11975 SW QUEEN ELIZABETH STREET I
11975 SW QUEEN ELIZABETH STREET
MECHANICAL PERMIT
CITY' OF TIOARD _-_-.- -.
EC1.
PERMIT#: M003-00442
DEVELOPMENT SERVICES
13125 SSV Hall Blvd., TPATE ISSUED: EC2igard, DR 97223 {503) 639 4171 2003
PARCEL: 2S110CD-07100
SITE ADDRESS: 11975 SW QUEEN ELIZABETH ST
SUBDIVISION: KING CITY NO 2 ZONING,:
BLOCK: LOT: 001 JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS WIO APPL: VENT SYSTEMS: 1
STORIES: _BOILERS/COMPRESSORS HOODS:
FUEL TYPES_ J &--_3HP: DOMES. INCIN:
I PC) — � 3 - 15 HP: COMML, INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS.
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS _ OTHER UNITS: 1
FURN 100K BTU: <= 10000 cfm: GAS OUTLETS: 3
> 10000 cfm:
Remarks: New gas service,gas fireplace, water hcatci Gni
Owner: ----------------- FEES --__
CAROL MURPHY Description Date Amount
11975 SW QUEEN ELIZABETH �Mli('{I� Peruut Pec 07/30/20( $72.50
KING CITY, OR a':aw Stete fax 07/30/20( $5.80
Total $78.30
Phone: .�03-024-964: —
Contractor:
GAS CONCEPTS & CONSTRUCTION
P.U. BOX 86232
PORTLAND, OR 97286 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503-698-4990 Misc. Inspection
Reg #: LIC 133149 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 pert-nit will expire if Nork 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: �c�C'iYL Permittee Signature: _
Call (503) 639-4175 by 7:00 N.M. for inspections needed the ne busin ss dey
i
137'29/2003 10:25 5036393771 CITY OF KING CITY PAGE 02
TRI-COUNTY
SERVI(ICEMFR Mechanical PerinitAppiication ' , '
Date received. ('0 Permit no#WC003.�
City of King City
13125 SW Hall Blvd. ProJectlappi.no.: Expire date: _-
Tigard,OR 97223 Date issued: By: lteaipt no.:
Clack mas Phone: (503)639-4171,FAX: (503)684.7297 Case fie no.: Payment type:
Multn
WashingtonBuilding permit no
C OUNT It o Land use approval: _
18c 2 famil
yy dwelling or accessory J ComrnercijUiTidn�,rrial U Multi-farruly 0 Tenant improvement
CI New construction U Additioti/alteration/replacement ❑Other:
101 SITE NFORMATION CONINIERCIAL VALTATION SCMDtTLE
Job Address: j,) w,e&t_rt t; i i't Wbd�t Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no.: -� value of all mechanical materials,eeluipment,labor,overhead,
Tax map/tax lot/arwount no.: profit.Value S —
Lot: idivlslon: *See checklist for tmponat-t application information and
Project name: jurisdiction's fee schedule,for residential per►nit fee.
City/county: i ,C IlLy 17-IP: Gj 7Z.7. t t t o
Description and location of"work on pretr'ses: _— i o I ' 6 r
✓�T, Fee(ee.) "total
Est.date of comple nNinan.ti n: _ Description Res oNv }th only
Tenant improvement or change of use: '*
Is existing space heated or conditioned?O Yes O No Air handling unit_ CFM
Air con coning(settpan r"d
Is existing space insulated?0 Yes U No Alienation i •:ti
— n ngttHVAC.,ystem
MECHANICAL 1 p, of erlcemprwsots
Business name:
State boiler permit no.:
— --�--- -- HP Tons _,,._ BTU/H
Address: a er smoke sn rdct smo
City: u Sate. 7- Gatum (sitplan/equimdI coPhonFax: E-mail: Install/replace mac rnerlce etectnts -
_
CCB no.: /• f Includin ductwoddvent liner ❑Yes O No
stn ace/te ovate heaters-suspends
City/metro lic.no.; _ _ wall,or floor mounted
Name(please p: R �/t J! �4 Vent for appl ianctother than?tanace _
eN�ACT , . s e�rigenetbur __.__
Absorption unto _ _BTUM
Name: Chillers _-- HP _
