Permit ,'
CITY TIGARD MECHANICAL PERMIT
i 6' DEVELOPMENT SERVICES PERMIT #: MEC2003 -00467
" 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/6/03
PARCEL: 2S112BD -02200
SITE ADDRESS: 14955 SW 79TH AVE
SUBDIVISION: DURHAM ACRES ZONING: R -4.5
BLOCK: LOT: 044 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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
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:
> 10000 cfm:
Remarks: Installation of a/c unit.
Owner: FEES
PRESTON, ROBERT J Description Date Amount
14955 SW 79TH AVE [MECH] Permit Fee 8/6/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 8/6/03 $5.80
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Cooling Unt lnsp
Phone: 503 624 - 2704
Final Inspection
Reg #: LIC 76359
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. ATTENTION: Oregon law
require to-foI w rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issu By
L • �'! /i
/ P ermittee Signature: /
1
I► _ „. � _'
Call (503) ; 9 -4175 by 7:00 P.M. for inspections needed the next business day Or
•
i
Permit no. �C
Mechanical Permit Application
Ili. ^ ` t .l'.. ti it~, i 11 .. „ City of. Tigard U ll �� u v pate received: g ?j Projeci/appl. no.: Expire date: CiryojTigard Addreh: 13125 SW Hall Blvd Tigard,, O R 9� in Phone: (503) 639 -4171 r UO Date issued: By: l Rec
Fax: (503) 598 -1960 CITY OF `' ' lase file no.: Payment type:
Land use approval: BU1LD1' . uilding permit no.:
0 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family • 0 Tenant improvement
0 New construction 'A • ddittion/alteration/replacement 0 Other:
JOB S1'1'E INhAItl11A'1'ION Cl)111i111iR('lAl. VALIIAI'IUN SC111:U11L1;
Job address: /tf� 3 ,,, o 7 9 ' Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: (Block: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 4 1 ZIP: 1 A 2. FAMILY 1/WELLING PERMIT F1 SCIIEIl1LE
Description and loc lion of work on premises: AND I' l) MME: R1(' AI. IINI )IISTIIAI.EQUIPM
' - $ f1c �L Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
/
Air conditioning (site plan. required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
Boiler /compressors
State boiler permit no.:
Business name:
ha,v414 64 4 M/G Itt- G + /INS _Tide. HP Tons BTU /H
Address: 1 00 d o)( 1,3 0 3 7 Fire/smoke dampers/duct smoke detectors
City: -ra 6,4 QO 1 State:OQ 1 ZIP: 907/441 Heat pump (site plan required)
Phone: ( 2c/ -.2 70 &/ 1 Fax jg QZ7C E -mail: Installlreplacefurnace/burner BTCJ /H
CCB no.: 94 3 9 Including ductwork/vent -liner 0 Yes 0 No
InstalVreplace / relocate heaters - suspended,
City /metro lic. no.: l:2 7 a wall, or floor mounted
Name (please print): 1 4. A - d_ / O /se-S . L ' Vent for appliance other than furnace
' ('l)NTA( °l' P1. JtS1)N
Refrigeration:
l /� Absorption units BTU /H
Name: PRM 0 /6 y/ /9 ' 06oiAeaty Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: 'State: I ZIP: Appliance vent
Phone: 0 Fax: E -mail: Dryer exhaust
Hoods, Type 1/ II/res. kitchen/hazmat
hood fire suppression system
Name: C //7_/ • S Exhaust fan with single duct (bath fans)
Mailing address: f S�95.✓! , s-2 4 / /J 9 Exhaust system apart from heating or AC
City: /, aid I State:6ti ,ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NO Oil
Phone:( a Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or. equipment:
Address: Decorative fireplace
City: State: ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/peIlet stove
Other:
Applicant's signature: C 4 i ,l,i Date:7�� _ ^n ,..
Name (print): "t 7is —,'6y \
Not all jurirdictio accept credit cards, please call jurisdiction for more information. Permit fee $
ro
O Visa 0 MasterCard Notice: This permit applicatio Minimum fee $
ex if a permit is not obtained
Credit card number. / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder u shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount
440 -4617 (64XYCOM)
eozwiter,4
HEATING & COOLING, INC.
ti 8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
•
K
JOB ADDRESS: /f9'55 (-L 7
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour „.
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISIDN Business Line: (503) 639 -4171 MST
BUP
Received Date Requested _ V AM PM BUP '' //
Location 9 s6 ��- Suite / MEC 3 _co `-k'
IPA/Y1 Person IPA/Y1 `'/
1 Ph ( ) 6 a. a 7 o PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing e / 6• , �V dZ e L 0 GH
Insulation
Drywall Nailing C e'l''uvi- C Lb,. f
Firewall
Fire Sprinkler
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 PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
`PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage '
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line p
ADA Date U — � Inspector - Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL