Permit 'C ITY OF TIGARD MECHANICAL PERMIT
a ;;'srjj DEVELOPMENT SERVICES PERMIT #: MEC2003 -00008
�� �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/10/03
PARCEL: 2S110CC -11500
SITE ADDRESS: 15895 SW QUEEN VICTORIA PL
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 028 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: 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install furnace and AC.
Owner: FEES
KOLBE, M P Description Date Amount
15895 SW QUEEN VICTORIA PL [MECH] Permit Fee 1/10/03 $72.50
KING CITY, OR 97224 [TAX] 8% StateTax 1/10/03 $5.80
Total $78.30
Phone: 503 684 - 1631
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 - 234 - 7331 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 1441 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -669• .
Issued By: I/� / jj / , P ermittee Signature: (l,c t�r11••l
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
01/06/2003 13:52 5036393771 CITY OF KING CITY PAGE 02
Mr. - ^
r �' Mechanical Permit Application
Da
a.tereceived; /- / 5 Pertnit no,: .. _ O
i 1I City of Tigard . R ECEIVED Pnoject/appl. no.: Expire date: , ,,�• o v
I :
...... -
Ciryof•Tgard Address: 13125 SW Hall Blvd, Tig , O 97223 •
• Phone: (503) 6394171 Dateissued: By: Receipt no.: • • •
Fax: (503) 598 -1960 IJAN 0 6 2003 Case file no: Payment type: '
;t .7 Land use approval: CITY OF TIGARD BuUdingpermitno.:
•i ► • •i.
TYPE OF PERMIT I
• .4 2 family dwelling or accessory Cl Commercial/industrial O Multi - family Cl Tenant improvement
■ New construction ❑ Addition /alteration/replacement Cl Other:
JOR SUE INFORMATION COMMERCIAL V1' LIJA'110N SCHEDULE
Job address: iyll �� • r.Q 4t l Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $
Lot: - B ock: Subdivision: *See checklist for important application information and
Project name: t jurisdiction's urisdiction's fee schedule for residential permit :fee,
o • R ♦
City/county: 1 .. ZIP: r I "21.ai1111:1' 1)#1''I417: G PERll('1''tEL SC7i1?I)1)Li
DescriAon and location of work • es: AND COMMERIC.AI. /INDU,S IA I.
— W i ly /1 cKe. ( i ' Fee(ea.) Total
Est. date of completion/inspecuon: Description Qty. Res -only Res.only
t. •
Tenant improvement or change of use:
Air handling unit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No Airconditioning (site plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existin: HVAC system _
ML( :II, #NICAL CONTRACTOR Boiler /compressors •
Business name: q State boiler permit no.: •
HP Tons __ BTU/I-1
Addres{ d-- Fire/smoke .: pers/duct smoke detectors •
City: ♦ S: ZIPOi .,• `eat�pump site planrequired) ` •
Phone; - 7'. _ Fax: ■ _ 24 E -mail; •lostall/replacefurnace/bumer_ CI
CCB no.: t Including ductwork/vent liner ■ O No
Install/repla- re ocate heater - suspended,
City/metro lic_ no.: t L‘ wall, or floor mounted
Name (please print). ' J A A C fa , , N ' Vent for . j• fiance other than furnace
CONTACT PERSON Re i n:
Absorption units ._ BTU/H
Name: Chillers HP
Address:
Compressors HP
Environmental exhaust and ventilation:
City: State: ZIP: A..liancevent
Phone: Fax: E-mail: Dryer ex aust
O•NLR Roo ypeI/ 11/res. kilchen/hazrilat
`` hood fire suppression system
Name: AAA At • Q /i r0-- Wo (Z_ Exhaust fan with single duct (bath fans)
Mailing a dress: Alif&MEMBIIIIMMEgins r - haust system a. art . cam or AC
� y � T � �i. IIIIII • IEME %TI V EI
Fuel . p . istrib oN Qup to 4 o O tar
PhOn . 112 L 11 E - mail: Fuel .1. inn each additional over 4 outlets .
ENGINEER 'rooaspp .g(schematicrequired)
Number of outlets
Name: Other listed appliance or equipment: '
Address: Decorative fireplace •
City: I State: I ZIP: k msen - type
Phone: Fax: E - mail: • /.. a— Woodstove/pellet stove
rL I$ J others
Applicant's sig ► �� Da 2, . i a •
Name (print): 4 7 w� 1 1,1 n'� w `� �
Not all jurisdictions accept credit garde, please call jurisdiction for more Infonnadoe. Permit fee $ l�f .v
❑ Visa C] Mastercard Notice: This permit application Minimum fee $
credit card number: / / . expires if a permit is not obtained
Plan review (at %) $
within 180 days after it has been State surcharge (8%) ..,, $
Name of cardholder as shown on credit card 3 accepted as complete.
TOTAL. surcharge
$ SS
Cardholder signature Amount � ggo-0$1 7 (6/00/COM)
- f654q3 •
•
01/06/2003 13:52 5036393771 CITY OF KING CITY PAGE 03
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FAx _563- 23'/- 6E52_
CITY OF TIGARD 24 -Hour
1UIb®ING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM AM PM BUP p�
Location S g ` 1.S CX 1&- Q.Q,vt uite p �-- MEC 3 - 0 o o O
Contact Person Ph ( ) PLM
Contractor �1 (, C� S \fi ( Ph ( ) 4- -73 I SWR
BUILDING Tenant/91 _r ELC
Footing 6 d Y — /6)3/
Foundation ELC
Ftg Drain Access: I- l2 ELR
Crawl Drain ' u D- c � " � ()
Slab Inspection Notes: � SIT
Post & Beam f ��
Shear Anchors
Ext Sheath/Shear Lc t •�� ii `i, ._, • c� 3 C3 / p
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: C 1
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__- AIL__
, MECHANICAL--
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Ud
PART FAIL c ELECTRICAL / A(/5 S
Service G
Rough -In (-//� / o I
UG/Slab
Low Voltage AO L ' (7 r)., ice) RS
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( S di Inspector Ext
Other:
Final DO NOT REMOVE this inspection record rom the jo site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested S--0 AM PM BUP
Location / S � ?S !D U Q _ . quite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner R ELC
Footing 6 F - /6 3 ( ELC jLzhre Foundation Access: , da p ��
Ftg Drain -ntgz, g 003 0, F� ELR
Crawl Drain
Slab Inspection Notes: in ? SIT
Post & Beam i//./A1.dt. 60
Shear Anchors Q/ 37 7
Ext Sheath/Shear 1-/( -141
Int Sheath/Shear
Framing f'rL C/ /�
Insulation /*ME / „ 6
Drywall Nailing ( •G l
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 I ) -
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
ma ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL _
Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA q
Approach/Sidewalk Date 5 / / Q 3 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL