12475 SW 127TH AVENUE ADDRESS:
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CITY OF TIGARD BUILDING IN'SP'ECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - ---
BUP _
11 D r� Date Requested_ AM PM�<-_ BLD
Location 7 S Z�:,I �G 7 . r/ �k- Suite _ _ MEC
Contact Person t' Ph a 0 Z16-77(PAI) PLM
Contractur Ph 5'Z( e/C) (A 01) SWR
BUILDING Tenant/Owner ELC
Retaining Wail _ ELR
Footing Access: 7
Foundation . 31` �. � FPS
Ftg Drain _
Crawl Drain Inspection Notes: SGN
Slab _-��/(/!'s� — -- SIT
Post&Beam J
Ext Sheath/Shear
Int Sheath/Shear
Framing _ P`7, %
Insulation V -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
Mitir.
(Final
PASS PART FAIL --- —_
PLUMBING
Post&Beam --- �
Under Slab
Al
Top Out - — -- - -- -
Water Service J C
Sanitary Sewer _
Rain Drains
Final -- -� — -
PASS PARI' FAIL
MECHANICAL _ -- - - -`
Post& Beam
Rou h In
s in-
Dampers
Fj
PASS ,PART FAIL
ELECTRICAL --- - -- - --` �- - -
Service
a Baugh In
CX UG/Slab
Low Vo;tage
Fire Alarm
r=- Final
J PASS PART FAIL
SITE -- ---�-- -----
Bar;kflll/Grading - - -
SF nitary Sewer
Storm Drain ( J Reinspection fee of$ requ red before next inspection. Pay at City Flail, 13126 SW Hall Blvd
Catch Basin Please call for reinspection RE
Fire Supply Line ( J p �___ _____ J 1 Unable to inspect -no access
ADA
Approach/Sidewalk
Other Date ` Inspector T e - Ext
Final
PASS PART FAIL_ DO NOT REMOVE this Inspectio-v record from the job site.
P,
CITY OF TIGARD MECHANICAL_
DEVELOPMENT SERVICES FERMI"r
FSE.RMIT #. . . . . . . : MEC98-032:9
13125 SW Hall Blvd., Ticard,OR 97223 (503)639.4171
DATE ISSUED: 08/07/98
PARCEL: 2SI04AA--00510
SITE ADDRESS. . . : 12475 SW 1.27TH AVE
SUBDIVISION. . . . : BEI-1-WOOD ZONING: R-4. 5
BLACK. . . . . . . . . . . LOT. . . . . . . . . . . . . :O54 JURISDICTION: TIG
-----------------------------------------------------------------------------------
CLASS OF WORK. . :OTR FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP'. . :R3 VENTS W/O APPl_: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL TYPES------------- 03 HP. . . . : 0 DOMF9. INCIN: 0
• 3-15 HP. . . . : 0 COMML_ INCIN: 0
MAX INPUT: 0 BTU 15-30 HP. . . . 0 REPAIR UNITS- 0
FIRE DAMPERS?. . : 30--50 HP. . . . 0 WOODSTOVES. . : 0
GPS PRESSURE. . . : 50+ HP. . . . 0 CLO DRYERS. . : 0
NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : 0
FURN ( 100K BTU: 0 10000 cfm : 0 GAS OU"rl-ETS. : 1.
FURN )=100K B-rU: 0 > 10000 cfm : 0
Remarks : 'Idd gas pipinq for existing fireplace.
Owner: FEES
JERRY SCHOFFSTOLI_ type Amol-trit by date reept
12475 SW 127TH PIRMT $ 25. 00 GEO 08/07/98 98-308108
TIGARD OR 97223 15PCT $ 1. 25 GEO 08/07/98 98308108
Phone #:
rontract or: ----------------- ---_---__--_
OWNER
$ 26. 25 TOTAL_
Phone
Reg #. . : 000000
-------- REOUIRFD INSPECTIONS
This nersit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, Stott of Ore. Specialty Codes and all other Final Inspertion
applicable laws. All wor, will be done in accordance with
approved plans. This pervit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAP, 952401-60I6 through DAR 952-661-0880. You say
Ln obtain copies of these rules or direct questions to OUNC by calling
>_ (903)246-9187.
Issi-ie BY:
Permittee Signati.tre :
..........................................4...4...........4++4•.............4...
Call 639-4175 by 7:00 p. m. for, inspections needed the next business day
..........4....................4.................................. ..........�+++++
OF O
Addi-css:
N L_ 7
Issued by: _ -- —--- Date:
1859
Statement: Information Notice to PropertyOwners
About Construction Responsib'lities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
cants who are not gistered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licenser
architect and engineer applicants, exempt from registration carder ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in
the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
. I own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
F13A. My general contractor is
(Name) Contra,.-tor regis. .
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Cort,actors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
a
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
V) name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Propert wners abo C ns ruction Responsibilities on the reverse side of this form.
LIJ
(Signa(u rmit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By -
312,5,SW HALL BLNID. Commercial and Residential Date Recd _
TIGARD, OR 97223 Date to P.E.
(503) 639-4171 , x304 Date to DST
Print or Type Permit#1;1Fll`rin'U
Incomplete or illegible applications_will not be accepted Called -
Name of Development/ProjectrA
esCrjption
— able 1A Mechan!„al Code _ Qt Price Amt
Job Street Address sines ) Permit Fee 10.00
! L22)
Furnace t./100,000 BTU
Address 5 -5(-v (�_ inclur ng duc+s&•tuts 6.00
Bldg# City/State zip Furnace 10C,OriU BTU+
A/(� �?)23 ir.cluding ducts&vents 7.50
Name(or name of business) t Floor Furnace
Owner J<fdfx �,Sllc�I t includingvent — 6.00
4) Suspended heater,wall heater
Halling Address
5 11 7' or floor mounted heater _ 6.00
,2� �_ _ 5) Vent not included in appliance permit
Cit /Stale Zip Ph no 3.00
.��. S�v — _
1 - �4�K'� n 7��3 HU) CHECK ALL 'Boiler Neat Air
-- Nam (off' r name or business) THAT APPLY: or Pump Cond Qty Price Amt
Comp _
6)<3HP,absorb unit to
Occupant Mailing Address 100K BTU —G..00
7)3-15 HP;absorb unit
Cly/state Zip Phone 100k to 500k BTU 11.00
8)15-30 HP;absorb
_ — unit.5-1 mil BTU 15.00
Contractor Name 9)30-50 HP;absorb
unit 1-1.75 mil BTU 22.50
Prior to permit Mailing Address 10)>50HP;absorb unit
issuance,a copy >1.75 mil BTU 1 37.50
of all licenses CRY/Stale Zip Phone 11)Air handling unit to 10,000 CFM
are requirerl if 4.50
expired in COT Oregon Const.Cont Board Lic# Exp Date 12)Air handling unit 10,000 CFM+
database 7.50
Architect Nome 13)Non-portable evaporate cooler
4.50 _
or Mailing Ade;ess 14)Vent fan connected to a single duct 3.00
15)Ventilation system not Included in
Engineer Cny/State zip Phone appliance permit 4.50
16)Hood served h;mechanical exhaust 1I
4.50
Describe work to be done:
17)Domestic Incinerators
New 101- Repair O Replace with like kind: Yes o No O 7.50
Residential O� Commercial O 18)Commercial or Industrial type Incinerator
30.00
Additional Information or description of work: 19)Repair units
4.50 _
20)Wood stove
4.50
21)Clothes dryer,etc
4.50
,-� Type of fuel oil O natural gas PGO electric O 22)Other units
4.50--
V1
.50
`" 23)Gas piping one to four outlets
I hereby acknowledge that I have read this application,that the information 9
F— given is cor ,that I am the o e 0ao edagent of 2.00
J the own t plans subm h Ore pn mate I A. 24)More than 4-per outlet(each)
z'
.50
Slgnat oi/ r/Agent Data —
L1 Minimum Psrmit Fee$25.00 SUBTOTAL P`'
W — —
J
5%SURCHARGE
Contact Person Name Phonr. PLAN REVIEW 25%OF SUBTOTAL
Required for ALL commercial permits only
--- TOTAL �rP
'State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
I lmechperm doc rev 07/20198