Permit -A : CITY OF TIGARD MECHANICAL PERMIT
r DEVELOPMENT SERVICES PERMIT #: MEC2001 -00283
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/7/01
PARCEL: 2S 115BC -08200
SITE ADDRESS: 16715 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: 1 DOMES. INCIN:
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: Replace furnace and a/c unit.
Owner: FEES
CYPRUS TESENG Type By Date Amount Receipt
16715 SW QUEEN ANN PRMT DEB 8/7/01 $72.50 KING CITY
KING CITY, OR 97224 • 5PCT DEB 8/7/01 $5.80 KING CITY
Total $78.30
Phone: 503 - 624 -5075
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 624 -2704 Cooling Unt Insp
Reg #: LIC 76359 Final Inspection
PLM 34 -175
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 1 s 1 throug R 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling 03)246 -9189.
Iss e By: t !i!! a li► �' . .1 Permittee Signature: /
Call (503) 6 • -4175 by 7:00 P.M. for inspections needed the next business day
08/07/2001 09:21 5036393771 CITY OF KING CITY PAGE 02/02
. A Mechan icalPermit Application
Datereceived: $ 10/ Permit no- :nfC/ ... 41 at3
City of Tigard • Project/appl.no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd,Tigard, OR 9722 bate issued:
Phone: (503) 639 -4171 BY Receipt no,:
.—
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
'I'1' I'I•: OF 1110111'
9 U & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
.1011 Sill: INFOIMIAI ll► COb1p1FJI(IAL VALUATION .SCHEDULE
lob address: I ,y del _ _.. A a' 1,1v% Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tex map /tax lot/account no.: profit. Value $ .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: ' jurisdiction's fee schedule for residential permit fee,
City /county: ' t i ekok,ra I ZIP: 9122y I & 2 FA1111.V Div El LING PERMIT hh:h: SCHEDULE
AND (' UIF1/FN 'fSCIIEDIrLF
Description and location of work on premises: Q
Y.t CAA ca q. rin 4- IA/ L Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only R. only
Tenant improvement or change of use: BVAC:
Air handling unit . CF'M
Is existing space heated or conditioned? 0 Yes 0 No Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system ,
l IJ11'IlANI('AI. CONTRA(' von Boller /compressors
Business name: C f (Lt..
,iviA. kt_4.n1 s- C paii ^\ Smote boiler permit no.;
HP Tons BTU/1.1
Address: A "tCIO SL...) , 4r,..l#" -e` Fire /smokedampers/duct smoke detectors
City: -Ti �, I StateO a ZIP: f 7 223 Heatpum (s squired)
Phone: / 'Fax: E-mail: Install ace fur urner BTU /H
_
Including ductworElvent liner 0 Yes O No f
CCB no.: toy �9
7 InstalUceplace/reloeeteheatets� suspended,
City /metro tic. no.: p (2 / 2 wall, or floor mounted
Name (please print): ; c Vent for app ante other than furnace
Refrigeration:
Absorption units BTU /H
Name: L)A,../ briue31AP4-6.1 Chillers HP
Compressors HP
Ad State: En�nO en exhaust and ventilation:
Db2 Zip: A pp li ance vent
Phone: Fax: E-mail: Dryer exhaust
Hoods, 1WeV1 re kitchen ha mat
hood fire suppression system
Name: r r � t. 51.4.1 ` Exhaust fan with single duct (bath fans)
Mailing addres ` (4 ir" S . 3 t i ,�.,,,, A t ,� Exhaust stem a. art from heatin or AC
City: �. ,, State: ZIP: 7 ' e P P .. an.. !1 , on up to , outlets)
q �� Ty.: LPG NO Oil
Phone: , • p-7 , + mail:. e .1.1n: each additional over 4 outlets
I. :N( :INI.1•:R 'rocessp p ,g sc ematicrequired)
Name: Number of outlets
- -- , Other listed appliance or equipment:
Address: Decorative fireplace •
City: , State: I ZU?: Insert -type -
Phone: I Fax: ( P.-mail: Woodstove/pelletstove
Applicant's signature-g..-N' l I Dare: -en
r- r---- -�-- -
Name (print): tley,,, r i\n - V ., •
N al jurledledans accept credit cards, please a cali jurisdiction for mote information Permit fee $
❑ Visa Q MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained
Credit card number / / Plan review (at %) $
Expire within 180 days after it has been State surcharge (8%) .... $ . �],�
Name of cardholder a s on nadir card $ accepted as complete; TOTAL $ 3 d
Cardholder signature Amount 46 440-4617 IroMl
•