Permit C ITY OF TIGARD MECHANICAL PERMIT
d �r r � DEVELOPMENT SERVICES PERMIT #: MEC2000 -00506
rl -! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/27/00
PARCEL: 2S110CC -07300
SITE ADDRESS: 16000 SW QUEEN VICTORIA PL
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 047 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:
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: Replace Furnace
Owner: FEES
POLANS, JACK + JEANETTE M Type By Date Amount Receipt
16000 SW QUEEN VICTORIA PL PRMT JMT 12/27/00 $72.50 KING CITY
KING CITY, OR 97224 5PCT JMT 12/27/00 $5.80 KING CITY
Total $78.30
Phone:
Contractor:
GARY'S HEATING + AIR COMPANY
PO BOX 1811 •
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 222 -5540 Final Inspection
Reg #: LIC 00059933
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: ��iyyrt Permittee Signature:
Call (503 639 -4175 by 7:00 P.M. for inspections needed the next business day
12/27/2000 11:11 5036393771 CITY OF KING CITY PAGE 02/02
TM-COUNTY
SERVICECENTER Mechanical Permit Application OFFICE USE ONLY
r C 1k ate received: `9' A 'I "CO Permit no.:
13 i 25 ty SW Of HKall l Blvg d. City Project/appl. no.: Expire date:
Clackamas Tigard, OR 97223 • Date issued: By: Receipt no.:
Multnomah Phone: (503) 639 FAX: (503) 684 -729 Case file no.:
Was Payment type: •
c o . rr T r c $ Land use approval: Building permit no.:
TYPE OF PI- :RMMMIT
0 1 & 2 family dwelling or accessory Cl Commereialindustrial 0 Multi - family 0 Tenant improvement
❑ New construction ti, Addition/alteration/replacement O Other:
JOII SITE LNFORNIATION COMMERCIAL. VALUATION SCHEDULE
Job address: , r; .'ti Q(Je 1 Glegip PL, 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: Block: Subdivision: 'See checklist for important application lnfarmalion and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county; 141,1.4 C Mt 'ZIP: . g,' 1 & 2 FAMILY DWELLING PERMIT EFL SCHEDULE
Descripdon and location of work on premises: :-qt Lit._.: .' . AND COMMERICAL/INDUSTRIAL EQUIPr lENT SCHEDULE
I•
Fee (ea.) Total
Est. date of completion/inspection: Description Qty. Res only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? IB Yes 0 No Air handling unit _. CSI.
Is existing space insulated? El Yes 0 No
Air Alteration o existing (sire plan requited)
Aration of existing HVAC system
RIECHANICAL. CONTRACTOR Boiler /compressors
Business name: ;/k e, A A 9 , p State boiler permit
Address: !" HP Tons BTU/H
�� 1 ' fl Fire/smoke dam rs/duct smoke detectors
City: WI LLg 1 7 S 8 J Stateog, l ZIP: C 7 J a,'3 Feat pump plan required)
Phone: ago, I Fax; l4 j�3 /E -mail Install/replace plsite ace fuade7burner•94 BTU/H / - t
CCB no.: .713 Including ductwork /vent liner Cl Yes 59 No
InstaWmplace/ielocare hearers - suspended.
City /metro lic. no.: / 7o wall, or floor mounted
Name (.lease print): �i;/ i A Vent for a..liance other than furnace
CONTACT PERSON e0rlgeration:
Absorption units BTU/H
Name: Chillers HP •
•
Address: Compteslots HP
City: Env onmental exhaust and ventilation: •
Y: I State: ZIP: Appliance vent
Phone: Fax: E -mail: Drier exhaust
OWNER Hoods, Type t Wres. kitche azmat .
� ` p hood fire suppression system
Name: V Ae4 o l »C Exhaust fan with single duct (bath fans)
Mailing address: JI J Of , , a . 3 Exhaust system apait7'rom heating or AC
Cit ,._ A, _ J (] �ol : Fuel piping and distribution (up to 4 outlets)
Phone: Fax: E -mail: T : LPG NG Oil •
Fuel . i • ing eac additional over 4 outlets
ENGINEER Process pip ng (schematic requ • )
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: TStare: I ZIP: Insert -- type _ •
Phone: I Fax: [ E -mail: Woodstove /pellet stove
Applicant's signature: 1 D te: Other.
a .. .., Other:
Name (print): -
to all Jurisdictions accept credit cords, please call juri;,diclion for mere information. Permit fee $
l Pisa Cl MasterCard Notice: This permit application minimum fee $ f la.7v
radii card number ____4 expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after It has been
State surcharge
Name of cardholder as shown on edil card accepted as complete. ar g (8%) $ •
v
a TOTAL $
Cardholder :ignalure - Atttetrnt
440.4617 (6'00rCOM 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1Z-- 4 AM PM BLD
Location / 6' 6 00 J4) CPN Ghv— ry itP A c Suite MEC ?dam
Contact Person Jock pa /an f (Gwn,k) h J y /7s z- PLM
Contractor ! Ph 2 -5 ruo �r�� SWR
BUILDING Tenant/Owr�/ >e Cai( rte` jL/ 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 —P-ABT FAIL
MECHANICAL?
Post & Beam 449,,,,
Rough In irry,,
Gas Line
Smoke Dampers
lip Fir
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 /c /r9 //b Inspector C5e1(1 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.