Permit A CITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2002 -00366
- �� ? DEVELOPMENT I N Tigard, SERVICES C ES ) 639 -4171 DATE ISSUED: 8/26/02
PARCEL: 2S110CA -01600
SITE ADDRESS: 15245 SW 116TH AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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: R &R A/C Unit.
Owner: FEES
KING CITY CIVIC ASSOCIATION Type By Date Amount Receipt
15245 SW 116TH PRMT BB 8/26/02 $72.50 KING CITY
KING CITY, OR 97223 5PCT BB 8/26/02 $5.80 KING CITY
Total $78.30
Phone:
Contractor:
MILWAUKIE HEATING + COOLING
9961 A HIGHWAY 212
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 557 -5562 Cooling Unt Insp
Reg #: LIC 104102 Final Inspection
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 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: f &,L ` 4 Permittee Signature: OY &p _
for inspections needed the next bu i�ay
Call (503) 639 -4175 by 7:00 P.M. p
Aug 26 02 08:17a Milwaukie Htg & Clg 503 - 557 -0790 p.2
08/409/20±2 08:40 5036393771 CITY OF KING CITY PAGE 01/02
,ER Mecha Permit Application OFFICE USE ONLY
:�.
City of King City • <(--.4 Date received: k -`7 •- Perm i no 4�1�2 -CO :>. 6 13125 SW Hall Blvd. Project/appl. no.: Expire date:
Clackamas Tigard, OR 97223 Date issued: 6y:1 By:,6.19 Receipt no.:
hlultnomal� Phone: (503) 6394171. FAX: (503) 684 -7297 Case file no.: Payment type:
Washington .
C O U N T I E S Land use approval: Building pctmit no.:
TYPE OF PERMIT
Cl l & 2 family dwelling or accessory Cl Commercia/industriial 0 Multi- family D Tenant improvement
D New construction 0 Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 16 rse L 4 ti 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 1ot/aceount no.: profit. Value $ .
Lot: Block: Subdivision: *See checklist for important application information and
Project name: ' jurisdiction's fee schedule for residential permit fee.
City /county: ZIP: 1 Si 2F' AMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: ArW ,,,, AND COMMERICAL/INDUSTRIAI. EQUIPMENT SCHEDULE
Fee (ea.) Total
Est date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC
Air
Is existing space heated or conditioned? Q Yes C/ No handling unit CFM
Is s r
Air conditioning (site plan required) Li
s existing (� insulated? CI ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR goiter /compressors -
Business name: � 1 R V„14 1d1 {. /A 5 State boiler permit no.:
Address; � l � , / w Fire/smoke dampers/duct smoke detectors 1
City: � ,g,��,,�} • T Slat= • ' ZIP: 5 Heat pump i re plan required) •
Phone: L - S.r_ F `. jv - mail: ll /rep ace acelburner
CCB no.: O l�z_ Including ductwork/vent liner 0 Yes 0 No
f , Install/replace/relocate heaters suspended,
City /metro lie. no.: et" gra / wall, or floor mounted
\lame (ple.sr print): at -• c i. , - .�i,. - vent for appliance other than furnace
CONTACT PERSON Rekigeration:
Absorption units BTU/H . • \Tame: Chillers HP
kddress: Compressors HP
Environmental exhaust and ventilation:
=ity: _ I State: ' ZIP: Appliance vent
'hone: Fax: E- mail: Dryer exhaust .
OWNER Hoods. Type U IUres. kitchen/hazmat
hood fire suppression system
lame: Exhaust fan with single duct (bath fans)
wiling address: ` Exhaust system apart from heating or AC
•i r Fuel piping and distribution (up to 4 outlets)
y State: ZIFr: Type: LPG NG Oil _
'hone: Fax: E - mail: Fuel . 1 . in. each additional over 4 outlets
ENGINEER Process piping (schematic required) - -
tame: Number of outlets .
Other listed appliance or equipment:
ddress: - Decorative fireplace
icy: I State: ZIP: Insert - type
hone: a AgIlt _ E -mail: Wood Stove /pellet stove
oplicant's signature: V '�' Date /�j Other.
ame (print): I ' ` � � Other:
N: Puri,... arm. , ., it CM/Pd,, picas: call luriidictron far more information Permit fee 5 9,./ • ..6
Asa Q MasrarCard Nonce: This permit application minimum fee $
li card aaad+cr. / / expires if a permit is not obtained Plan review (at _.__ %) $
Expires within 180 days after it has been State surcharge (8%) $ s
Namc of cardholder as shown on crcdit card accepted as complete. �
S TOTAL ....................... $ r •
cardholder signature Amount - 1.104 (5
617 OO,VOM>
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 --ld
INSPECTION DIVISION Business Line: (503) 639 -4171 TTY __
Received Date Requested / AM PM
Location l - - - '-- L----Suite topfig
Contact Person ` On // �y Ph ( ) . ' f 7 �S�o1 PLM
Contractor l 5 w ( 2 C� ' ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation ' . e"'
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: mmilprOTAIMIlpe- SIT
Post & Beam
Shear Anchors ,
Ext Sheath/Shear ►' • _,' `.. -
Int Sheath/Shear
Framing __ a_g,�, _ �► -� ' °
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 (/
st & Beam
Rough -In
Gas Line
S..• - Dam •-rs
an PART FAIL
E TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Ti Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE n Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA /0 n` �
Approach/Sidewalk Date U inspector ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL