Permit : 4
A ' CITY O F TIGARD MECHANICAL PERMIT
X1 DEVELOPMENT SERVICES PERMIT #: MEC2002 -00475
II 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/24/02
PARCEL: 2S 115BA -90114
SITE ADDRESS: 11992 SW ROYALTY CT 14
SUBDIVISION: ZONING:
BLOCK: LOT: 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install gas insert.
Owner: FEES
CROBARGER, JEFFERSON E + Description Date Amount
HELEN C [MECH] Permit Fee 10/24/02 $72.50
KING CIT Y, OR 97224 Permit ROYALTY CT [MECH] Pe Fee 10/24/02 $0.00
KING CITY,
[TAX] 8% StateTax 10/24/02 $5.80
Phone: [TAX] 8% StateTax 10/24/02 $0.00
Contractor: Total $78.30
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 620 -5643 Gas Line Insp
Mechanical Insp
Reg #: 66578 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: id2iledidjil Permittee Signature: f a A L q o' v'
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
10/21/2002 10:13 5036393771 CITY OF KING CITY PAGE 02/02
TIJ- COUOITY OFFICE USE ONLY
iERVICkeINTER Mechanical Pernnit Application
s`
D ate received: / Permit no.: L. , ,,,)_.,00q -
City of King City - , r
- ‘r,
13 b W"1 - Iall Blvd. 'j� i no.: Expire date:
Tigard OR 97223 , •ate �M Receipt no.:
Clackamas Phone: (503) 639 -4171. FAX. (503) 84 -72970 t. e
Multnomah Ga file no.: Payment type:
Was hington - • c o U N T t E s Land use approval: Vl �,- , i : perm no
i.. .li I. trr._7., . l . 1. N! -
TYPE OF PERMIT
Al & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
0 New construction pr 4s. ddition /alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ( ( q99_, .SGv f2tg /4.�J - 1/ C:r -O ,tf 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 $ .
I
Lot: Block I Subdivision: I *See checklist for important application information and
Project name: & b )261 J2 jurisdiction's fee schedule for residential permit fee.
City /county: Ki Cirri J ZIP: 1'•2 . . 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: . AND COMAIERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
Fee (es.) Total
Est. date of c plcainspection: /[/y$. /e V-- Descriecton f • . Res. o' Res. only
Tenant improv mw nt or change of use: HVAC:
e • •
Is existing space heated or conditioned. '' - Yes 0 No Air handling unit CFM
Is existing space insulated? t` .Yes 0 o Air conditioning (site plan required)
g pac _Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: : / ,4-, (,/ . i� ' f State bo permit no.:
HP Tons BTU/H
Address:
g5 �LC� 'y/z4,/ r _s Fire/smoke darn �rs �� ct smoke detector
City: .17. . 4,1 d I State: t,� ZIP: 9 72�.� Hear pump (sae peed)
Phone: - _2•Q : Fax:6 - , -p'? /; E trail: Install /replace furnace/burner BTU/Fi
Including ductwork/vent liner 0 Yes 0 No
CCB no.: Ce a5 • Install/replace/relocate heaters - suspended, �� I
City /metro lie. no.: 1 O f wall, or floor mounted
Name (please print): ; • /y/ 4...g 01 • . efs Vent for appliance other than furnace ,_j
CONTACT PERSON Refrigeration:
Absorption units BTU/H ,
Name: 1bin Sk n.t•r I Chillers HP
Co m • ressor HP
Address: ° �S� y (/'[, I Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent •
Phone: Fax: I E mail: Dryer exhaust
OWNER Hoods. Type if Il/res. kitchen/haxmat W
,.� hood fire suppression system -
\lame: y �_p p eR /1 / Qi Exhaust fan with single duct (bath fans)
Mailing address: / ( Q' 2 �'W ,
Rat i--ty cy --#7if Exhaust system apart from heating or AC
I.iry: I State: 14ZIP: c/ 1_2_2_5 Fuel piping and distribution (up (o 4 outlets)
Type: LPG NG . Oil •
'hone:
f - l 3 f I Fax: I E- ail: Fuel piping each additional over 4 outlets
ENGINEER Pr -piping (schematic required) I_
•
game: Number of outlets
• I Other listed appliance or equipment:
\ddress: _ Decorative fireplace
:ity: , State: . I ZIP: Insert - type _ . . /
'hone: I ax: .I E -rail: woodstove /pelle't stove n --
• the
ipplicant's rig re: (24‘11014 a � i v t pL0ate: 04-740 2.- Other -
lame (print): �Qp I ,Sf�/Jt1le�►"
' Al jurisdictions accept credit Cads. please call Jurl(4Ic Ion (Or mare in(orrrutiOn
Permit fee $ ' - C'
Notice: This permit' application Minimum fee $ _
li c ard number: ' / / ❑ .MasterCard expires If a p ermit is not obtained _dii c - Plan review (at %) $
_
Expire. within 180 day after it has been State surcharge (8%) $ C - - g°
Name of eerdholdcr as ahe va oa credit card accepted as complete.
S TOTAL
Cardholder signeture • Amount 4404617 (600(COMI
CITY OF TIGARD 24 -Hour A
-BUILDING Inspection Line: (503) 639 -4175
p ../
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Request / 11) AM PM BUP
Location ! / q 9 c Suite / MEC - -66 'i 7
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ l, `3 ELC
Footing `Z - � 1 3
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
MECHANIC
Rot & Beam
Rough-In l
as Lift
teDam.-
4 9 PART FAIL
- TRICAL
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: Unable to inspect - no access
Fire Supply Line
ADA l "'J�
Approach/Sidewalk Date 1 ` /v31 d Inspector _ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL