11125 SW 123RD PLACE 11125 SW 123"' Place
CITYOF TIGARD __ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00025
13125 SW Hall Blvd.; Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/2.2'03
PARCEL: 1 S134CB-09200
SITE ADDRESS: 11 125 SW 123RD PL
SUBDIVISION: ANTON PARK ZONING: R-7
BLOCK: LOT- 054 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATEh3: VEP IT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTFtvIS:
STORIES: BOILERS/C%"^PRESSORS FLOODS:
_ FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LNG — 3 - 15 HP: COMML. �NCIN:
MAX INPUT: RTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP- REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 _AIR HANLLING UNIJS
----
FURN —1 O1„ER UNITS:00K BTU. <= 10000 cfm: G
> 10000 cfm: AS OUTLETS:
Remarks: Rep;ace gas furnace.
Owner: — ---- -- __ - ---- --FEEL
BATEMAN, CRAIG i_+ BONNIE .1r AN M Description Date Amount
11125 SW 123RD PL --� --�-- – --
TIGARD, OR 97223 IMEC'III I'Aillit I�cc 1/22/03 $72.50
[TAX]8%StatcTax 1/22/03 $9.80
Phone: --Total $78.30 --
Contractor:
COLUMBIA HEATING + C. )LING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
i;eating Unt Insp
Phone: r,..4- 704 Final Inspection
Reg#: LIC 76359
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws, All work will be done in accordlaoce with approved plans. This permit will expire if work is
not started within 180 days of issuance. or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow niles adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: � _ Permittee Signature: /
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day "- 1
1!'Iechanicai'Permit Application
Datereceived:� _V� Permit no..tjI aQp3„ S
City of Tigard Project/appl.no.: Expire date:
1i4,,r Addre53: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: fay: Receipt no.:
Fax: (503) 598-1960 rase til'.no.: Payment type:
Land use appro%al: Building permit no.:
Effm Wil 1011
U I & 2 family dwelling or accessory U Commercial/industrial f-1 Multi-family U Tenant improvement
U New constru.aion �6Additioti/alteration/replacemciit U Other:
t '
Job address: / i `teL- Indicate equipment quantities in boxes below. Indicate the dollar
Bidg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no,: profit.Value$
Lot: Block: I Subdivision: *See checklist for important application information and i
Project name: jurisdiction's fee sch,dul: for residential permit fee.
City/county: ZIP.. t r
illj
Description and locatfon of work on prem-es 1 1 1111 N t
I It P 30
Vee(ea.) 'Total
Ihycri rtion
Est.date of completion inspection: �L—_.—
Qty. Res.oid Res.only
Tenant improvement or change of use: 1�—
Is existing space heated or conditioned?U Ycs U No Air handling unit Ci
Air condi uoning(site,plan required) -_--- --_--
Is existing space insulated?U Yes U No Alteration of existing HVAU system
o er compressors
Business name: � S'au:boiler permit no.:
_� CAA _ HP __Tons BTU/H
Address. j0 ��� hire smo c amper act smoke detectors
City: _ State: I L F 92/ Neat pump(site plan require
Phone:4,24, 7 7 py I fax _ Ef,ail: nits rep ace urnac urne
Including ductwork/vent liner Yes U No X
CCB no.: -L 3 ."S 9 nsta rep ac re ocate renters-suspen ed
City/metro lic.no.: /4 7 A _ __ wall,or floor mounted
Nance(please print r 177,'-c A p r- enc fora ianc•e of er t an urnace
Refrigeration:
CON'I'Al-V PERSON /�- A morption units BTUAI _
Name:_ PAM QA /b�� Chillers _= HP
Address: Ctmr ,ressors _ HI'
___ — ------- n ronmenta ex ust an Yfnt at on:
Pity. State: ZIP: Applioncevent
Phone: I'n ,j F marl )ryerex aunt --
t —floo s,Type res.kitchen azmat
hood fire suppression system
Name: syr, Exhaust fan with sin le duct(bath taus)
Mailing address: `7P ,
x ousts stem a art tom eat n or
Swte: ZIP: _"
uanout ets)
City: ` / ._ eT LNU __-- NO -- Oil •
YPe
Phone: I E snail: ue I in eac t—i ad id tionuf over out ets
TM rocaapiping(sc emat crequire )
N.:mher of outlets
Name: ter llstR appliance or equipment!
Address, Decorative fireplace
City: State: ZIP: _ Insert-tyEe --
Phone: Fax: E-mail: oo atov_pe et stove
Other:
Applicant's .signature!�' Date: /• ter:
Name (print): __
Nor all Judwllcaont accept credit c",please call itifixtiction forme Information. Permit fee.....................$
U visa U MasterCard expires
This permit application Minimum fee. ..............$
expires if a permit is net obtained Plan review(at _ %) $
Credit coil number:_ — within 11x0 days after it has been
rrp ret Y Slate surcharge(9%,) ....$ �
—lNtmte or crihal�er a shown on credit c S accepted asst complete.
TOTAL .......................$ 78.W
-- Cordholder trauma Amouar 4404617(6ANCOM)
CITY 017'PtGARD 24-Hour
BUILDING Inspection Line: (503) 639 4'175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received —DateRequested— BUP
Location ,Ad L, —Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
-BUILDING Tenant/Owner ELC
Footing az ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain - SIT
Slab Inspection Notes:
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shoar
Framing
Insulation
Drywall Nailir 3
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Root
Other:
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhola
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
SS RT FAIL
LEG I RICA
.Service
Hough-In
UG'Slab
Low Voltage
Fire Alarm
Final Rollroppcdon be of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
pAss PART FAIL
_411ft— Pkmw call for reinspection RE --- F-1 Unable to inspect-no access
Fire Supply Line -12
Lie C4
ADA 4�tfl � _-�
Approach/Sidewalk Aor 77
Data. per
Other:
Finil DO NOT REMOVE this Inspection record frorh the job site.
I . .;,,, _-_PAF11 FAIL
CITY OF TIGA►RD 24-Hour
BUILDING Inspection Lime: (503)639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BLIP
Received _ Date Requested— I AM_ 1-
_. FM BLIP -
1 f . 1 �� �L
Location 5 � -
Suite MEC
Contact PersonPh( ) –c; 76 PLM _-
Contractor Ph SWR
BUILDING Tenant/Owner _ ELC
Footing ----
Foundation Access- ELC -
Ftg Drain ELR
Crawl Drain
Slab Inspection Nu(t)s: SIT
Post&Beam --
Shear Anchors -- _
Ext Sheath/Shear
Int Sheath/Shear - -- - -
Framing - - —
Insulation -
Drywall Nailing _
FirewallFire Sprinkler -
Fire Alarm - -
Susp'd Ceiling - — ------_.__
Roof - - --—�
Other:
Final
PASS PART FAIL
PLUMBING 1 • /`�4PF► �� � ----
_c� InSE' I rP —
Post& Beam r t -----
Under Slab _w keye TI re- S4
O 1J'S
Rough-In --
Water Service �( �
Sanitary Sewer 1 -
Rain Drains -
Catch Basin/Marn,-;e "
Storm Drain -- ---- -
Shower Pan
Other: -----
Final
PASS PART FAIL
ME_CH_ANICAL
Pn• 8 Beam - ---------__-- - ----_---- -- -
Rough-In
Ga,i Line --
S;no4Q(tampers
(fin-A) - - ----- -- ---
PASS PART FAIL - - --- _- _
ELECTRICAL -
Service - - ------- -_ ----.-
Rough-In
UG/Slab -- - - _
Low Voltage
Fire Alarm ----
Final
PASS _PART FAIL L-� Reinspection fee of$_._._ _-required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITEupply Line_ Please call for reinspection RE: ❑ Unable to inspect-no access
Fire S -
ADA O d
Approach/Sidewalk Dab----- Inspector—
Other. - -- Ext -...--
Final — _ DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL