Permit A CITY OF TIGARD MECHANICAL PERMIT
tl DEVELOPMENT SERVICES PERMIT #: MEC2001 -00293
� i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/17/2001
PARCEL: 2S110CC -19000
SITE ADDRESS: 12422 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT: 067 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:
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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Furnace replacement and add gas water heater.
Owner: FEES
MIELEN, STANLEY J + ELAINE J Type By Date Amount Receipt
12422 SW KING GEORGE DR PRMT BB 08/17/20C $72.50 KING CITY
TIGARD, OR 97224 5PCT BB 08/17/20C $5.80 KING CITY
Total $78.30
Phone:
Contractor:
•
ENERGY MASTERS HEATING + NC
7470 SW 76TH
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 244 -8880 Mechanical Insp
Reg #: LIC 58556 Final Inspection
PLM 26 -476PB 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 of thes- rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: �u ' � Permittee Signature: 1)1 6/12,/(2.7,44',41/0
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
08/16/2.001 10:47 5036393771 CITY OF KING CITY PAGE 02
SERVICE > R M Permit Application OFFICE USE ONLY
v- 64-r-: , ..i. 0
city of Kin city • `
�i!i� ► received: ! - ltp - j ( )/((� / --6190-q3 �3
13 125 SW Hall Blvd_ ,0._ �i appl. no,: Permit no. Expire date;
Tigard, OR 97223 Date issued: By: Receipt no,:
Clackamas
Multnomah Phone: (503) 639 4171, FAX: (503) 684 -7297 Case File no.: Payment type:
Washington Building permit no.: •
COu TIE 5 Land use approval:
. TYPE OF PERMIT
D t & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family 0 Tenant improvement
O New coos[ruction 0 Addition/alteration/replacement O Other: ,
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: _ Lk) N , - ,t 64._ ', (f , Indicate equipment quantities in boxes below. indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax ma. /tax lot/account no.: profit. Value $ . _ .
Lot: Block: Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: (& f(,- C.-. ZIP: 7 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: ,,,,,,; .., _, ,,./ AND COMMERICAL NDUSTRIAL EQUIPMENT SCHEDULE
a • "i • .GA (l—AJ . . ' J _l4 0-17� Fee (ea.) Total
Est date of completion/ins• - tion: ; Ze) MIIIIIIIIIIIIIIIIII Desert .don Q . Res. oil Res. only
Tenant improvement or change of use: /� HVAC: V
Is existing space heated or conditioned? ta< 0 No Air handling unit ,, CFM
Is existing space insulated? 6es 0 No Alteration conditioning (site plan required) �-
Alteration of existing HVAC system NEM
MECIIA.NICAL CONTRACTOR Boiler /compressors
Busi State boiler permit no.: ■
ness name: 0 l(. �' HP Tons BTU/li
Address: ' r
7 sw , Fire/smoke dampers/duct smoke detectors -MIME
City: "( 71__) EMIMII ZIP: • Z Z3 Heat pump (site •lan re. wiled) � -
Phone • 3 Z -fVO Faxes _- 2,s E- mail: - Install/replace mac- •umer BTU --
CCB no.: - 55�. b I AL'' tk7 Including ductwork/vent liner 0 Yes Q'No
Install/replace/relocate heaters - suspegded, _--
City /m of etro tic_ no._ 3 t o floor 1 wall, or floor mounted
Name lease print): vent for a• .Rance o er than f urnace
(P P ) - IZ..t • �r2t�' -
CONTACT PERSON Refrigeration:
Absorption units . BTU/H
Name; Pr r C l A s' t E isE.A2r. Chillers HP V-
Address: - 0 S W ` to Compressors HP
Env exhaust and ventilation: iiiiii
City: "p - r - i_. EIMMII ZIP: ci'7 �. Appliance vent ,
Phonef°Z. , -g'/n FI'' t( - zsZ5 E -mail: -.,• - Dryer exhaust IMIlilnielli
OWNER Hoods, I ' s itc aanat _V
hood fire e suppression system
'Jame: V4/L S ' 1 L, r A) Exhaust fan with single duct (bath fans)
ylailing address: Z FJPIRMIERVEZIMEIRIM x it ' I • - ' ' A IMMO�
.. try: L t kl Cl T ' ZIP' 91 ZZ - T y p e piping and distribution ra 4 o Oi ls) • ••S TYPE= LPG ✓ NG 011 • Ell
hone
,c' * (n Fax E-mail: "--- Fuel •i•ing each additional over outlets 1•111111■11111
,,. ENGINEER Process piping (schematic required) r
Jame; FW L,� tiS Number of outlets .11111.0.
Other listed appliance or equipment:
kddress:
0 .S w 6 Decorative fireplace
:ity: •^L State:p ZIP: 2.3 1111=11b —
'hone. • _ ! inamaiiim Woodstove /pellet stove
ipplicant's signature: / ° Other.
1 • - O Other:
dame (print): R. j MEM .
x211 jurkeliclions accept credit cards, please call jurisdiction for more information' Permit fee $ 7
Visa MasterCard N armo: This permit:application Minimum fee $
ddir card number. i / expires if a permit is not obtained Plat, review (at %) $
Expires within 180 days after It has been
State surcharge (8%) $ r �e / �
sh
Name of cardholder as own on credil card accepted as complete.
5 TOTAL $ F -../6
Cardholder signature Amount
4-00.4417 (&OOtCOMI
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 3- z- 3 AM PM BLD
Location / , Z Z A • / uite MEC 00/ —
Contact Person / h PLM
Contractor Ph SWR
BUILDING : Tenant/Owner '. (�� 3 -- �� �Z ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
• Crawl Drain Inspection Notes: L L
Slab ���[.� LU ! i SIT
Post & Beam
Ext Sheath /Shear -
Int Sheath /Shear
Framing ✓ �/ C? CA, L. fit/t_ R 44 / /Gl
Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBIN =
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
4 - ART FAIL
ELECTRICAL , " mk
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
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
Other Date _ G S 6/ Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.