12110 SW 124TH AVENUE 12110 SW 124th Avenue
CITY OF TIGARD 13UILDING INSPECTION DIVISION
24-Hour Inspection Line; 638-417ai
Business Line: 639-.4171 MST _
____-_Date Requested_/() —1 AM BUP _—
Locatioi-�2 L> S w / — PM ---_
_11_." Z �- — •- BLD
�. -�`— ----.--------
Contact Person Suite^� _ MEC el
Ph SGS PLM _
Contractor —
rFoundation
ING — Ph SWR ---
Tenant/Ov'ner -- -'------- _
g Wall ELC
-----Access: — _t"R
nain FPSInspection Notes — SGN
eam ----
Ext Sheath/Shear ~� --�--- SIT _
Int Sheath/Shear -�- - -
Framing 4 - -
Insulation --
Drywall Nailing
Firewall
Fir-)Sorinkler ~- - -
Fire Alarm
Surp'd Ceiling -
Roof _
Misc,
F inal
PASS PART FAIL
PLUMBING "-
Post& Beam
Under Slab - - ----
Top Out -- - - - _
Water Service
Sanitary Se,., - --- - ---
Rain Drains --
Final - --- _
P ART FAIL
---------
EC ANI , — ---------___________
Pos eam -
Rou h� --
jas,Ll
o Dampers
M
S ) PART FAIL - -
CTRICAL - --------
Service ------_-
Rough n
UG/Slr b --`- - --------.__
I cw Voltage ----
Fire Alarm
Final
PASS PART FAIL
SITE — _
Backfill/Grading _ __.-. - -
Sanitary Sewer
Storm Drain [ J Reinspection fee of$
Catch Basin -__ _required before next Inspection. Pay at City Hall, 13125 SW Hell Blvd
Fire Supply Line [ J Please call for reinspection RE:
ADA [ ]Unable to Inspect-no access
Approach/Sldewelk I P
Other Deter - Inspector
Al-
PASS PART FAIL --Ext
DO NOT 11EMOVE this inspection record from the job sits.
CITYOF TI GAR D _ MECHANICAL PERMIT
(DEVELOPMENT SERViI�ES PERMIT#: MEC200000369
13125 SW Hall Plvd., Tigard, OR 9722.3 (503) 639-4171 DATE ISSUED: 9/12/00
PARCEL: 2S 103BB-05100
SITE ADDRESS: 12110 SW 124TH AVE
SUBDIVISION: BROCKWAY ZONING: R-4.5
BLOCK: LOT. 0 1 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOiLERS/COMPRESSORS !FOODS:
FUEL TYPES 0 3 HP: DOMES. INCIN:
GAS 3 - 15 HP: COMML, INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PP.ESSUPE: 50 + HP:
CLO DRYERS:
FURN < 100K 61 1: __AIR HANDLING UNITS
-- OTHER UNITS:
FURN >=1001( BTU <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Gas logs
Owner: — ---- — - ^-FEES
SCHOBEF., JON F AND C RACE M Type By Date Amount Receidt
12110 SW 124TH ST PRMT CTR 9/12/00 $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 9/12/00 $5.80 2720000000
Phone:
Total $78.30
—
Contractor:
REQUIRED INSPECTIONS
Gas Line Insp
Phor e: Final Inspection
Reg #:
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. A TTENTION Oregon law
requires you to follow rulE:s adopted in the Oregon Utility Notification Center Those rules are set forth in CAR
952-001-0010 through OAR 952-001-0080 You may obt� 11 copies of these rules or direct questions to OUNC by
calling (503)246-9189
Issue By: --� Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
CITY OF TIGARD Mechanical Permit Application Plan Check#
p P Recd By
13125 SW HALL BLVD. Commercial and Residential � Date Rec'd
/,
TIGARD, OR 97223 � Date to P.E.
(503) 639-417'i, x304 Print or Type l Date to DST
Incomplete or illegible applications will not be ....;cepted Permit#
Called
- 1Wf D enuPr ject Description
`� Table 1A"Mechanical Code _ _ Qty Price Total
Job Street Address sone a 1) Furr..-ice to 100,000 BTU
incluo+, d ducts&vents _ 14.00
Address _ _ 2) Furnas 100,000 HTU+
Bldg# City/State Z P includinq ducts&vents 17.40
3) Floor Funiace
Name(or name of bu3lness) including vent 14.00
4) Suspended heater wall heater
Owner
or floor mounted heater 14.00
Mailing Address -- - –
> 5) Vent riot included in appliance permit 130
clly�ate Zip Phone --- — -
�.� Q�/ C Repair units _ 12.1._ —_
Name(or name of business) Check all that apply: 'Boiler Heat Air I
For Items 7-10,see or Pump Cond Qty Price I Total
footnotes 1,2 Curr+p
Occulpart Mailing Address 7)<3HP,absorb unit to
100K 011l 1400
Cily(Slate ZIP Phone 8)3 absorb unit
loci k bTU 2560
gill. absorb -- -- —
Contractor Name unit.5-1 mil BTU 3.5_.00
10j 30-50 HP,absorb
Prior to permit Mailing Address unit 1-1.75 mil BTU 52.20
Issuance,a 11)>50HP;absorb unit>1.75 mil BTU
ropy — 87.20
of all licenses City/State Zip Phann 12)Air handling unit to 10,000 CFM
are required if _ 10.00
expired In COT Oregon Const Cont Board Llc a f:P n.+r 13)Air handling unit 10,000 CFM 1.
database 17.20 _—
Architect Name 14)Non-portable evaporate cooler
10.00
15)Vent fan connected to a single duct
Or Mailing Address � — 6.8_0
16)Ventlletlon system not Included in
Engineer CltyrState zip Phone appliance permit 10.00
17)Hood served by mechanical exhaust
— - - _ 10.00
Describe work to be done: 18)Domestic incinerator s
New O Repair O Replace with like kind Yes O No O 17.40 —
Residential O Commercial O Modification O 19)Commercial or Industrial type incinerator
- 69.95
Additional Information or description of work: 20)Other units,inglu ding wood stoves
_u 1/ 10.00
NOTE: For Commercial projects only,Units over 400 lbs.,located on the 21)Gas Oiping one tol6ur outlets 5.40 J
roof,require structural talcs.prepared by licensed engineer.
Type of fuel: oil O natural gas O LPG O electric O 22)More than 4-per outlet(each)
_ 1.00
Minimum Permit Fee$72.60 SUBTOTAL
I herebyacknowledge that I have read this application,that the — —
9 PP o
information given Is correct,that I em the owner or authorized agent of _ ___ S
8 h SURCHARGE x
the owner,that plans submitted are in compliance with Oregon State PLAN REVIEW 25%OF SUBTOTAL
laws Required for ALL commercial permits only _74
+
- TOTAL b'
SlgAatu of b,._,ine41Agpht Date
Other Inspections and Fees:
_ cm _ t Inspections outside of normal business hours(minimum charge-two hours)
Coon,--Na—;e — Phone S72 50 per hour
J JL?7 Inepectlons fol which no fee Is specifically indicated (minimum charge-haif hour)
Zr 9r� $72 5o per hour
Footnotes jiir commercial projects only: J Additional plan review required by changes,additions or revisions to plans(minimum
1 Provide full schematic of existing and propo+ed gas line and pressure charge-one-hatl hour)S72 50 per hour
2 Provide d,awings to scale showing existing and proposed mechanical 'State Contractor Boiler Certification required
units "Residential A/C requires site pian showing placement of unit
I\fists\forms\rmechperm_rev doc 9/8100