Permit CI TY OF TIGARD MECHANICAL PERMIT
r; DEVELOPMENT SERVICES PERMIT #: MEC2001 00138
{�° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/30/01
PARCEL: 2S103DC -05300
SITE ADDRESS: 13820 SW 115TH AVE
SUBDIVISION: VIEWMOUNT ZONING: R -4.5
BLOCK: LOT: 041 JURISDICTION: TIG
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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas line for gas cook top.
Owner: FEES
DOUGLAS, MARY P + BRIAN H Type By Date Amount Receipt
13820 SW 115TH AVE PRMT CTR 4/30/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 4/30/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 624 -2704 Final Inspection
Reg #: LIC 76359
PLM 34 -175
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 c of these rules or direct questions to OU •y ca ' ; - 46-9189.
Issue By: _ ja p�j��` Permittee Signature: ' _ �4
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busin:ss da
. A Mechanical Permit Application
d
i
Datereceve: y/26/0/ Permit E'
},, /`9 C�oO/ Do /.g.? ��l �� C of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: Byeceiptno.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
on & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
0 New construction ' ddition/alteration/replacement 0 Other:
JOB SITE INFORMA'T'ION COMMERCIAL VALUATION SCHEDULE
Job address: /3vo (o / /,jtl Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: Ma pp LA. ci /q < jurisdiction's fee schedule for residential permit fee.
City /county: Ti G r'ci /�fi. (ZIP: R 7? 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and locdtion of work on premises: ion V < /,' ft e, AND COMMERI(:AI /INDUSTRIAL EQUIPMENT SCHEDULE
� - 0 l'.nokfoj) Fee(ea.) Total
Est. date of completion/inspection: 61/ /Of Description Qty. Res. only Res.only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes U No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? O Yes 0 No Alteration of existing HVAC system
Boiler /compressors
Business name: State boiler permit no.:
_ v UM e in 4 0D I: n 9. 1 r, HP Tons BTU /H
Address: p, Bo' a3O39 Fire /smoke dampers /duct smoke detectors
City: Ga rc,1 I State: 012. ZIP: q 7,9,2 3 Heat pump (site plan required)
Phone ft E - mai l: rnace/burner BTU /H
�n�y - ���� Fax: 5�b� J 10 Install/replace
ductwork/vent liner ❑ Yes O No
CCB no.: rf (g ?
Cil City/metro lic. no.: Install /replace /relocate heaters- suspended,
Y ? - 3(, D ( wall, or floor mounted
Name (please print): a f ai, 6> re; i f t.t ri Vent for appliance other than furnace
Re geration:
Absorption units BTU /H
Name: 5 k Q GO A a ron fund Chillers HP
Address: 0 Q. j3 N , 3n3R7
Compressors HP
Environmental exhaust and ventilation:
City: T.q a rd I State: ne I ZIP: q Appliance vent
Phone: - "204 Fax' -c'z E -mail: Dryer exhaust
Hoods , Type I/ II /res. kitchenlhazmat
hood fire suppression system
Name: /1 '1a j' Dot Ia'< Exhaust fan with single duct (bath fans)
Mailing addres / • , ?X 5.6c) a/ 6 Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: / card I State' J/e ZIP: 9 7��.� Type: LPG X NG Oil S 40
Phone: - Fax: E -mail: Fuel iping each additional over 4 outlets
rocess piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: 1 ZIP: - Insert - type
Phone: _ 'i: : E-mail: Woodstove/pellet stove
0 Applicant's signaturiOnMeMl late: — D40 rA
Name (print): � ►jr44,i ,r) Q_C0n tau
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application $ ', 6-0
inimum fee
e xpires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $ v
Name of cardholder as shown on credit card accepted as complete. TOTAL $ U
Cardholder signature Amount
440.4617 (6 /00 /COM)