Permit CITY TIGARD MECHANICAL PERMIT
. I DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00134
' !I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/24/03
PARCEL: 2S110CC -15400
SITE ADDRESS: 12375 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT: 006 JURISDICTION: 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:
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:
Remarks: Replace gas furnace.
Owner: FEES
JUNE NIELSON Description Date Amount
12375 SW KING GEORGE DR.
KING CITY, OR 97224 [MECH] Permit Fee 3/24/03 $72.50
[TAX] 8% StateTax 3/24/03 $5.80
Phone: 509- 639 -5556 Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
1601 SE RIVER RD
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 66578
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 - 01.00. You may obtain copies of these rules or direct questions_to_O_UNC_b_y calling
(503)246 -6699.
Issued By: '- ,J /,4 4 /L i ► /L Permittee Signature: 1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
03/20/2003 08:48 5036393771 CITY OF KING CITY PAGE 02
T'RI- C6Ub;' " , v it
SERVICE CE`.. R ,. ? Permit Application OF' CE USE ONLY
r' .. received: pia -? -p Permit no ,�}j 3 .C9 1311
City of King City RECEIV,ii_
13125 SW Hall Blvd.
Date issued: Bea Receipt no.:
•rvJeeVaPPi, no.: Expire date:
Clackartlas Tigard, OR 97223
Multnomah Phone: (503) 639-4171, FAX: (503) 684-7297 MAR 20 20 ' Case file no.: Payment type:
Washington CITY OF TIGA'i�. .
c o u N r l e s Land use approval: - l permit no.:
�UILDI C DIVI Ci
TYPE Q F PERMIT 8
A I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction 4 Addition /alteration/replacement 0 Other: _
JOB SITE INFORMATION COMMERCIAL , ALUATION SCHEDULE
Job address: ie .20 ; r .f. ' • J/ 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: i7 , , ,-,, jurisdiction's fee schedule for residential permit fee.
City /county: A . ;, ZIP: 9 7.2..1 / 1 & 2 FAMILY DWEL 11 'G PERMIT FEE SCHEDULE
Description and I. l lion o work on premises: _ e(2,1 c,522 AND COMMERICAL/IND i � RLtL EQUIPMENT SCHEDULE
Fee (ea.) Total
Est. date of completion /inspection: 3 - Z6s/42 3 Description f •ty. Res. only Res. only
Tenant improvement or change of use: H
Is existing space heated or conditioned ViYes 0 No Air handling unit tFM
Is existing space insulated ?IQ Yes ❑ No Air conditioning (site plan required)
Alteration of existing HVAC synem
MECHANICAL CONTRACTOR Boiler /compressors
Business name. � /I State boiler permit no.;
a G �. ' /L' %i. �r G • HP Torts _ BTU/II
Address: /f D '? 4, ton Eire/smoke dampers/duct smoke detectors
City: ,e/ ` . -
aQ State: p�, ZIP: Qizl� Heat pump (site plan required)
Phone;440 , - &4.97 I Fax:410 -0/21 E -mail: install/replace furnace/bumer BTU/H I ,
:CB no.: ,,.5 i.--- Including ductwork/vent liner GI Ye U N / , -
[nstall,/replace/relocate heaters - ' suspended,
- 2ity /metro lic, no.: /(o " t% wall, or floor mounted
Name (please print): 57 , - . e. / S' Vent for appliance other than fw^pace ■
CONTACT PERSON Refrigeration: •
Absorption units BTU/H
"lame: 4/. k �� Chillers HP
\ddress: � �V Compressors HP
Environmental exhaust and ventilation: -ity: State: —� ZIP, Appliance vent •
'hone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/kitchen/haianat
., hood tare suppression system ,.,,
game:
. ' S . Exhaust fan with single duct (bath fans)
'failing address:/ a, "S(,v . rM : r - xhaust system apart from heating or AC
i[y: , Stater ZIP: Fuel piping and distribution (up to 4 outlets)
Type: I-PG NG , Oil
,hone; , a7 6"S Fax: E -mail: Fuel piping each additional over 4 outlets , . . . ,
ENGINEER Process- piping (schematic required)
; Number of outlets .
Other listed appliance or equipment:
.ddress: Decorative fireplace
itv: j State: ZIP: Insert — type
hone: I a, • , E - mail: W other oodstove /pellet stove
rplicant's sig 7 .7 r• . , /0" . ?z.Ie I DateV /i i' I .
t (printy '` r Ocher: m t
am
. ,A�' • , f
..iJ( iuri5d■etiona accept crcdir cnrd$. ea c call juriwrliction (or-more information` - -- Permit fee $
Notice: This permit application 14fin mart[ fee
e"),54 Z MasterCard p a PP
lit Ord number
_L —L_ expires if a permit is not obtained
Plan review (at %) $
u withur 180 days after it has been
State surcharge (8%) S
Name of cardholder Qb ShOwn oa credit card accepted as complete. TOTAL $
Cardholder signature Amount --{.
3 6
03/20/2003 08:48 5036393771 CITY OF KING CITY PAGE 03
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SITE PLAN
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STREET
Specialty Heating & Cooling, �Cnc
9528 SW Tigard Street
Tigard, OR 97223
Phone 503.620.5643 Fax 503.598.0718
Hillsboro Phone 503.640.3607 Fax 503-.6-8-L0793
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Lint; ,. x(503) 639 -4171 MST
►' ' BUP
Received Date Requested = ® AM PM BUP
Location - �� r ' .r Suite 003° (x)/3/
l C ( ) go-3 2 7
Contact Person � Ph � 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 4 3' /3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
ihAr
Roof
Other:
Final
PASS PART FAIL
PLUMBING
\ \IF
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PAS FAIL
CHANIC
st& Born --
Rough-In
Gas Line
- - campers
- •T FAIL
LECTRIC
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
ITZ 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4iktAI P RT FAIL
S LI Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line -_ ___ - "
ADA 3/' 7/
Approach /Sidewalk Date Inspector _ Ext
Other:
Final DO NOT REMOVE this inspection record from the job. site.
PASS PART FAIL