Permit CITY TIGARD . • MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2001 -00294
f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/17/2001
PARCEL: 2S110CA -01600
SITE ADDRESS: 15245 SW 116TH AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: Al VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
GAS 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:
Remarks: Replace A/C unit.
Owner: FEES
KING CITY CIVIC ASSOCIATION Type By Date Amount Receipt
15245 SW 116TH PRMT BB 08/17/20C $72.50 KING CITY
KING CITY, OR 97223 5PCT BB 08/17/20C $5.80 KING CITY
Total $78.30
Phone:
Contractor:
MILWAUKIE HEATING + COOLING
9961 HWY 212
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 557 -5562 Cooling Unt Insp
Reg #: LIC 104102 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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246 -9189.
_
Issue By: 2z� / .i / jL Permittee Signature: e777
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
08/16/.2001 10: 5036393771 CITY OF KING CITY PAGE 02/02
-C TY OFFICE USE ONLY
SER TRI -C I CE CE OU NTE Mechanical Permit Applicatio
:4., a te r eceived: /4-61
e City of King City ,1' .> �'- 13125 SW Hall Blvd. 'toject/appl. no.: Expire date:
Tigard, OR 97223 Date issued: Mal Receipt no,:
Clackamas Phone: (503) 639 -4171, FAX: (503) 684 -7297
Multnomah Payment type:
Washington
C O U N T I C S Land use approval: Building permit no.:
•
TYPE OF PERMIT
Q 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family O Tenant improvement
❑ New construction 0 Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
-
Job address: 14'_,A 3 7 s , , /I 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 information and
Project name: C,, , f , r � r 4 ( s p jurisdiction's fee schedule for residential permit fee.
City /county: ,. , . „ ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
•
Description and l• :''on og on premises: ' r e -, 1ND COMNIERICAIJINDUSTRL%I. EQUIPMENT SCIIEDUL
A 1 U i , ( ' . — Fee (e&.) Total
Est_ date of cornpletioninspection: Aescripeioa Qty. Rea oily Res only
Tenant improvement or change of use: H
Air handling unit . CFM
Is existing space heated or conditioned? ❑ Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system (
MECHANICAL CONTRACTOR Boiler /compressors
Business � 1,,,.. State boiler permit no.:
ess na
ce., kt- #4:4-7; t✓fi I Coo L J ni HP Tons BTU/H
Address: . - = 4, - ^ _ Fire/smoke dam rs/duct smoke detectors
City: u r IA. „ Stater ZIP: 5 Heat •um ∎ (site p an required)
Phone &-s.7... ;sue 2 Fax :,r-j- _ 07x4 E -mail: Ins rep ace mace/burner BTU/H
CCB no.: O di d Including ductwork/vent liner C I Yes 0 No
Install/replace/relocate heaters - suspended,
City /metro Ile. no.: wall, or floor mounted
Name (please print): ® , vim S' , 4., Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/U
Name: Chillers _ HP
Address: Compressors HP
- Environmental exhaust and ventilation:
City: State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type If II/res. kitchen7hazmat '
hood fire suppression system
' k *A/* C; t/i r" 4 ,c s O , Exhaust fan with single duct (bath fans)
•
vtailing address: i,�'e y ; S //4. 7 Exhaust system apart from heating or AC
6 Fuel piping distribution (up to 4 outlets)
:i �r e _ ; -,--„, , S tatep 4 ZIP: — Type: I,PG NO _ Oil
'hone: I Fax: E- mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Jame; Number of outlets
Other listed appliance or equipment:
ddress: , Decorative fireplace
icy: State: ZIP: Insert - type _
'hone: Fax: E -mail: Woo. stove pellet stove
Other
pplicant's signature: pate: Other:
lame (print): / C
4 all jurisdictions accept credit cads, please cell jurisdiction for more inform tion7 Permit fee $ (I�., JD
visa Q MasterCard N ot ic e: T his permit application Minimum fee , $
di, card number: ex if a permit is not obtained
/ / Plan review (at %) $
Expires within 180 days after it has been rryy S
Name of cardholder as shown o credit card accepted as complete.
State surcharge (S 7o) $
$ TOTAL $ 77. Se)
Cardholder signature Amount J
Ma-4417 Iti/OOACO M 1
litION
OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST ,
UP
Date Requested / 8 - 2 ?- AM ' . PM BL
Location IS a- 7. S ! /6 )` A-V`e--- Suite EC 0- -Ova 9c f
Contact Person . ` rte, Ph S 7- SS4 D- PLM
Contractor )1 ,_�,� Ph SWR
BUILDING Tenant/Owgr 1, , ` _ • /_,, 4-,__/,/ - ELC
Retaining Wall / / ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear /7 ,
Int Sheath /Shear `l►I! WA
Framing I 1 f 1 —f
Insulation Nu" Drywall Nailing
Firewall i /1 . � `. y 3 5 9
Fire Sprinkler V
Fire Alarm ( / p
Susp'd Ceiling IAA-- u l Q Q 3
/ " 1/://
Roof
Misc:
Final ` C- ( `� l o C�.. 1 s__ 5
PASS PART FAIL �.(C'
PLUMBING X0‘,9--y
SL_J\ 0 p . r r '' '' d - t� n
-'c
Post & Beam
Under Slab
Top Out
Water Service --- -8 ( Ad ( S
Sanitary Sewer
Rain Drains t — ,_4 Q 1< ■-57 4.,.c.
Final )
PASS PART FAIL I.
MECHANICAL
Post & Beam I
Rough In t!/ 1 Q1` C-�� Q�� �S S� C
Gas Lin (\--6,-¢---\ -0 • Dampers /' LL (� '�J -
`�-(� 7 "� ►✓� c_-0L
Fin- ►
S ' PART FAIL `, \ — C---1\t_ — .Q X S -
ELECTRICAL ' 11
Service � l •-- `�'��'�J
Rough In
UG /Slab 104 ►�vk L ' S L�C �, C_ S .- - S '
Low Voltage --) v • tqc ,p ) `►d\ �d✓�C of c
Fire Alarm ✓� 3 Final
PASS PART FAIL 1 C l -e---A 1 � ✓ --v- (S . ! / 2 J D )
SITE itc c t 1 5 ' s �( v- N
Backfill /Grading r � %� t
Sanitary Sewer try lJ� 1 5 `SAS A--5 Z2 C 6/ �_ 0 .
Storm Drain [ ] Reinspection fee of $ required before next inspection. ay at City Hall, 131 5 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk �� t)1 7
Other ( I
Date In spector v ^ Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.