Permit 6
CITY OF TIGARD MECHANICAL PERMIT
4. DEVELOPMENT SERVICES PERMIT #: MEC1999 -00552
, 1 • DATE ISSUED: 12/13/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 0.010. PARCEL: 2S110CC -00700
SITE ADDRESS: 15960 SW ROYALTY PKWY 4
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 016 • ICTION: 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: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install gas piping and gas log in single family dwelling.
Owner: FEES
MILDRED MAJORS Type By Date Amount Receipt
15960 SW ROYALTY PARKWAY PRMT KJP 12/13/19c $50.00 KING CITY
TIGARD, OR 97224 5PCT KJP . 12/13/19f $4.00 KING CITY
Total $54.00
Phone:
Contractor:
HOLMES INSTALLATION SERVICE
RAYMOND FLANDERS
33535 NW VADIS ROAD REQUIRED INSPECTIONS
CORNELIUS, OR 97113 Gas Line Insp
Phone: 647 -9320 Misc. Inspection
Reg #: LIC 00102473 Final Inspection •
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ORIGINAL
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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 obta •• • of these les or direct questions to OUNC by Oiling (503)246-9189.
Issue By: Permittee Signature: 72etAL�L
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
DEC -08 -99 WED 10:41 AM City of King City FAX:503 639 3771 PAGE 2
Plan Check #
• CITY OF TIGARD 'Mechanical P Application Redd By (Z.-1)0..
13125 SW HALL BLVD.. Commercial and Residential: • Date Redd 61 I- i.6 TIGARD, OR 97223 \' . Date to P:E. • •
(503) 639 -4171, x304 • Date to DST 12. l-ii9
:Print or Type . • . • ' • . Permit #
• • :I ncomplete or illegible applications will not be accepted c
- • Name of oevelopmenliPreiect ' . . . • Description
•
. Table •1A Mechanical Code • • Qty • Price Amt
Job Street Address sunea A) Permit Fee . . • ; ,; ; . ! r `a.: /..'--- 16.00
Address 1 ) Furnace to 100,000 BTU
elegt+ City/State including duds & vents 9.65
2) . Furnace 100,000 BTU+ .
' including ducts & vents 12.00 •
Name (ornaa of business) 3) •Floor Furnace . • .
•
Owner 1 f I C �� I r� 1 C�, jay( J' including vent 9.65 •
• f . 1
Mang Add dress' r 4) Suspended heater, wall heater •
L O ' �� R 0Y L-ri 8lf 5) or •
oor . 9.85 .
6 ' )Vent n not mounted included in heater appliance permit • 4..75
epy/State • Zip Phone
• Check ail that apply: i "Boller Heat Alr
• 1 (( t; ' 0 ee. 0722 For items 6.10,' see ' or • . Pump Cond Qty Price Amt
Name (or name of`busbtess) . .. footnotes 1,2' Comp ••
/ a fi 6) Repair units .
"1 8.40
Occupant MalUny Aedresa 7 <3HP;absorb unit to ' • '100K BTU 9.65 - City/State Zip I Phone 8) 3 -15 HP;absorb unit • ' •
• .
100k to 500k BTU • • 17.65 •
Contractor Name 9) 15-30 HP; absorb
• : unit .5 =1 'mil BTU . . 24.15 •
C)Lt7(° .1 4/.51411 Q " �� .. . 10) 3050 H P; a bsorb . : . ' •
Prior to per •erg Aadresa unit 1-1.75 mil BTU • : 36.00
mit
Issuance, a COPY 33 . ...?R R D �� Vc S Issuance, 11) >50HP; absorb unit >1.75 mil BTU .
of all licenses City'S+ete Zip • Phone 60.15 • • •
are required if • Co /1,r-e°1-.4 (i ( 0 /Lr pC C29 .12) Air handling unit to 10,000 CFM •
expired In COT Oregon Cone, Cont, Board Lio.O • Exp. e • • :. . • . 7.00 •
database i d 2 . ( j 7!3 . 1 w i f e 0 13) Alr handling unit 10,000 CFM+ • • •
Architect Name . ' 11.85 • .
• . • • ' 14) Non • portable evaporate cooler •
or Mailing Address • • .. • 7
. • 15).Vent fan' connected ,to a single duct
• CltylSate Zi Phone 4.75
Engineer t .. 16) Ventilation system not included in • .
. . • appliance permit. • • • • • 7.00
Describe work to be done:. . • 17) Hood served by mechanical exhaust •
• • • . , 7.00
New Repair 0 Replace with like kind: 0
Yes No 0 • : • 18)• Domesllc incinerators .
Residential t8( Commercial . 0 ' Modification 0 . 12.00
. 19) Commercial•or industrial' type Incinerator • • Additional information or description of worts:,, 48.25
OS P 1 e' � . *, ja„ J ( s / 20) Other units, including wood stoves
I �^'� � � 7.00
NOTE: For Commercial projects ony: Units ov' r 400 Ibs:, located on the ' . 1) s piping one to four outlets . • . 1
roof,.re9uire btrudural calcs. prepared by licensed engineer.. • .. 1 3.75
Type of fuel: od 0 natural gas . LPG 0 electric 0 22) More than 4-per outlet (each) .15 •
Minimum Permit Fee $50.00 • SUBTOTAL • 1 1, ; 4 •
I hereby acknowledge that I have read this application, that the Information 88% SURCHARGE � . r v ti Y; MOD 00
` , ,
given is correct, that I am the owner or authorised agent of • • • • .. ' , "tiimpli►>!: 3"t). %1
PLAN REVIEW 25% OF SUBTOTAL •i l ; ,.E, , •
the owner, that plans submitted are'in compliance with Oregon State laws. • Required•for ALL commercial permits only :V,' ,..,:�r :,:: • .a
S lure of Owner /A ant • Data �j ;;;• e ., rl
TOTAL i s M,; :'+r ° s
' • 1 2 / l T-. Other Inspections and Fees: :
Contact P erson Name . . Phone . .. • •
•
( y `y/ ' �� et G Z y 3 2 1. Inspections outside Of.normal business hoursd ae um charge -two. hours) 550.00 per hour
0 2. Inspections for which•no fee is specifically Indicated (minimum'tharge• hair. hour)
Foonotes for commercial projects only: S� tional our
I nh .3. Additional plan review required by changes, additions or : revisions to plans (minimum
1. Provide full schematic of existing and proposed gas line and pressure. chaieeone.half hour) 550.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical • •state•ontraitor Boiler CenlfI Uon required
• units. "Residential NC requires site plan showing placement of unit
:krhechperm.doc rev 11/1/99 •
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6/13/00 Activities for Case #: MEC1999 -00552
2:13:55 PM •
ti
Assigned Hold Updated 50 w
• Activity Description Date 1 Date 2 . Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 12/8/99 KJP RECD No Hold KJP 12/13/99
MECA008 Create Permit 12/13/99 KJP DONE No Hold KJP 12/13/99
MECA705 Gas Line Insp 12/13/99 12/13/99 No Hold KJP 12/13/99
MECA750 Misc. Inspection 12/13/99 12/13/99 No Hold KJP 12/13/99
MECA799 Final Inspection 12/13/99 12/13/99 No Hold KJP 12/13/99
MECA060 (F) Issue permit 12/13/99 KJP DONE No Hold DEB 12/16/99 King City payment made on
receipt #99- 320467.
MECA845 Request inspection research 5/22/00 ST DONE No Hold ST 5/22/00
MECA880 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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