Permit � , CITY OF TIGARD MECHANICAL PERMIT
1 A , DEVELOPMENT SERVICES PERMIT #: MEC2000 -00419
,.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/24/00
PARCEL: 2S110CC -11000
SITE ADDRESS: 15845 SW QUEEN VICTORIA PL
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 023 JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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: Replace furnace
Owner: FEES
MORGAN, CAROLE D Type By Date Amount Receipt
1548 SW QUEEN VICTORIA PL PRMT JMT 10/24/00 $72.50 KING CITY
KING CITY, OR 97224 5PCT JMT 10/24/00 $5.80 KING CITY
Total $78.30
Phone:
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 222 -9654 Duct Inspection
Reg #: LIC 00060947 Final Inspection
PLM 3 -234PB
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: Permittee Signature:
Call ( 03) 639 -4175 by 7:00 P.M. for inspections needed the next business day
OCT -16 -00 MON 03:59 PM City of King City FAX:503 639 3771 PAGE 2
I rcrt.wrr I .
SHIM CaNTER Mechanical Permit Application OFFICE USE ONLY
City of King City bate received: 0 - (( Perm nmtt e.t. .2170. 9 L 9
r Project/ I_ no.: Ex ire dare:
�t� 13125 SW Hall Blvd. �_. y P
Clackamas Tigard, OR 97223 Date issued: By: Jeceipt no.:
Phone: (503) 639-4171. PAX: (503) 684 -7297 4
Multnomah 1( Case file no.: Payment type:
Washington
C O U N T I E S Land use approval: Building permit no.:
TYPE OF PERMIT
1 & 2 family dwelling or accessory CI Commercial/industrial 0 Multi- family 0 Tenant improvement
New construction O Addition /alteration/replacement Cl Other:
JOB SITE I FORMATION COMMERCIAL VALUATION SCHEDULE
Job address: f S' 3 l S 51J 121 Y/ eeJ» 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/amount no.: .r profit. Value $ _ _
trot: "Block: 'Subdivision: ' • *See checklist for important application information and
Project name: . jurisdiction's fee schedule for residential permit fee.
City /county: — "ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
D
ption and location of work on premises: (oj-}S c/.4 AND COMIMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
PLA (' ‘r4,lr,- ,._, Fee (®-) Total
Est. date of completion/Inspection: Description Qty. Res. one Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 'gees • 0 No Air handling unit CFM _
Arc conditioning (site plan required) _
Is existing space insulated ?,'. Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boi er mpressors
Ian/ P 1j\ t 1 �•�72r'G State boiler permit no
tt
Business atrtte: / i HP Tons BTU/H
Address: i s 1 / Fme/smoko dampers/duct smoke detectors �
City: , r_. State: ,ne / I•: 36 1 2 Heat pump (site plan require •
Phone: 2'�;- el _ S I Fax: ") - ' E-mail: InstaWteplace furnace/burner .2 BTU/11 •
y . --- Including ductwork/vent liner'�1 Yes O No � ,.
CCB no.: Install/replace/relocate heaters •- suspended, , ...............
City /metro lic. no.: i v - S P f wall, or floor mounted
Name (please print): L / • /a1, ' eat or appliance other than furnace
- CONTACT PERSON Refrigeration:
�� Absorption units BTU/H
Name: S14-11/ .P
• Chillers HP
Address: Compressors .. HP
Eovironmeatal exhaust and ventilation: •
T City: I State: I ZIP: Appliance vent _
Phone: Fax: E -mail: ' Dryer exhaust
O WNER Hoods, Type U II/res. kitchen/h=nat
hood rut: suppression system ,
Name: /1/1/3i e Exhaust fan with single duct (bath fans)
Mailing address: j s--5)43 ,, G..J 4 u/574_, 1// erv2JA Exhaust system apart from heating or AC
City: I State: IP: Fuel piping and distribution (up to a outlets)
Phone: Fax: E-mail: Fuel LPG NG Oil _ __..
Fuel piping each additional over 4 outlets
ENGINEER . Proems piping (schematic required)
Name: • Number of outlets
— . - listed appliance or equipment:
Address: . , Decorative fireplace
_ _ State: ZIP: Insert - type
one: Fax: f -mail: r. stov let soave
Applicant's signature., Date: jd - /Z -Q Other:
Name (print): r/ D /
Not all jurisdictions accept credit cads, please call juriedietion rte wore infomwtoa Permit fee S 7A1.
N ot ice : This p app O j i Qit Mi n i m um fee $
O Visa O MasterCard expires ija permit is not obtained
Credit card aumhcr / Expires 7 ^ - saitlrin 180 days after it has been Plan review (at %) S $�
State surcharge (8 %)_..__S
Name of cardholder as shows oa credit card accepted as complete.
$ TOTAL $ ?fi
Cardholder signature Amouer / 4404617 (61:10 /COW
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /1- Zy AM PM BLD
Location / ��j c S 5s 7u�� (JI L L v✓ 7 IL / ( /Cc) Suite MEC � vv e# //
Contact Person at"-- Ph L1 2- Zy PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
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
<MICHANIC
Post & Beam
Rough In
Gas Line
S i• Dampers
�1
PART FAIL
RICAL
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 / Inspector._ ' �� 6 a"/ Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.