Address: --- _--.--_-- --._.__- - Com mssors
: Appliance
nvrroomental
Cit State: exhAuvt ani entilatinnt
City: — ZIP:; A liance vent
Phone: I Fax: E-mail ere aust '-- —
Hoods,Type Ui/3-T" it�n/timat
hood fire suppression system _
1'arue: ItF� Exhaust fan with singl_educt_(bath fans)
Mailing address._ 175 $LA f N art r E-haust ryFtemspars f�ling or Ac- -
City + t state: ZIP: 72 — Fuel Rig and dLift4bu on i up to 4 ourirrs)
Type: LPC) N+3 O i I
Phone: rax: E-mail: u i m sae a 'tions ovmr�ouilcl -��-
ZN
piping
x emetic rtquu'�)
of outlets
_Name: b tip asorequipmaott
Address; ive(lree lace
SWe: ZIP: ty Phone: l: ovc�e et stoveAppticant's signature: U
Name(print):
Na All jurisdictions aceept Credit cords,pleuc edljurisdiaion for ON Inrorrnmioe. Perinit fee......................S -(7
❑Visa ❑MaatefCArd Nehee•This panicpermi not
Minimum fee ................S
/ / arprrrs iJ'a permit is oat obttatrtsd plan review(at _ %) S
Credit or a number: _-- - - two within /Ro days gft*r it has been State nurcharge(8%).....S
tilt u cardholder u shows oa 1 and RCC[pftd as tOnepiltt. TOT,�, to
cardholder p ataa um — ^Amtwnt
Ito♦ 6 i
CITY OF TiGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST _
SUP
Received ___ - Date Requested__._ _ AM- PM _ SUP
Location _ l I ? ?S _ �j ��Q�YLiSuite- --- "E 3 Y
Contact Person - Ph( ) -- PLM
Contractor Ph
SWR
BUILDING -� Tenant/Owner Cr"� --- '�
ELG
Footing - ---- �-. � - -------- -
Foundation _ El_G
Fig Drain A ''�� /� SLP -
Crawl Drain / ` � ,•�
Slab Y Inspection Note,, SIT _
Post&Beam ��-- ---- -3
Shear Anchors 2 - - - -- --
Ext Sheath/Shear
nt eat Shear _
Framing
Insulation Ue
Drywall Nalling
Firewall
Fire Sprinkler -
Fire Alarm - ' 4
Susp'd Ceiling -�-�'�` - -�. -
Roof
Other:
Final 4--
PA88 PART -
PLUMBING
Post& Beam
Under Slab
Rough-In
Water Service ,*
.'aSewer �—
Rain fn Drains �-- 3 .' o y _
Catch Basin/Manhol .1
Storm Drain - -�
Shower Pan ot, E,
Other -
Final
PASS PART FAIL '�-�--G --`--- - -
MECHANICAL
Post&Beam —
Rough-In _ --- --------.-_-
Gas Line
ampers -l- -- - ----- -- --
ffy-ni
PART FAIL -G�.L - r
Service -
Rough-In
UG/Slab
Low Voltage - --- -- ---- - -
Fire Alarm —
Final Reinspection fee of$_- _-required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [ Pleas3 call for reinspection RE: -- Unable to inspect -no access
Fire Supply Line
ADA
Approach/Sidewalk Dats I _ Inspector
Ext
Other:
Final — DO NOT RENIGVE We Inspection record from C,a,fob site.
PASS PART FAIT_
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP -
Received _ Date Requested_ S AM PM -__- ____ BUP
Location —�� S OU-9941 6"'6 Suite MEC 60 qty
Contact Person, _— Ph( ) ._- PLM
Contractor Ph(__. _) �_ SWR
BUILDING Te ant/Owner _L/J4A.-4_1 . — _ ___ _ _ ELC
Footing UJ a 9 r- C� 9 0 o ELC
Foundation .^ess:
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear ' ..- 3: '
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 Lirs
Smoke Dampers
Final
PASS PART FAIL.
ELECTRICAL
Service
Rough-In
UG/Slab
LowVoltage __-- —___- ----_---- ------------- --- __._____._
Fire Alarm
Final �] Reinspection fee of required before next inspe&on. Pay at Ci all, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [� Please call for reinspection RE:—_ Unable to inspect-no access
Fire Supply Line
ADA '
Approach/Sidewalk Date J-_g - Inspector - ______Ext
Other.
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL