUMBING
Post 8 Beam - -__-------- -----------
Under Slab -_.-_-- ------ -------
Rough-In -
Water Service -------_ -...... -- -------------
Sanitary Sewer
Rain Drains --------
Catch
----- --_Catch Basin/Manhole
Storm Drain -- ----- ._ - ------- - - --- --- -- -
Shower Fan
Other: -
Final -
_SS PART FAIL
MECHANICAL
Post&Beam
Rough-In --
Gas Line
Smoke Dampers --- ---- ---------- --- - --
P PARTFAIL -- - ------------ -- ----- -_-- --
ELECTFi-^.AL_
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
SITE Please call for reinspection RE:_-. _ _ --- Unable to inspect-no access
Fire Supply Line
ADA l
Approach/Sidewalk Date--__/ O Inspodor_ Ext-__-
Other:
Final - - - DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL