Permit CITY OF TIGARD1VNIMO
MECHANICAL PERMIT
4*r� DEVELOPMENT SERVICES PERMIT #: MEC2000 -00034
`� r � l l � 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/00
PARCEL: 2S 115BC -17600
SITE ADDRESS: 16678 SW QUEEN ANNE AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
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: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN <100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of existing gas furnace with like kind.
Owner: FEES
JENULESON, ALVIN J + MARY VERA Type By Date Amount Receipt
16678 SW QUEEN ANNE AVE PRMT .DEB 1/27/00 $50.00 KING CITY
KING CITY, OR 97224 5PCT DEB 1/27/00 $4.00 KING CITY
Total $54.00
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Heating Unt lnsp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
•
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 m - obtain c• • ies of t ..e r- les or direct questions to OUNC by c- (ling ( 03)246 -9189.
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Iss By: � •_ id . !i J ; Permittee Signature: , / /,, 2
Call (503) 9-4175 by 7:00 P.M. for inspections needed the ne busine s day
JAN -27 -00 THU 11:35 AM City of King City FAX:503 639 3771 PAGE 2 •
CITY OF TIGARD Mechanical Permit A lication • PlanCheda •
PP Reed By
13125 SW HALL BLVD. • Commercial and Residential • • • Date Rec'd I- 2-1-00 •
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST I-21- Oa •
Prynt o Type`. Per it# m . •
• • I nc o mp l e t e or illegible:applications will not be accepted c •
Name of DevelopmenuProiect • . Description . . . . .
• 'Table 1A Mechanical Code • Qty Price Amt .
Job Street Address • • suited . . A).• Permit Fee • ;'' =4'cf,;,; 16.00
• Address ' l lO 1 Q N. i rs,r� . i,SZ 1) Furnace i 100,000 BTU
i nclud i ng d & vents see footnote 1,2 • i 9.65 o 805
• MO City/State zip 2) Fumace .100,000 BTU+
• G� o(C q• 1. ncluding' vents • . see footnote 1,2 • 12.00. • •
N arna (or na of bu Ineas) 3) F loor Furnace -
owner ( 10 t rr1 e(\la1425.DY1 including vent see footnote 1,2 9.65
Mailing Address . . 4) Suspended heater, wall heater. ••
•
I .45-1c,• or floor mounted heater • see footnote 1,2 9.65
`6 Q k.�QSLn a V\�2 41 5) Vent not included in appliance permit 4.75
•
City/State ZIP • Phone Check all that apply •Boiler : Heat . Air • • • • ' • .
'4- 4' T7 • • For items 8-10, see . 'or : .Pump Cond • . Qly • • • Prig • • Amt
t.. C.� 02 --. • • footnotes 1„2 ..Comp
ante (or of Du ess) ; 6) e3HP unit to •
• • . 100K BTU 9.65 • •
Occupant Melling Address • . • •.7) 3.15 HP;absorb unit •• . •
• • 100k to 500k BTU • • • • .. 17 •
et►yistate • . • . • : Zip. . Phone • . • 15 HP; absorb • .
• unit .5-1 mil BTU ' 24.15.
. 9) 30-50 HP; absorb • ' •
Contractor . Nar"e. unit 1 -1.75 mil BTU 36.00
Arabs ji 1 rick • 10) >50HN; absorb unit
Prior to permit Mfg Ad dress 1 • , - r ' 1 ^' >1•.75 Mil BTU . • ` • 60.15 •
Issuance, a copy q 1 1 . ;Sp /' Wra-rJ..�1 & .d l i .�. 11 Air handling unit.to 10,000 CFM
of all licenses Cpy/3late • • n Zip • Phan . • . •: . .. . . . 7.00
• are required if ,,,C
- O f . • "t - 7 12) Air handling unit 10,000 CFM+ • • -
• expired In COT 'Oregon Coast Board l6c.d Exp. Date . .. . 11
•
• database •.. 13)' Non-portable evaporate cooler ,
Architect " 7.00
• ,14) Vent fan connected to a single duet •
or Melling Address .
4.75
15) Ventilation system not included in •
. appliance permit 7.00 •
Engineer •ilrislIe • ziP . Phone . • • 16) Hood served by mechanical exhaust .
. .7.00
Describe work to be done: . 1.7) Domestic Incinerators •
• . 12.00. •
New 0 ' Repair 0 ' Replace with like kind YesW No O • • . ` 18) Commercial or•Industrial type incinerator .
'Residentialfi?:.,.Commerdal 0 •• ' . •
. -. . ... 19) Repair units' . ._ • .... - . •
. . ...
48 25
Additional information or description of work 8.40 . • ,
20) Wood stove/gas FP /other units/clothe dryer/etc.
:CQ - r - 1...e r'1GCQ .. • ' . . • 7.00: , •
•
NOTE: For Commerci only; Units over 400 lbs. require . : 21) Gas piping one to four outlets . . •
structural gas ;alas. ' • ' • See footnote 1 • • . . • 3.75 .
Type of fuel: oil 0 natural gas •• . LPG:O • electric O 22) More than 4 per outlet (eac ' . 75
•
Minimum Permit Fee. $50 ;00 . SUBTOTAL .1 •.•
I hereby acknowledge that I have read this application, that the information
°A SURCHARGE '
given is correct, that I am the owner or authorized agent of • •. . • •• PLAN REVIEW 25% OF SUBTOTAL ; „ ' { :
gi y OD
the owner, that plans submitted are In compliance with Oregon State.Jaws. • e f
• Re quird tor ALL commercial p ermits only ,' : *_. ^ ,
p l TOTAL r i �r�+ . f d 4E �r t
Signature of Ovmer/Agent . Date : ••
� /� Other Inspections and Fees:
t � LL1XC� Q -( \L I • • • :1. Inspections outside of nornalbusiness hours'(mininum charge -two
Contact Person Name . a Phone hours) $50.00 per hour .
. ' I 2. Inspections for which no fee Is specifically Indicated (minimum
�(,g(�4 -AIR" a3 733I charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes; additions or revisions to.
• 1. Provide full schematic of existing and proposed gas line and pressure. • plans (minimum charge -one -half hour) 550.00 per•hour • •
2. Provide drawings to scale•showing existing and proposed mechanical • .
units. . • . . .. • *State Contractor Boller Certification required
Residential requires site plan showing placement of unit
1:v
; rnechperm.doc rev 02/4/99 • • . • . • • .
2/14/00 Activities for Case #: MEC2000 -00034 .
4:32:47 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 APPlication received 1/27/00 DEB FAXD No Hold DEB 1/27/00
MECA008 Create Permit 1/27/00 DEB DONE No Hold DEB 1/27/00
MECA725 Heating Unt Insp 1/27/00 1/27/00 No Hold DEB 1/27/00
MECA799 Final Inspection 1/27/00 1/27/00 2/2/00 TLP PASS No Hold AKJ 2/2/00
MECA060 (F) Issue permit 1/27/00 DEB DONE No Hold DEB 1/27/00
MECA800 Case Finaled 2/2/00 AKJ DONE No Hold AKJ 2/2/00
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested Z 00 AM PM BLD
Location _ / !1 Jo/ � uite 4.1.P W �hfi,3C/
Contact Person 1�.��1 r AAVV! t J, Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
HA
Pos C
Rough In
Gas Line
Smo e Dampers
ASS PART FAIL
ELECTRICAL
Service —
Rough In
UG /Slab
Low Voltage
I ly
Fire Alarm
Final
PASS PART FAIL
SITE
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 Date Other D a Z q- 1 0 V Inspector 70 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.