Permit C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2003 -00191
" I II DEVELOPMENT H BMENg Tigard, ACES 639 -4171 DATE ISSUED: 4/15/03
- 13125 PARCEL: 2S1 11 CA -01800
SITE ADDRESS: 15537 SW SUMMERFIELD LN
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 335 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: DOMES. INCIN:
LPG 3 - 15 HP: CQMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace gas furnace with like kind.
Owner: FEES
RITCHEY, CALVIN J + Description Date Amount
MAYDORIS A, TRUSTEES [MECH] Permit Fee 4/15/03 $72.50
15537 SW SUMMERFIELD LN
TIGARD, OR 97224 [TAX] 8% StateTax 4/15/03 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: Heating Unt Insp
hone: 624 -2704
Final Inspection
Reg #: LIC 76359
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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
Issued = ! ��i«i � i � Permittee Signature: ` _
X 503) .39 -4175 by 7:00 P.M. for inspections needed the next business day
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a.
Mechanical Permit Application
Date received: /" I ? Permit no.:HL Avg - Gl!tFf1
„,11 City a Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW W Hall Blvd, Tigard, OR 97223 Date issued: By: I Rec
eceipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
'LITE OF PERMIT
0 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction ..dition/alteration/replacement 0 Other: ,
JOB SITE INFORMATION COiIMERCIAL VALUATION SCHEDULE
Job address: /5.5'37 ,5 / ,, y ,,, A / , /,,/ C Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I 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: -- / . 14 _,I I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and loca 'on of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
/�w 9L /J fLLr,-?a "N.f J Fee(ea.) Total
Est. date o completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: - HVAC:
Air handling unit CFM
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
MECI IAN ICAI, CONTRACTOR Boiler /compressors
Business name: 6 /u 4, 6,14;44 ( 4 / /N 4 State boiler permit no.:
H 4 _+►� HP Tons BTU /H
Address: p 0 6 OK 4.5 03 7 Fire/smoke dampers/duct smoke detectors
City: - - , State: 0. ZIP: - Heat pump (site plan required)
Phone: a%2 7pa, Fax S9g =02.7, E -mail: Instal replace furnace/burneOre7IBTU /H
CCB no.: �` 3 +� 9 Including ductwork/vent liner O Yes�No
Install/replace/relocate heaters - suspended,
City /metro lic. no.: /a74 wall, or floor mounted
Name (please print): 1 c A a G / o /.SuSeIL, Vent for a liance other than furnace
e gera on:
P Absorption units BTU/H
Name: PAM OA /6 y 01914) 0L a AeA, Chillers HP
Address: g y Compressors HP
Environmental exhaust and ventilation:
City: I State: 1 ZIP: Appliance vent
Phone: 0 Fax:3,. , L ,, E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: (>9 - / ,, .7 LA e / t ' Exhaust fan with single duct (bath fans)
Mailing address: / ,..5 ,..5 d ,..... , c Exhaust s stem a . art from heating or AC
..
e pp 'gals .1 , ut on up to . out ets
City: , moo State:e ZIP: - 7 Type: LPG NO Oil
Phone: 6 ? Fax: E -mail: F leu piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Address: Other listed appliance or equipment:
Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: y2Q 4 J Date: .-7'f -c , - d er;
Name (print): �4142 4.0-. /
Not an jurisdictions accept credit cards, please can j fiction for more information` Notice: This permit application Mi m fe fee $ $
O Visa 0 MasterCard
credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been
State stucharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete. $ TOTAL $
Cardholder signature Amount 440 -4617 (6 /COM)
%
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503)39 -4171 MST
• BUP
Received Date Requeste ° 9 AM PM BUP
Location / 5 _ 3 7 bzzi Suite FYI MEC 3 - /7/
Contact Person P ik Ph ( ) 4� `7 �°' �d PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes SIT
Post & Beam
Shear Anchors 4/64A 7/ e g
Ext Sheath/Shear
Ina Sheath /Shear !� e
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
PAS FAIL
CHANICAL)
ost Beam
Roug - n
Gas Line
Smoke Dampers
PART FAIL
C • ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El 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 5--- l 03 Inspector 1 ° Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL