9715 SW LAKESIDE DRIVE I
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97+3 SW Lake Side Drive
CITYO F I I G A R D MECHANICA!_ PERMIT
DEVELOPMENT 'ERVICES PERMIT#: MEC2002 00177
13125 SW Ha'I Blvd., Tigard, ')R 97223 (503) 639-4171 DATE ISSUED: 5/2/02
PARCEL: 2S1 1 1CA-0370(,
F: E ADDRESS: 09715 SW I.AI.E SIDE DR
SUBDIVISION: SUMMERFIEI_D NO 12 ZONING: R-7
BLOCK: LOT: 637 JURISDICTION: TIG
t✓LASS OF WORK: ^'_T FLOUR FURN: EVAP COOLERS:
TYPE OF USE: UNIT HPATERS: VENT FANS:
OCCUPANCY GRP: R3 VEP.(S W/O APPL: VENT SYSTEMS:
STORIES. BOILER.WCOMPRESSORS _ HOODS:
_
FUEL TYPES 0 - 3 HP DOMES INCIN:
SAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: EiTU 15 - 30 HP: REi`AIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: V'.'OODSTOVES:
GAS PRESS'JRE: 50 + HP: CLO DRYERS:
FURN < 100K F--TU: 1 AIR H_A_N_D"_IN-G LiNII S
FURN >=10UK Bl 11: <- 10000 cfrt: --- -- OTHER UNITS.
> GAS OUTLETS:
10000 cfm:
Remarks: Install gas furnace.
Owner: -- ------------_FEES
KINSLEY, FRED H AND ETHEL M Type By Date Amount Receipt
9715 SW LAKESIDE DRIVE f'RMT CTR 5/2/02 y72 50 2720020000
TIGARD, OR 97223 5PCT CTR 5/2/02 $5.80 272.002000C
Total $78.'x0
Phone: ------ -
Contractor:
PIONEER GAS FURNACE
3615 NE BROADVVAY
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Mechanical Imp
Phone:249-5000 Heating Unt Insp
Reg#:LIC 36102 Final Inspection
This permit is issued subject to the regulations contained in the Tigan; Municipal Code, State of Ore
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans -This permit will expire if work is not started with'n 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-P010 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189.
Issue By: � 1�� ; _ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next buslness day
t t c'II1 1 I I(IWil Itlllrnl
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�'•� MCC.�1:1i 8�PQ1'Il�lt/��1�l;�ICi1 uI.� Permit na.m n '
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City of 1 igard project/appl.no.. — LKphcdatt
Address: 13125 SW hall ftivdripim ,flat
Date issued _- Y:f4::
CirynfTignrr! phc'le: (503)hat)4171 Came file 1'aynlrntly r
t ax (5(13)598-19611
►tolhliag prmlt nu.;
1.autl test:approval. ----- -- -
U Multi-famil; .1'I t•nanl incl+n.,l•n+�•nt
1 1 &2 fancily dwelling or accossot'Y U lConliticrcial/industrial
(]Now C17n5tn1Cllo11 U Aklditil +/aUrlxUnn/rlrrlarl'"lrnl
1
1 '
t _, ���Ln '���. �r.-. _ lndicale equipmentqutlnti'ifi in 1)(11"hrlaw.Indicnt(•the dollarlob:1il.ress: ^` value of all mechanical maU•rials,cquipmrnt,labor.melilenl,
Sl__rile,no.:
Bldg.no.- __ -_ --.-- profit.Valtic$
Tax snap/tax lot/account no.: - '- •5�c checklist fiat inlprn�ant npplirntian infil matinu mad
Lit: If4W.ck: ____ SUbdivisfon: ___ --__
_ __- jurisdiction's fcc schedule for rrsitlentital permit trc
project name: l �l #1%_-
City/cllunty: •Iicat,&Atlof
%II': �?.t{ _ 1
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Descript n an(1 kl work on p ad , t„(,A., lilt;
,lsQ _.- t!cy.and Iter.mal}
list,dal compact an/ulO.'t,
I
Tcrinot improvement'•r chatlFc of use.: Airhnndlingun;t - 1:11N
(s cxisUnr.sfnuc!lcnlcll or c>ndiliuned 1 O Ye, U No Aircon iwn ng l+ice pluu tcyu Ic ) __
feral nn u cx sling i1V1�(.`syatrin
Is existing space in:ulnted7 U Yc•. U N�� ,+i rrh"mprrRgorg
1 1 51ntc bulla pcnnit no.:
Sa name: ___ HP -_ 1'o"g
1lusinC _tt'rtUll
Addtt,ns. _ `1Telgnto cdam�c`r(s(uctam�kn c�dEicciutR _
-
Hcntpimip(TepianIrqutj 4i(Hii
urn
City: 1 j St.tc
J - - -- nate Urep ncr. acrlhurnet- lfX
Fax: �} �F.-Iv; 'l Including ductwork/veol.litter U_Yeg U No -y,db
—` —,. .,._-_,_ IaS� t 1 aeC rC10Cnle ICn1CtR—RttStl(•rlllrll,
'Co nJf, �. --- - -�'--_- wall,at f lour mounted
City/metro tic.nn.: b _13�C'_ -- -- -- -WTI or a unceollet JR-ml urnncc
Name ienlc rant : U� Q 3 � a Sero ant IIT11/It
Ahsurption units lip
-
Natnc:- tram -
AddrFss: m routae"a ex lint is ant vfn lint"n: -
: Slalc:G rnnlll
rl: Appliauvn
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CityT,ryrauatcenli
lx'honc: (xxs. - -
lypc l hcc i.uth......
lt.nc,i
hood firesupill casiun YyRlrai
F-haust fan with single duct(badl; nc
Namf � _��t __ — x ca1161 SyAtel"0 1011 10111 Eal ag Ur��
— 71 - �'
Mailin�address: I P p ".uf j�TnR nn( st 1u un(up In nut tll g
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State:4X� rtl'_� •}yl,c. 1141 --- nc;
City: I _ }:-Inel(I T I�ef iri iar1i n(iI gion iii»i i�i uiiih in -
1'I m� - 7 I ax: tm rtt Y p IRchema a req I tell
d l -
Nustiln-,[if M100%
..f icrllnrd epp once or rq- u-Tpi-1H�M'
Decolalive tlrcpinc_-- - -
Adrhl•::;; --- - - -nsert-type --
-
City _ i�uo stov w.11rtslnve
L'-mull: _!.
F'tlon_. rFax: -2f}t ier: - -- -• F-
_
l}ale: ere
ly f 0b
tVd 1111)iNlYiticlbllf act ettl ClGtll Canty,paeaYe-At Oil Action tn1 Inmr ili nulmllMl.1 Notive• I Ili5 penml app kation nl I Illllllllll fr(• ... .. - .-_!'�'
U 1;nn U m 'terCiad I cxpireR if a permit fa nal ul+l"i"ed hall rcvirw Lal "f} °
4vlthin 180 days alter it ling lice" Stair. mrclinrpe(811
uccerled m complete. TOTAI, . .... .._. ... 7� �
- Nuae nl eu oL r n,�iowa nn e1�11 t•wT- S
ern 1611(titan" t'
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I I 111 110 1111 1 I ' \ ..n.'. .,'i I 'ii n 11 1 I til III,MI,
MECHANICAL F ERMIT FEES
COMMERCIAL FEE SCHEDULE: 'I & 2 FAMILY DWELLING F1 1- SCHEDULE:
- - -- -� Description price Trl
_TOTAL VALUATION: _ FEE_ _ -__ Table 1A Mechanical Code _ qly (EG).. Ali,,
$1.0010.56,000.00 Minimum lee$72.50 1) Nrlece l0 100,000 0111 v
_ - - -- -
35,001.00 le 310,000.00 572.50 for the frit$5,00).00 and Including ducts&vents - 14 00 -
$1 52 for encll,addlllunai$100.Ou or 2��tlrnaro 100,000 t]TU* W _ .- --
traction thoreol,to atilt Irctudln0 - includin�lucts 6 vents 1!40
_ _ _ s10,u00.00. 3) Floor Furnuco -
S1b 001 00 to$25,000 OU__ $148.50 for the firs l0,)OO,OU Ant! Ineludin vent 14 0U _
$1.54 for each additional$10o,0o or -,�) rSuspende�d ealhealh er,wall healer
Ua<;Ilnn It lerool,to and Ir cluding or floor mounted hooter
_ 25 000.00 _ _ _ -
52 ,401.00 le$50,000.00 (178 50 for the first$25,)00.00 and fit-Vent nut Included In rippllancR pennll
$1 45 for each adrlifiona'$100.00 or - -_ . - 6 ao
Iractinn thereof,to and It cluding 6j�rpnir unila-
_ $50 000.00. _ _ - - _ - 12.15
- --- r Uuiler - Hent !►Ir
$5 ,001.00 and upi -
$742.00 for the filsl S.,O,J00.00 and Check all that apply:
$1,20 for each additiona $100.00 or For Ilerltiii 7-11,Geo or PUI71p Gond
fraction lhersol. footnotes below. Com
- - - -- - 7)<31If';absor1)tinil
- -• --- - - to 100K 11TU 14.00
_AS_SUM_ED VALUATIONS PER APPLIANCE:_ _ 8)3-15 HN:absorb
�J Value Total will look to 50ok BTI) 25.80
uoscriLon- -_ Amount _ r0)15.30 HP;absorh
F rnaco to 100,00013T11,Indud-Ing g5•`' unit.5.1 mil BTU
ducts B vunts _ - - - -- 10)30-50 HI',absorb 0
Furnaca 81'
> 100,000 0 Including 1,170 unit 1-1.75 11)11 BTU _ _ �?n
_ -
ducts 8 vents _.- - 11)>501-I1':absorb
- - - -- - -
Floor furnace including vent! r_ unit>1.75 mll_[JU 8120
Suspended heater,,WOil Iteatar Or 9J5 12)Air hnndling unit to 10,W0 CFM
floor mounted heater tO Un_
b'enl nal Included in applicants 445 13)Alr handling hill 10,000
ponnit
Rotralr_units_ - _ _ gn J- --- 1A)Non portable evaporate cooler
c 3 hp;absorb,unit, ` 10 00
to'I 00k BTU __ -_ _ - - I 15)Vont fan connected la a single dol
3 5 hp:aboorb.unlf,i 1,700- 1 _ 8.80 _
folk to 5oCk BTU - _ 16)Vonlilation syslem not Included In
15.30 hp;absorb,unit,5011k to 1 1,3 0 apy0ance enp nit - tU o0
mit BTU, 17)blood served by machanleal exha�iAl
30.50 hp;absorb.unit, 3,400
0
1.1.75 mil.BTU _ - -- -- 18)Domestic Incli eralrim
-
>50 tip;absorb,unit, 5,725 17.40
>1 75 mil.BTU
�35d - 19j COnunerclal or indtlslrltll ly►1c(ncincraler
Air Itandlin unit to 10,000 cfm._ _ _ _ ny 95 _
Air handling unit>10,000 r-111" -_, - _- l a68 ___ 20)Other urns,Including wood strnes
Nan odable eva�orate cooler - _ -- -. - _ 10.00 -_
Vent fan connnrled tog single duct,._ 446 21)(3as plping one to four outlets
l Vent systam not Included Ili _ _ _ S 40 -
plian2!j_pOrmil _ -._ -- — 22)More than A-per outlet(each)
Hood servedFy mechanical oxhaust - _056 — _-_- _1 0-
Demeslic lnclnoralor - 1 74_ -- __ - intmum Permit FaoJ72 - 80TOTAI.:
Commercial or industrial Incinerator_ 4,590 _ - _ _ _ _ _ , --7)-Se
sr-
Other unit,Including wood s(ovos, -656 -- 8%slate surcharge )
Inserts,etc. _ - - — _ _ _
pas-iii ding 1-4_autlets _ - _ 30n _ - 25%Plan Rovirtvlr Fee(el tsubtola) $
Each addfllOnill outlet - _ _.__
63 -- --. -- I?nrirllred for Alt conanerdal perndts ofrly
TOTAL COMMERCIAL $ T TOTAL RESIDENTIAL PERMIT FEE: 7
VALUATION_
— — Vtllcr trap r loris end Ftglt�
1 Inspeclloml oulalde of normal hii-top s Ixxnn(mminlurn chtxgn two houre)
S72.!i0 per hour
7 Inapaiclio-ir fur which no lee Ig spocircrilly F1dU;nlrrd (mUlimwn rhlrge-'Intl hon11
S?z50 pot hnur
3 Addllidnal plan rovinw twqu +d by rhinge,,nrlri0lnn,nt Invl%iuus it)pinns 00011 Ium
Chnt{)e-0110 It:1il houil$77 fir)pp,hnto
*swe r aritinctor Boller Codification rtrq tired for wills>20ek 8111.
"Resldenllal NC requires aIle plan showing placement of unit.
Iadsts\torrn9\1nech-fees doe 10111/00
CITY MJF TIGARD 9-4-Hour
BUILDING Inspection Line: (503)639.4175 / MST
INSPECTION DIVISION Business Line: (503) 639-4171 BUIP
Received —___-___ Date Requested__ -__ s -3 - AM __ PIA _L/ BLIP -77
Location — - `-- �4 -{. ' - 6LILSUite_ __ MkC c2 c) i
Contact Person _ '_�/ — Ph( ) PLM
Contractor - _____- Ph( ) ��� ~DO _ SWR
BUILDING lenanJOwner ELC _
Footing ELC
Foundation Access:
Ftg Drain ��' ELR -- --- _--
Crawl Drain — -----
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors - -
Ext Sheath/Shear _
Int Sheath/Shear
Framing _ - -
Insulation
Drywall Nailing -
Firewall
Fire Sprink!ar - -- — "— -
Fire Alarm
Susp'd Ceiling -- -"----
Roof
Other: -
Final _
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab - ----- --
Rough-In
Water Service - --- - _
Sanitary Sewer
Rain Drains ------- - _-. __._..__.._
Catch Basin/Manhole '
Storm Drain -- - - - - - - --- -- --- --
Shower Pan
Other:
Final
PASS �OJBT FAIL
__ ---- --- - - --- -- _- .__. ------------- -
HA `TL
Post A Beam--- T
Rough-In
Gas Line
eke Dampers
ti
5 PART FA!L --
ELECTRICAL
Servicr,
Rough-In .--- — - - — -- -
UG/Slaa
Low Vohage _.-
Fire Alarm
Final Reinspection fee of$ -required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
PASS PART FAIL
SITE [ 1 Please call for reinspection R!::_ _- - Unat a to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date/ ��- Inspoder _-
Other: -
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL