Permit CITY T MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2003 -00296
c�J I 1 SW Hall Blvd., Tigard, O R 97223 (503) 6 39 -4171 DATE ISSUED: 6/5/03
PARCEL: 2S103CB -09400
SITE ADDRESS: 12376 SW QUAIL CREEK LN
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 052 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
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: Installation of a/c unit.
Owner: FEES
JASON BIRD Description Date Amount
12376 SW QUAIL CREEK LANE
TIGARD, OR 97223 [MECH] Permit Fee 6/5/03 $72.50
[TAX] 8% StateTax 6/5/03 $5.80
Phone: 503 524 - 1706 Total $78.30
Contractor:
•
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 76359
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 -00
Issu =d By: , • •, / �� �' • Permittee Signature: _,J
Call (503 639 -4175 by 7:00 P.M. for inspections needed the next business day
•
A, MechanicalPermit Application
of Date received: 6, a3 Permit no.: He03-40„2
z ,ll;''.:�� �i City of Tigard Project/appl.no.: Expire date:
Cif o Ti and Address: 13125 SW Hall Blvd Ti A
fY f g �� ri a ate issued: By: I Receipt no.:
Phone: (503) 639 -4171 Q
Fax: (503) 598 -1960 1 /t n ase file no.: Payment type:
Land use approval: r i ; i3 ( < l(/ Building permit no.:
1 i IT.'
'nil': OF PERMIT
0 1 & 2 family dwelling or accessory riSpija ► ' • industrial O Multi - family • 0 Tenant improvement
0 New construction • ` : ddition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: pg 7 _ S _ �, I _ ✓, a 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: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: e1,t e I ZIP: I & 21•'AI1'lII.Y DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPA1ENTSCIIEDULE
/A /5•∎ / Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
space insulated? 0 Yes ❑ No Air conditioning (site plan required)
Is existing p Alteration of existing HVAC system
Boiler /compressors
[� a bit a .iN6 v- C iA ,, G State boiler permit no.:
Business name:
t H I HP Tons BTU /H
Address: p 0 6 oX ,Z ' 03 7 Fire/smoke dampers/duct smoke detectors
City: State: ZIP: Heat pump (site plan required)
Phone: 4, 24k 2 7 0 Fax5ggr.2,7 E -mail: Install/replacefurnace/burner BTU /H
CCB no.: 94. 3 f + f Including ductwork/vent liner 0 Yes 0 No
Install /replace/relocate heaters - suspended,
City /metro lic. no.: /a 7 a wall, or floor mounted
Name (please print): 1 c A t oe_ / o /sc-A Vent fora fiance other than furnace
e gera on:
P Absorption units BTU/H
Name: /`S AM 6A a. �/ AO AM; Oda Ae 4 Chillers HP
Address: J 4 y Compressors HP
Envfromnental exhaust and ventilation:
City: I State: i ZIP: Appliance vent
Phone: 0 Fax: E-mail: xhaust
0o s, ype res. tc a azmat
hood fire suppression system
Name: - . - - . 1 4 c / / ,p' Exhaust fan with single duct (bath fans)
Mailing address: 2 / u: • • J Exhausts stem a. art from heatin: or AC
City: 774, A [ State:p ZIP: 97,99 3 T e pp ' g an' 'I ut on up to out ets
Type: LPG NG Oil
Phone: p 4, Fax: E -mail: Fuel i in each additional over 4 outlets
P rocess p p g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert -type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: �j� I Date: 6/$/03
Name (print): P 1 .Qj 61 •
Not all jurisdictions accept credit cards. please call Jurisdiction for more information. Permit fee $
0 Visa O MasterCard Notice: This permit application Minimum fee $
Credit card number. / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
• S TOTAL $
Cardholder tlgmature Amount 440-4617 (6t00/COM)
•
•
at
eozzatev,4
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E110
TIGARD, OR 97223
(503) 624 -2704
• FAX (503) 598 -0270
5 fff
• / 44-cA-6 1 -/- (
JOB ADDRESS: /, A.
SITE PLAN FOR AC OUTDOOR UNIT LOCATION
CITY OF TIGARD. 24 -Hour
BUILDING = Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested C — RS'
AM PM BUP
Location 1 i? 7C. C2 I.k.( ellaok " r l Suite MEC 3-6 ()a_ ' (
Contact Person C6-Inex Ph ( ) CB d- — ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: • ELC
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
Roof
Other
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
r ie PART FAIL
ECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ' / Inspector ,777 Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL