Permit • CITY OF TIGARD MECHANICAL PERMIT
; gr� DEVELOPMENT SERVICES • PERMIT #: MEC1999 -00412
�� DATE ISSUED: 10/01/1999 • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 • PARCEL: 2S115BC -07800
SITE ADDRESS: 16755 SW QUEEN ANNE 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
. GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Furnace •
Owner: FEES
RALPH PATTERSON Type By Date Amount Receipt
16755 SW QUEEN ANNE AVE PRMT BON 10/01/19c $50.00 KING CITY
KING CITY, OR 97224 5PCT BON 10/01/19c $3.50 KING CITY
Total $53.50
. Phone: 503-598-9332
Contractor:
JACOBS HEATING +A/C .
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Misc. Inspection
Phone: 503- 234 -7331 Final Inspection
Reg #: LIC 1441
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ORGtNAL
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.
' 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 obtai copies o ese rules or direct questions to OUNC by callin (503)246 -9189.
Issue By: a,{/� - Permittee Signature: MA__ ( (� — /J�LAt -
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the nil'�`t business da
( 3 ) Y p day
OCT - 01 - 99 FRI 01:41 PM City of King City FAX :503 639 3771 PAGE 1
CITY OF TIGARD Mecha Permit Application Plan Cheek#
PP Ree'ii By' IneobJ
• 13 5 SW.HALL BLVD. . • Commercial and. Residential Date Rood • / o - o /- Fir •
TIGARD, OR 97223 Date to P.E,
(503) 639 -4171, x304 • . . . . . • Date to DST 10 9 q
Plint •or Type Perini(# •
•
• • Incomplete or illegible •applications•will not be accepted • . .Called . ;
Name or Development/Project
• . Table •1A Mechanical Code _ . . _ Q Price Amt •
Job Street - Sulteir A) Permit Fee ; • ''' :. i :18.00 '
Address 1U1S 50 Q Qnr'1QCtt L • 1) Fumaceto100,000 BTU ' •
i nducting duds at vents see footnote 1,2 1 9.85• q. (tr .
.Bklgli enylState . 2* 2) Furnace 100,000 BTU+ •
• IS -1. C16, C. ty, ":3 _ including ducts & vents. see footnote 1,2 • 12.00 .
• • name of business) s 3) • Floor Furnace • = .
Owner � S ` _ rn (- 2 ✓soy, including vent . sea footnote 1,2 8.65 •
Melting Address 4) Suspended heater, wall heater
' • • or floor mounted heater . • see footnote 1,2 9.65
•
(t, ~ 1 JL) Q t\ A vine � • . 5) . Vent not•induded in appliance permit . • 4.75. • • ply/Stele . . .Zip 1 Phone Check all that a •
apply: Boiler Heat, • Air
jam; r G q - 1ay 15 e l- d i 31Q For items 6-10, see• • or Pump Cond . Qty Price • Amt .
• tooNotes 1,2 Comp .
• Nerrfa of huslnees). . . - • .
. • 8) <3HP :absorb unit•to • .. .
Occupant Mailing 100K.BTU •. ' .. . • • • ' • 9.65 • . • •
• P 7) 3-15 HP;absorb unit
100k to 500k BTU • • . 17.85
City/State zip Phone . 8) 15 - HP; absorb •
unit ,5.1 mil BTU . • •' 24.15 •
Contractor Name .9) 30- 50'HP; absorb • • •
.�� ^ , � -_ 5 n unit 1 - 1.75 mil STU 38.00
C'�'' 10) >50HP; absorb unit
Prior to permit MIN Address >1.75 mil BTU ' • • 80.15 • •
issuance, a copy "'i # 4 71 44 5 4 i I i: �� r r . R'� . 11 Air handling unit to 10,000 CFM • '
of an licenses It a ' Zip Phone : • , .. .... . ..... . .. • • • • • 7.00
are required If V44. Q Z ° l - 0E2 . 2 ?'. 1 . 12) Air handling unit.10,000 CFM; . • • .
expired In COT Oregon "F ( Board bolt . Exp. Date. • . . . • . ' 11.75
database ►► 13) Non - portable evaporate cooler .
Architect Name ' . 7.00 . , • • . 14) Vent fan connected to a single duct •
or Mailing Address 4.75
• • 15) Ventilation system not included in .
• • _ • . appliance permit . • 7.00 .
Engineer citYlslata ti p Pho • . • 16) Hood served by mechanical exhaust •
•
'7.00
Describe work to be done:. . '17) Domestic incinerators • • . •
• • • • . .12.00 '
•
New 0 Repair 0 Replace with like kind: Yes,W No 0: 18) Commercial or industrial type incinerator .
ResidentiatZ Commercial 0 . . 48.25 A .
. 19) Repair units'
Additional information or description of work: . . • • •
.20) Wood stove/gas FP /other'units/clothe dryer /etc. • • . • • • ' • .
• 7.00 •
NOTE: For Commercial projects only; Units over 400 lbs. require . • . • 21) Gas piping one to four outlets • • . .. . • • . . .
structural gas calcs. • • • See footnote 1 3.75 •
Type of fuel• -oil 0 natural gas t( LPG O electric 0 22) More than 4-per outlet (eac • .75 •
Minimum Permit Fee $50.00 . SUBTOTAL e H : 56
I hereby:acknowledge that I have read this application, that the Information '"l 6 SURCHARGE _3,52) .
given is correct, that I am the owner or authorized agent of • • PLAN REVIEW 25% OF SUBTOTAL " ` .
r11r • the owner, that plans submitted are in compliance with Oregon State laws. • .. Required for ALL commercial permits only : `„ _ •
.• • TOTAL '± rasw ; y ,,,►; . , .;y
Sign of Ownerl'Agent . Date , , 1 • r
Cn ., n � IL r u f L. l a- , I Other Inspections and Fees: .
�.�C !) 1. Inspections outside of normal business hours (minimum charge -two
Contact Person Name (/ Phone hours) $50.00 per hour • • .
( (61 11 i 1 M( ' U ✓ 1 _ - -71, . 2. Inspections for which no fee is specifically Indicated (minimum •
T�!� charge -half hour) $50.00 per hour. •
Foonotes for commercial projects only: r/ .3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. 'plans (minimum charge- one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical • . •
units. .: '•State Contractor Boiler Certification .required
. "Residential NC requires site plan showing placement of unit
1:tmechperm.doc rev 02/4/99 • . . •
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C / l t ..t n I ' . . .. • • •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�1 A'� S
/0 _ a� BUP
Date Requested �(� � AM PM BLD
60' Location / 75 ���G1 Q C
4,4 / ite MECI19 00 4 7 f /2
Contact Person Ph �3� 7337 PLM
Contractor • *-. _ Ph SWR
BUILDING W Tenant wne %, �!L Q ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab c— SIT
Post & Beam Lea jiu r1
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation ?�/�
Drywall Nailing ! J Q — / &
Firewall
Fire Sprinkler / / A1
Fire Alarm J� L
Susp'd Ceiling '
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
•ke Damper
,t1.
P = S PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Date a Ext
Other j Inspector
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.