10815 SW SUMMER LAKE DRIVE r
10$15 SW Summer[rake Drive
r
CITY '1�,,, F TIGARD _— nP—ERM T-;-. PERM!T
�� PERMIT #: MLC2003-00007
DEVELCit MENT SER"MCEv DATE ISSUED: 1/9/03
13125 SW Hall B&vd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S133AD-07400
SITE ADDRESS: 10815 SW SUMMER LAKE DR ZONING: R-7
SUBDIVISION: AMART SUMMERLAKE LOT: 118 JURISDICTION: TIG
BLOCK: _ --------
"— — FLOOR FURN: EVAP COOLERS:
CLASS OF WORK: ALT UNIT HEATERS- VENT FANS:
TYPE OF USE-. SF VEN F SYSTEMS:
OCCUPANCY GRP: R3 VENTS WIO APPL: HOODS:
STORIES: BOILERS/COMPRESSORS DOMES. INCIW
FUEL. TYPES 0 - 3 HP:
LF�G
—"- 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTO-VES:
GAS PRESSURE: 50 + HP' CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS.
FURN >=100K BTU: <= 10000 cG: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace a gas furnace — --
FEES _
Owner: _ --
Description Date Amount
SCROGGIN,MAPY LYNN $72.50
10815 SW SUMMER LAKE DR IMLCIIJ Prr,ni1 I rr 1/9/03
TIGARD, OR 97223 I'rAXl x"„S1,11c 119/03 _ $5.80
Total $78.30 _
Phone: 503-431-5401
Contractor:
COLUMBIA HEATING + COOLING INC.
P.O. BOX 230397 REQUIRED INSPECTIONS
TIGARD, OR 97223 ---- — —
Heating Unt Insp
Phone: 624-2704 Final Inspection
Reg#: LIC 76359
This permit is issued subject to the regulations contained in the Tigard Municipal
Clods. This of Ore.
Spill ecialty
pire if Codes
and
ork is
;end all other applicable laws. All work will be done in Lz,00rdance with app plans. � . Orec-n law
1 not started within 180 days of issuance, or if work is tilispNotificdat�on Center more anThos�rules are set foOrth•in OAR 952-001-00
requires You to follow rules adopted in the Oregon Utility
Permittee Signature: - ' � r•; �
Issued By: -- ----- _
Call (5031639-4175 by 7:00 P.M for inspections needed tha next business day 1
Mechanical Permit Application
T Date received: —C' 7
City Of Tigard Project/appl.no.: Expire date:
City ofTigard Addref5: 13125 SW Hall Blvd,Tigard,OR 97223 pate issued. By: I . Rrceipt no.:
(503) 639-4171 �=-
Fax: (503) 598-1960 6 / Case file no.: Payment type-
Building
61 ^�
Land use approval: permitno.:
,
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction ia"Addition/alteration/replacement U Other:.1011 SITE IN FORMATION COMMERCIAL
VALUATION t
Job address: j r - Indir,o-equipment quantibc• 1 n boxes below. Indi 1 11 dollar
Bldg.no.: Suite no.: value of all mechanics'. muter+ais,equipment,labot,o�crhead.
'fax ntap/tax lot/account no.: profit. Value$
Lol: Black: °ubdivision: *See checklist for important application information and
I'rojr.ct name: 'I liction's tee schedule for residential permit tcc.
City/county: ZIP: r
Description and location of work on premises: t t 1
1.?sl.da(c ofcomplet bn/iospection: Description (ttv. Res.only Re".onl�
Tenant improvement or change of use: A °
Is existings ,tee heated or conditioned?U Yes U No Airconditi unit C(FM
�P� A+rcon ltiomng(siteTnrcquired)
Is rxistin)t space inuflalcd?U Yes ❑No Ali-ration of existi„g A system
t :ofmpressors
Business name: State boiler permit no.:
• lLdPl�/aC4>`[- 6 • ^t>)I�, HP Tons I3 rum
Address b d I'I re/smoke ampers/ uct smo c electors 1
City: y''i C, State: ZIP:Q7/, eat pump(site p an r::qu+r�- _
1 hone: Drax E-rr.ail_ nste prep ace urnac urne /
Including ductwork/venr liner U Yes U No
CCB no.: __'24 3 S iista rep ac re ovate. ealcrs-suspended,
City/metro lic. no.: /474._ _ wall,or floor mounted
Name( lea:, In 1111 i /,'',.'e`t o,_ / �� ,/,�i_•��2,-- \ant for a lance other than unlace
a gent on:
Absorption units _ BTU/H
Name”: OA1 /��Q.._4( Chillers__ —_.— -_ HP
Address: Com ressors HP
nv ronmentA exhaust an ventilation:
City: ��_ Stale: ZIP: Appliance vent
Phone; I .IK: Li-mail: Dryer exhaust — _{
0o s,Type res. itc ten t�a1t
Intl im hood fire suppression system
Name: N ` Exhaust fan with single duct(bath"ins)
y, 7 :xTTinust ss ,tem apart sons catu+ or C
Moiling uddres.: G'�i S SK%
Fuelp�g an str ut on(+p to out ets)
City: Stale:C.� ZIP: -. L LPG Nil Oil
YPe
I
Phone: Wax:Fax: E-mail: Fue i ping each additional over 4 outlets
rocess piping(sc ematic require ) _
Naltte: Number of outlets
t er appliance or equipment:
Address: _ Decorative fireplace _
City: State: ZIP: nsert-type
Phone. Fax: E-mail' oo swv pe eIstove
OtTicr-
Applicant's signature: (__ Dale:/-
Name
ale:Name (print): / 12e!2&2 -
Not all jurisdictions wcepi cn dit coda,plena call jurisdiction for more inforn+saon, Permit fee.....................$ _
U Visa U MasterCard Notice:11tis permit application Minimum fee................$
(',rdit card numi>cr .._
expires if a permit is not obtained plan review(at _ %) $ �—
_ ---_---- _. --1---
vitltin Igo days after it has been State surcharge(8%)....$
- -' —` t cce ted as complete.
Num of cardholder u shown on ctir&_Curr P P TOTAL ........................ _
l_ Cardholder sietunt + Amount 4404617(6000rCOM
CITY OF i"1G/11�D 24-Hour
BUILDING Inspection Line: (503)639.4175 —
MST _--
114SPECTION DIVISION Business Line: (503) 639-4171
BIIP _.
Received _____ Date Requested _ U_ AM--- PtA BUP —
Location - Suite_ MECO
Contact Person _ _ _ �� 1 _ Ph( ,) �� �" —a 7U PLM
Contractor _ - - _— -- Ph( ) _ SWR
BUILDING - Tenan 2wne D w ELC
Fcnting 5 ELC
Foundation Access:
Ftg Drain ELR __—
Crawl Drain
Slab Inspection Notes /J SIT
Post&Beam
Shear Anchors
Ext Sheath/Shcar
Int Sheath/Shear
Framingu1 —
Insulation ..���_,'�•—..������c:s �L,��'�'�jC'y1.�,, /�ijl/✓d/C.
Drywall Nailing
Firawall � it ?
Fire Sprinkler
Fire Alarm
Susp'd Coiling �— ---- — -- --
Roof
Other: - -.._—�— --- -- ---
Final --
PASS PART FAIL --PLUMBING
Post&Beam
Under Slab -- - - - ---
Rough-In
Water Service -- --- — — ----- -- - ----- —
Sanitary Sewer
Rain Drains — - ------ — -- ---— -- ---- -------
Catch Basin/Manhole
Storm Drain ------- _ ----,.— — ---- —.�._----------- --------
Shower Pan
Other: _ —_��—_-------- --Final
PASS
PASS PART FAIL
MECHANICAL --__— ---- ------ ----- -- -- - ---_ ----- --- ----- --
Post&Beam
Rough-In -- ---- . - --- - --- -------- - ----- --—
Gas Lina
Smoke Dampers -- _ _ ----— ----.._.— - ---- - - -- -
i1
FTCe
TART FAIL
---- ---- ---- - ---- ---- -------- ----- —
CAL
Service ----- — -------------
Rough-In —
UG/Slab
Low Voltage --
Fire Alarm
Final F] Reinspection fee of$—_ required befire next ins tion. Pay at City Hall, 1312E SW Hail Blvd.
PASS PART_ FAIL
SITE _ 0 Please call for reinspection RE:— � Unable to inspect-no access
Fire Supply Line
ADA f �� f- �
Approach/Sidewalk / J-- clot - --El[t
--
Other:
Final __—^ I 00 NOT REMOVE this inspection record from the Job site.
PASS PART FAIL J