Permit 4 14 CITY O F T I GARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -26008
All PERMIT 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DAT ISSUED: 9/30/02
PARCEL: 2S115BB -06200
SITE ADDRESS: 16350 SW KING CHARLES AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Replace furnace.
Owner: FEES
WARREN, ROSS W + SHIRLEY C Description Date Amount
16350 SW KING CHARLES AVE [MECH] Permit Fee 9/30/02 $72.50
KING CITY, OR 97224 [MECH] Permit Fee 9/30/02 $0.00
[TAX] 8% StateTax 9/30/02 $5.80
Phone: [TAX] 8% StateTax 9/30/02 $0.00
Contractor: Total $78.30
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 624 - 2704
Final Inspection
Reg #: 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 -0010 through OAR
952- 0 - 0 You may obtain copies of these _ rules _ or_ dir_ ect_ questio
(503)246 -6699.
Issued By: A` s . ' Permittee Signature: j�/(f f}/ AGl C' }-% /O /�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
09/23/2002 14:43 5036393771 CITY OF KING CITY PAGE 02/02
TR►-COUNT echanical Pe�rtni 1I Application
SERVICE CENTER , OFFICE USE ONLY
cl ` - C ity of K�> r> tg City _ J '' : Date received ?/23/0 2 Per mit no.:/ eZDOZ- 21 008'
13125 S W Hall Blvd. �` a � `� • roject/appl. no.: P Expire date:
Tigard, OR 97223 ; �""
Clackamas a gale issued: e Re ceipt no.:
Multnomah Phone: (503) 639.4171, FAX: (503) 72 7`� ��
Case file ne: Payment type:
Washington -u ),. l — ,.._
C O U N T I E S Land use approval: 4 •ti A It V ... m„t ,,T;R : ;7 „ Building permit no.:
TYPE OF PERMIT
❑ 1 Sc 2 family dwelling or accessory ❑ t ommerciailindustrial 0 Multi - family ❑ Tenant improvement
❑ New construction 111 ,, ddition/aiteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
lob address: O —, y Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: µ Suite ne value of all mechanical materials, equipment, Tabor, overhead,
Tax map /tax lot/account 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: A G ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
/G � c � Fee (ea.) Total
Est_ date of completion/inspection: _ Descri Qty. Res. oil Rest. only
Tenant improvement or change of use: HVAC: —
Is existing space heated or conditioned? ■ Yes CI No Air handling unit CFM
Is existing space insulated? 0 Yes 0 Ni Air conditioning (site plan requ ed)
Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: /LC / e- State boiler permit no.:
)r'ea... IV 6 HP Tons BTU/H
Address: Po .QLaX
°e45 .39 f Fire/smoke dampers/duct smoke detectors
City: .L ” State: • !ZIP: 917► . Heat pump (site plan required)
Phone: „2 , , _ E_ ail: install/replace furnace/bum �L. , BTU/k4
CCB no.: Including ductwork/vent liner • ea Yes 0 N
� �-�, %aJ r 2 Irtstall/replace/relocate heaters suspended.
C ity/metro tic. no.: wall, or floor mounted
Name (please prinI): • a, o/S Vent for appliance othW --- an furnace
CONTACT PERSON Refrigeration:
. Absorption units BTU/H
d 4
dame: PA4y n i/d Chillers -HP -�""
\ddress: Compressors HP
Environmental exhaust and ventilation:
:icy: State: Zr: P
Appliance vent
'bone: `, A . '70 , , ail: Dryer exhaust T—
OWNER Hoods, Type U ll/res.' hen/hazmat •
hood fire suppression system
' g D . .S Lk) As/)--fl . r
_/} Exhaust fan. with single duct (bath fans)
/failing address: .(... A /..) � Exhaust system apart from heating or AC
-icy: Stater 7 Fuel piping and distribution (up to 4 outlets)
�• Type: L_ NG Oil /
'hone: ! Fax: Fuel 'i eac addi o over 4 outlets
ENGINEER Process piping (schematic required) . - -.
lame: Number of outlets
• then listed appliance or equipment;
ddreSS. Decorative fireplace
ity: State: , ZIP: Insert - type - - -
hone: 1E a il : Woodstove /pellet stove
pplicant's sigrxatur•�.. I Date: . ''"7,F0 '2 Other.
Other:
ame (print): 0 _____
l all jurir.diGOOrt5 aCmcpl- cTCdit_rm•di.- plczsc- mall - juriudiesion rh -1b Or - informatio., -� -- - -- ----- 1�errriit- fee $ - - - -
visa ❑ MasterCard !Notice: This permit application Minimum fee $ ?_1 - - 0
d il csrd AdMbcr: expires if a p ermit is not obrained
/ Plan review (at %) $
Expires within 180 days after It has been State surcharge (8%) of cardholder as shown on credit card accepted as complete, ( ) $ —
$ TOTAL $ _,,_ ' C)
Cardholder 51, no ure mount
440.4.517 (6170/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re Nested //b AM PM BUP
Location / (a 3S-0 7l C 4 Vtb4 Suite MEC o 2 oZ6 .
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access: *7
Ftg , ELR
! //
Slab Inspection Notes: SIT
Post & Beam -
Shear Anchors � -- -'
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation f r`
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
- A - FAIL
MECHANICA
•
Gas Line
Smoke Dampers
in
AS 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 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
-
ADA
Approach /Sidewalk Date /6 / /0 /G' Z - - Inspector 7 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
-