Permit 4 / 111 ‘' CITY OF TIGARD MECHANICAL PERMIT
i , DEVELOPMENT SERVICES PERMIT #: MEC2003 -00297
- � 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/5/03
PARCEL: 2S110DD -13300
SITE ADDRESS: 15585 SW 109TH AVE
SUBDIVISION: SUMMERFIELD NO.14 ZONING: R -7
BLOCK: LOT: 703 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: 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of residential a/c unit.
Owner: FEES
BOB VANVLACK Description Date Amount
15585 SW 109TH AVE
TIGARD, OR 97224 [TAX] 8% StateTax 6/5/03 $5.80
[MECH] Permit Fee 6/5/03 $72.50
Phone: 503 620 - 4952 Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 - 624 - 2704 Cooling Unt Insp
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
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued C ---___,
j �� / Permittee Signature: 6 -- -e
-- Call (503) • 9 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical'Permit Application
s i Date received: v S Q Per mit no.:�e3�ac 7
,1� '' I! City of Tigar Projec n o.: Expire date:
City of Tigard Addre §s: 13125 SW Hall Blvc), Ti,�a01,6)1 E323 Dat B y: Receiptno.:
i i
v
Phone: (503) 639 -4171 u
Fax: (503) 598 -1960 CITY OF TIGARD Case fileno.: Payment type:
Land use approval: SUILDINC - 'VISION Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ ommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction I tddition /alteration/replacement ❑ Other:
JOB SITE INFORMATION ('OMMERCIAL VALUATION SCHEDULE
Job address: sasses ,5-Ail l/ - ' Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: "7;;,.7, a[ I ZIP: I A 2 FAMILY DWELLING PERMIT HIE S(TIEDULI
Description and locaon of work on remises: ND ('OMMFltI('AI./INDUSIRIAI. EQUIP%IEN'FSChi1 DU
/.4# 15 �� e-- 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? ❑ Yes ❑ No Air handling unit CFM
space insulated? 0 ❑ No Air conditioning (site plan required) /
Is existing P Alteration of existing HVAC system
Boiler /compressors
Business name: /u 6% t e 7t /A/G vc- t, .+ad / /IV G State boiler permit no.:
H ti HP Tons BTU /H
Address: Q 0 d OX 1 3 O .3 1 '7 Fire/smoke dampers/duct smoke detectors
City: �, 6, 49 aG I State:Q ZIP: 9.7/4// Heat pump (site plan required)
Phone: 424- ? 7 041 I Fax 591.. 62,7ti E -mail: Instal /replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: ` 3 .5" 9 Instal l /replace/relocateheaters- suspended,
City /metro lic. no.: 1.311_2A wall, or floor mounted
Name (please print): , cAac / O /s Vent fora ianerthanfurnace
e gera on:
Absorption units BTU /H
Name: pAM 6A lb y DAN ODG AeA, Chillers HP '
— Address: 4 y Compressors HP
Envfronmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 0 Fax: E -mail: Dryer exhaust
Hoods, Type U II/res. kitchen/hazmat
'/ hood fire suppression system
Name: a AN f� A. GI-- Exhaust fan with single duct (bath fans)
Mailing address: /+ ,9 , p +r e ._, 4 Exhaust s stem a art from heating or AC
City: �9 a�►d te:r/t� ZIP: Ajz..y� F uel p p g an distribution up to out ets
Type: LPG NG Oil
Phone: • 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: I State: ZIP: Insert - type
Phone: Fax: I E -mail: Woodstovefpelletstove
Applicant's Date Other:
PP s si g nature• G 0.� Other:
Name (print): /' Q .0A-t4
Not all jurisdictions accept credit cards, please call jurisdiction for more information.
Permit fee $
❑ Visa Cl MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit cared accepted as complete.
. $ TOTAL $
Cardholder signature Amount 440-4617 (6r1701COM)
.1
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE El 10
TIGARD, OR 97223
(503) 624 -2704
FAX (503) 598 -0270
JOB ADDRESS: /.S�S�S , ; �J /D 9 CC
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION , - Business Line: (503) 639 -4171 MST
BUP
Received Dat eRquested ° - 7 AM PM BUP
Location r 6 7S — g-s / 0 vt. — Suite MEC 3 --� d a 1 7
Contact Person farri Ph ( ) a -2
. Z - 7 e PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain g/s. ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
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
Rough-In
Gas Line
S moke Dampers
PART FAIL
ICAL
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line -- ,
ADA
Approach/Sidewalk Date / � Inspector \ f Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL