11375 SW LAKEWOOD COURT CA
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CITY 'Ir TIGARD BUILDING INSPECTION DIVISION MST
24-Hot rection Line: 639-4175 Business Line: 639.4.17}}',,����'' n -------
G 4"U,''.,5�LIP __ __
Date Requested �` >_. `-I AM___ PM _� BLD
Louatien
A75
SSW (�� x.11 .�C_ �� Suite :�EC �I Q'
Contact Person QLI Ph _ /C� " `_7 , _
Contractor — Ph _ SVVR
BUILDING w Tenant/Owner _ C
Retaining Wali -
Foo;iny Access: � �" _^ ----- --
Foundation rr. ,�/ � r ./tet, /'.
,�" _ FPS _
Fig Drain SGI�
Crawl Drain Inspection Notes: ---- ---
Slab _ S1T
Post 6 Beam -
Ext Sheath/Shear d ' t7� L
Int Sheath/Shear -
Framing
Insulation ' --
Dryrvall Nailing
r•r wall
Fire Sprinkler --____--
Fire Alarm
Susp'd Ceiling
Roof
Misc: -- -- - - ----- - - -
Final
PASS PART FAIL ---.---- _--- —_ ____
PLUMBING
!pest& Beam -- _... - ----- - --
I Linder Slab
f,,f,Out
Water Service
Sanitary Sewer
Rain Drains
Final
Nq$S-- -Py4kz FAIL
Post&Beam
ough n
(—IT—fine -
'ampers - ---
F A5 PAR r v FAIL
77 EC RICAL - --
�erVlce
f;ough In - ---- -- ----- __
LIG/Slab
Low Voltage —
Fire Alarm -- - _-- __---
Final
PASS PART FAIL
SITE
Backfill/Grading - _---
Sanitary Sewer
Storm Drain I RPinspectlon fee of`F _ -_required before next inspertion. Pay at City 1-'911, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I IPI^asr,can i r reinspection RE ____ [ j Unable to'.napect no access
ADA
Approach,Sidewalk
Date I _ InsPector-_kJ&I ExtvW
Other - - - -- -- � '�
F nal
PASS PART FAIL DO NOT REMOVE this inspection record from thc, job site.
CITY Of Ti G A R e MECHANICAL
DEVELOPMENT SERVICES P E R.'I I T
PERMIT #. . . . . . . : MEC98-0501.
13125 SW Hall Blvd, Tigard,OR 97223(503)639-4171 DATE ISSUED: It /(jG/`_38
PARCEL: 1Sl3,4AD--01E0V*
SITE A00RES9,. 11375 SW LAKEWOOD CT
SURD I v I S I ON. . . . : ENGLEWOOD ZONINIO: R-4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . .. . JURISDICTION: TIS
Cl ASS Oc" WORK. !ALT FLOOR FURN. 0 EIMP COOLERS-, 0
TYPE OP !15E. - - ;n` UNIT HEATERS. . V':-_NT F'FINS. . . : 0
OCCUPANCY SRF. , :R3 l; NTS W/O APDL: VENT SYSTEMS: 0
STORIES. . . . . . . . ' 0 BOILrDS/COMPRE5SORS HOODS. . . . . . . : 0
FUEL. TYPES---- 0-13 HP. . . . : IZI DOMES. INC'TN: 0
3-15 HP. . . . : "N COMYR... INCIN- 0
MAX I NPUT u BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS'1. . : 30-50 HP. . . : 0 WOMSTOVES. . : I
GAS PRESSURE. . . . 504 HP. . . : 0 Cl....n_ DRYERS. . : 0
1\10. OF AIR HANDLING UN T TS OTHER UNITS. -. 0.
t..-URN ( 100K BT11- 0 t= 10000 (_-Fiv : 0 GAS OUTLETS. : 0
F*URN > :=100K BTU- 0 > 10000 ctm: 0
Rema, Ks : Install new woodstavo insert into already existing fireplace
Owner: .- - --- FEES
MIKE REID & JAN REV3 type amos-ini, by date reept
11373 SW LAKEWOOD CT PRMT $ 25. 00 ,ISD It/06/98 96--310621
TICARD OR 97223 5PCT $ 1. 25 JSD 11 /06/98 98-310621
Phone #: 590-4593
Contractor-
R & 1) INSTALLATIONS
5246 SE 62ND
:6. 25 TOTAL
PORTLAND OR 97206
p
774-7142
Reg 95236 REQUIRFI) INSPECTIONS
I *Ihis perm. is issued subject to tne regulations contained in the Woodstove Insp
Tigard Municipal Code, State o! L-ire. Specialty Codes and all other Final fn--pectic'n
applicable laws. All work will he done in accorev,cp with
approved plans. This permit will expire if work is not started
within 180 days of issuiince, ur if work is suspended for more
than 160 days. ATTENTICIN: Oregon law requires yiu to follow rules
'adopted by the Orel. Utility Notification Center. Those rules are
set forth in LIOR 952-001-0010 through OPr 952-00V-P80. You may
obtain copies of these rl!!;i or direct questions to OUNC by calling
(503)246-9187.
Permittee Signat i.tre -_130—'
4++++++++++++++++++•+++++++++-F+++++++ .....i-++++1++++-F•++++++4...............1-+++
Call 63`3-i 175 by 7:00 p. m. for inspections needed the next h�_isiness dad,
......... .........4-++++++4-+++.�+++_j .................................4 4-++-+++4
i1_
CITY OF TIGARD Mechanical Permit Application Recd Plan Cha ho 9-
13125 SW HALL BLVD. Commercial and Residential Date Rec'd_ l i�--
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type Permit#-ZL- Ca -O��r'1
Nemaoroe�eopncomplete or illegible applications will not be accepted called - �
Der,cription
Table 1A M.chanical Code_ City Price Amt
Job Street ddress SuRe# - A) Permit Fee _ 10.00
Address II r7 Sw L- -CwkvA C}• 1) Furnace to 100,000 BTU
I(IL!udin ducts 8 vents _ 6.00
Bldg# Cay/state zip 2) Furnace 100,000 BTU+ ---
i
_
114aka 9 7.)�t 3 including ducts&_vents _ 7.50
- -Name(or name of buelnass) - 3) Floor Furnace
Owner 1y1,ki t- 3cL- Re-,cL includingvr • - 6.00
Mailing Address Ji Suspended neater,wall heater
or floor mounted heater _ 3.00 _
a-bov 5) Vent not included in appliance )ermit
City/State Zip phone _ 3.00
510- -fT1-5 CHECK ALL �- 'boiler Heat Air
flame(or name of business) THAT APPLY. or Pump Cond Qly Price Amt
_ Comp
Occupant Ma,ing Address J --v -- 6)<T116 BTU
unit to
_ _ 6.00 _
7)3-15 HP,absorb unit
City/state Zip I Phone 100k to 50Uk BTU _ _ 11.00
8) 15-30 HP,absorb
Contractor Name - unit.5-1 mil BTU --_ 15.00
9)3U-50 HP.absorb -�1.�
1•n4al:aL,V1 un.t1-1.75 mil BTU _ 22.50
Prior to permit Mailing Address Nd 10)>56HP,absorb unit
issuance,a copy . is (pa >1.75 mil BTU _ 37.50 _
of all licenses v' Zip Phone 11)Air handling unit to 10,000 CFM
are required it c nc* 9 730 77y- 7110-- / )_ ___ - 4.50 _
expired in COT Oregon Conat.Cont Board Uc.# Exp.Dat G 17.)Air handling unit 10,000 CFM4
database 15"t3 ao / /1199 7.5_0
Architect Name �' �' 13)Non-portaL,-�evaporate cooler -�
4.50 _
C Mailing Address 14)Vent fan connected to a single duct
_ 3.00
15)VentJatlon system not included In
Engineer CRyfS(a(e _z r Pho„P appliance permit _ _ 4.50 _
16)Hood served by mechanical exhaust
Describe work to be done: __ 4.50
17)Domestic incinerators
New O Repair O Replace with like kind: Yes O No O _ 7.50
ResidentiEI jK Commercial O 18)Commercial or industrial type incinerator
30. 0
Additional Informat;^n or description of work: 19)Repair units
Tins+'.li l ac,A 4.50
t.XIX�S�GJ�, I P'l 'vt lr 20)Wood stove -
calv{udy- ex�s+�►+q �irRPlaGc- 21)Clothes dryer,etc. 4.50
4.50
Type of fuel• oil O natural gas O LPG O electric O 22)Other units
4.50
I hereby acknowledge that I have read this application,that the Information 23)Gas piping one to four outlets
given is correct,that I am the owner or authorized agent of _ _ _ _ 2.00 _
the owner,that plans submitted are in compliance with Oregon State laws 24)More than 4-per outlet(each)
Signature of GvwerlAgent- v Date �-
Minimum Permit Fee$_25.00 _SUBTOTAL
Y _ i - 5%SURCHARGE 7
Q tact Pr rson Name Phone - PIAN REVIEW 25%OF SUBTOTAL
Required for ALL commercial only r
.j a h ROCIJ `j`1r^ `1:' `l 5 --- -� TOTAL 7
'State Contractor Boiler Certification regjired
"Residential A/C requires site plan showing placement of unit
I lmechperm.doc rev 07/20198
CITY OF TIGARD _ MECHANICALPERMiT
PERMIT u: MEC2004-()0276
DEVELOPMENT SERVICES
DATE ISSUED: 5/13/2004
13125 SW Hall Blvd.- Tigard, OR 97220 (503) 639-4171 PARCEL: 1S134AD-01600
SITE ADDRESS: 11375 SW LAKEWOOD CT
SUBDIVISION: ENGLEWOOD ZONING: R-4.5
FLOCK; LOT: 056 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
3TORIES: _ BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= '10000 cfm: GAS OUTLETS: 1
> 10000 Cf in:
RP, Install gas line to 1lrver.
Owner: _ i_ FEES---- _ _
JIM GIBSON Description Date Amount —
1 1375 SW LAKEWOOD CT �tl r I I I'crn,it I rr 5;13/2001 $72.50
TIGARD, OR 97223 I I.� „Slaic SI,I L h,rt 5/13/2002 $5.80
Total $78.30
Phone: 503-597-24W
Contractor:
SUBUR,i/kN@HOME
6014 NE 112TH AVE,
PORI LAND, OR 97220 _ REQUIRED INSPECTIONS
Gas Line Insp
Phone: 5(13-257-5438 Final Inspection
Reg #: 1 IC 143335
This permit is issued subject to the regulations contained in the Tigard Mur'^ipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done'n accordance with approved plans. This permit will expire If work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or dirert questions to OUNC by calling
(503)246-0699.
Issued�j�: / (�-1�+ 1 11� Permidev Signatorp: —
Call (503)639-4175 by 7:00 P.M. for inspections needed the ne%t business day
10/03/00 TIT t ,:59 FAX 503 598 1960 CITY OF TIGARD IM002
Mechanical Permit Applicaflon
Date received: Permit no.:
City of Tigard V AY '101 Project/a pl.no.: -_XRTMdatc:
City of'Tigard Address: 13125 SW Hall Blvd.'figard,OR 97223 Date is B ecei
Phone: (503) 639-417i .,i i y tri i iGARi.: y P tno.:
Fax: (503) 598-1960 At{lptmf31F,N(41R1f.FCase fil- .,: Payment type:
Land use approval: - Building permit no.:
;1 &
2 family dwelliWIor accessgry--' C3 Connnercial/industrial U Multi-family J Tenant improvement
OW construction _ U Addition/alter;tion/replacement U Other:
1
Joh address: \\ r ' Indicate e,,tji.mens quantities in boxes below,Indicate the doll:,,-
Bldg.
oll:,,Bldg.no.. Suite no. value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Vilue$ -1 -ov .
Lot: —�Block�S_ubdivAior:- 'See checklist for important application information and
Project name: jurisdiction's fee schedi le for residential permit fee
City/count;` S'Q ZIP: q1 L3 .+
Description and location of work on premises: -_-_.- INll_
C.6&s. Uwa q� !p ry+-�rt1 Z -_- Fre(va.) Total
Est.date of completion/inspection: Description (L. Res.only Re•i.nnly
Tenant improvement or change of use: r
Is existing space heated or conditioned'1 U Yes O No Air handling unit
Is existingspace insulated"O Yes U No con iti3 oning(die plan red tired _
Pi A tcration of existing HVAC sysmm
Bol cr/compressors
Business name. State boiler permit no.:
Ill? __Tons__RTUAI
Address_: nIkA Tari- t __ Fire/smoke ampers/ductsmokcdetectors
City: ;tate: Zll',c:� 1��� cat pump(site Tan require
- - ---
� _- nstal/re ace furnaceTurner U/H
Phone: -2. �; Fax:�q gJJb E-moil: P
-- Includirg ductwork/vent'iner U Ye.,U No
CCB no.: ( 33 _, nsta replaceire ocate heaters-suspende ,
City/metro lic.no.: wall,or floor mounted
Name(please print): ---- ---- Ventf�or a pp�Lance other an-?urnacu
Re6•ge�ration—
CON i-ACT PERSON
Absorption units -__._. BTIJ/11
Chillers HI' --- -
Address: Compressors fill
qty NCity. ,�- `� ronmenta�hauyt and yc- nit ation!
_ �� � State- ZIP: °,I-I:ZZb Apphancevcnl
Phone: 'Z�1 S`t3g, Fax: 943p iu tuall: ryerez aunt�. - -Hoods.Type 1111hes.kitchen/hazniat
hood fire suppression system _
Name: G,,v3S Exhaust fan with single duct(bath fans) -
Mailing address: 1 ��S w i Tpi Fng-sn apart from eating or ti
City: -� State:pia Zfp. -I Fncl p ping and istr button G to 4 out ass)
- �--- Type: LPG _..� NG Oil
Phone:G Entail: Fuel tin each trona over outlets
rocest piping(se sematic required)
Name. Number of outlets
___- titerl)Ste ail p�iance or cyn pi m�nl:
AddRss:_ Decorative fireplace
City: _ State: ZIP: --Insert-type
Phone: - Hex: E-mail: oo stnv pet let stove
Other,
Applicant's signaDate: other:
Narne(print): - _
Nol all Jurisdictions wcept credit cards.please call juNalletlon fix mom inlormatloa Permit fee.....................
expires i1 a Hermit
3 Visa U MasterCard Notice:This permpermit
i applications not obtained Minimum fee................$
n
Credit cud number;..__ �_/ Plan review(al v)
Eapin:. within IAO days after it has been
None of mdboldcr as shown on credit card accepted as complete. State surcharge(85'0)....$
= TOTAI. .......................$
Cardholder sigtmtore V Amount_ 4404617(15MCONt)
CITY OF TIOARD 24-Hour
BUILD114G Inspection Line: (503)YO--4175
MST
INSPECTION DIVISION Business Line: (5 639-4171
BUP
Received — Date Requested AM PM _ BUP
Location __ a l— cite_ _ MEG
Contact Person te ph( 1 . 7 5 y,�J PLM —
Contractor Ph( =') �— �l�[ ' SwR _
BUILDING Tenanf6v�neb ELC _
Footing -- SLC
Foundation Access:Access: 1Jeoc--s ; ELR
Ftg Drain -—
Crawl Drain _
Slab inspection Notes: SIT --
Post&Beam
Shear Anchors
Ext Sheath/Shear - --- --
Int Sheath/Shear L-1Framing
Insulation --- - - �;_ - -----�
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler — --- ---- - — -- ----
Fire Alarm
Susp'dCeiling - ------ — - -- ------ — —.
Roof
Other - --— — -- — —.�.
—- -
Final _
PASS PART FAIL _-- ~
PLUMBING ----
Post& Beam ---
Under Slab --
Rough-In
Water Service --- -- - — -- --
Sanitary Sewer
sins
Catch
--
Catch Basin/Manhole _
Storm Drain - -- —' - --
Shower Pan
Other. -- - - . — ---- --- - ---
Final --- - — - -- -- --
PASS PART FAIT.
MECHANICAL ,— - _ ---- - - --- --- -- —
Post&Beam
R2ugh-In
Gas Line iyt c J
$ma a 15ampersr - - -- -- - -- ---— - -
11n
;1 § PART ''AIL -
ELECTRICAL -
Service
Rough-Ir,
UG/Slab
Low Voltage --— - - ----- --
Fire Alarm
Final Reinspection fee of$_.. _ -__—__required before next inspection. Pay at C H:.At. 13125 SW Hall Blvd
FdSS PART FAIL _
SITE ❑ Please call for reinspection RE: ��l Un to inspect-no access
Fire Supply Line
ADA _--- ----, t—
Approach/Sidewalk Dote Ins{Netor
Other:_
Final De, NOT REMOVE thli In:part"on r ord from the job site.
PASS PAR1 FAIL