15865 SW QUEEN VICTORIA PLACE 15865 SW Queen Victoria Place
/
CITY
��� ^C TIGARD
����� MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: ME/;2002 00182
DATE ISSUED: 5/6/02
13125 SW Hall Blvd., Tigard, OR 97223 (533) 639-4171
PARCEL: 2S 110CC-11200
SITE ADDRESS: 15865 SW QUEEN VICTORIA P!.
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 025 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: _BOILERSICOMPRE_SSORS _ HOODS:
FUEL TYPES 0 3 HP: ^— DOMES. iNCIN:
3 15 HP COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 1+?: 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: Replacement of furnace.
Owner: --- ------ FEES --------
HUBBLE, GARFIELD R Type By Dat-s Amount Receipt
ARDATH E PRMT BB 5/6/02 $72.50 KING CITY
15865 SW QUEEN VICTORIA PL 5PCT BB 5/6/02 $5.80 KING CITY
TIGARD, OR 97224 — ---
Total $78,30
Phone: '- -
Contractor: —�
COLUMBIA HEATING+ COOLING INC
8900 SW BURNHAM
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone:624-2704 Heating Unt Insp
Reg#:I-IC 76359 Final Inspection
PLM 34-175
This permit is issued sibject to the regulations contained in the Tigard Municipal Code, State Of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 thrOUgh OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189.
Issue By: I L� < Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for insp actions needed the next busin, is day
04/29/2002 13:24 5036393771 CITY OF KING CITY PAGE 02/02
1 �
1Pi/ 2/2001 10:46 5036393771
l J CITY OF KING CITY PAGE 01/02
SERv CIN Mechanical Permit APPI14 ffoxi ism
ication
i City o� King City Due received: Permit no.;J) � ��J$;�
131%5 SW Hall Blvd. F;U ecVappl.no.:5/ ! Expire date I
c � Date Il'$UCd; y ) pt no.:
Tlgafd,OR )7x23 Ret'ej
C'lackamaz Phone: (503)639-4171,FAX'(103)884-729'' naso file no.: Payment type'
Mul;namati ._.—..._-- -
Washington Building permit no.:
Land use approvai;
1
�l &2 fattilly dwelling or accessory O CnMMercI9J/:ndu5u:al 0 Mult1•family Q Tenant improvement
0 New consmictlunat
Addition/a1lerationlrepiecemenr a Other - r __
1 1
Lttdicute eyuipmenc quantities In boxy below. tndicate the dollar
Bldg. no,; 1 Suite no,` _ value of all mechanical materials,equipment,labor,overhead,
Tax map/tpX lodfit;:ount no.. profit. Ve1ue S "iii
Lot: Blot:l; Subdivision; eSee cherkllrr farttrtao►rrrmt appArujr ct name; jurisrNction's fee scltt'!file for re
airy/county: Kin 'LIP:
Description raid loch on of ork on premlges: _,�_ e
�Srr dTotal
RaDalt Res oalvl
a _fft�rmple'
i
'Cenant i nprovement or change of use` A �1I
Is existing space heated or conditioned?O Yes ❑No Aii ham unit CFM _
Is e)ustiag space itut�lated7 Q Yes ❑No Gond ontng site M r u )
Pe A iem6on o existUg` AC s stem T
of er oomprenors
State boiler permit no,: I
3usineet;tsante; �Fi ? - — _ Hp T'o(!s HTUM
'rd�6 00 f ti irdamok—ems-. uct smoke etrctors
�i ; r' f _ State: ZIP: au pat tut re Uvi{d)
hone 7 _ Fat; Email: meta rep ace Furnrlbum•r �_
1nc1u vent liner 12 Yes 0 No
:CS no.: '�`-�S nitall/rep ItceJre oartte eater;--luspende
'it0metro lie, no.. wall,or floor mounted
a rr,e(ilease rt ,.1 o J s r ant ora rsnce o er ar, --eco
yei
a *ratio".
Absorption unitsAMC:
Chillem __ HP
Curopmssory HP i
- rl oarlran ettLtetLst ad vents et+oa:
A hanea vent
Ione: 2 rZ t/ ` -Fait: E maJ.l: er exp
1of, Floe ype tea. etc atntat I
hood fire suppression system a
Itt1e: KA/ f u b�tG 11 _ Exhaust flan with�sin ids duct(bath fans
Wing address: Exhaust system art from eatn or Ai,
ty• — - State Z1P; Fuelpiping an distribution(up to 4 ouNeft)
ane: Fax: Fi•mail TLPG NG Oii
Fuze
ipinA each a dit, over :t ets
Ifticl DIM ace"p p es(schematic requ )
nit: Number of outlets
drm<s: t tr MiFci eppl ace or eQ-`u m`nt:
beaotetive finphce __
T state: T 71Pi nsen•-
ne: g• l; Wood stovelpei let stave
7lieant's rfgnatr.re Date: 5 that.
_ ^r — /�rc:.1JLL ypt ars J
___.1
tl jur:ed,ehoM*eaep!�nedh tarda,plw.cell iuri' coon ror rare Intomatlae. Permit fee• ............... .... _ Z. 56
� �Mu:ertau'e Natter
This permitepplicatron ........ ...5 0 -
cold number -ALJ •rpbet if permit rt not oAtrtlned fY vit �ctlt
-_ l
E=pita Wi:htn 180 4*1 ltftet►it tart bteq ar---e't-w..
CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PI_rA2002-00182
13'125 SW Hall Blvd.,Tigard, OR 972.23 (503) 639-4171 DATE ISSUED: 5/22/02
SITE ADDRESS: 15865 SW QUEEN VICTORIA PL PARCEL. 2S11UCC-11200
5L13DIVISION: KING CITY NO, 3 ZONING:
BLOCK: LOT: 025 JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
.TORIES: WATER HEATERS: 1 CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water heater.
FEES
Owner: --- -
-'� — Type By Date Amount Receipt
HUBBLE, GARFIEL.D R PRMT DLH 5/22/02 $72.50 KING CITY
ARDATH r 5PCT DLH 5/22/02 $5.80 KING CITY
15865 SW QUEEN VICTORIA PL _
TIGARD, OR 97224 Total $78.30
Phone 1:
Contractor:
COLUMBIA HEATING+ COOLING INC
PO BOX 230397
8900 SW BURNHAM ST STE E-110 REQUIRED INSPECTIONS
TIGARD, OR 97281-0397
Phone 1: 624-2704 Final Inspection
Reg#: LIC 76359
PLM 34-175PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
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 by the Oregon Utility
Notificatiun Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued Perm °/�
Permittee Signature: �', ;�rZ/C'r9T70/L
6811 (5051139-4175 by 7:00 P.M. for an Inspecrion needed the next business day
05/16/2002 13:51 5036393771 CITY OF KING CITY PAGE 02/02
TRI-CO(INTY
SERYCE LINTER Plumbing Permit Application OFFICE 6%, 6NIA,
City of Kin" City etc received: permit no.:
'} 13125 SW Hall Blvd. wer pennit no.: Building permit no.:
Tigard,OR 97223 Projeet/spptlno.; Expire date:
Clackamas Phone: (503)639-417 1, FAX(503)684.7297
Multnomah a.,,. Date isswed:
� , `,: _ By Receipt no,
Washington QTrTT►"*�- Case file nu . payment
type—. , . , Land use approval-
1 & 2 family dwelling or accessory U CommerchtVindustrial _ ❑Multi-family O Tenant improvement
:-1 New construction ddi aon'altrra YE7act- 0 Food service Ll Other;
jOB SITE INFORNIATH4 Fit t . ,
Job address: 1!58( SW Description _Qty.'Fee(ea.) Tota)
Bldg. no.: _ Suite no.: New I.and 2 emily dwelling Drily:
Tax ma /tax lodaccot.nt no.: - (includes 100 ft.for etch utility connex:troo)
SFR 1)bath
Lot: Block: Subdivision: _ S ( ) -bath -
Pro acct name: ..FR( )bath
Cit)/county: ZEP: 7_.� Fac additional hath/kitctten _ --
Desscnct'iption and loca i n of rk on promises: Site uttlltles:
!mac t Catch basin/am drain
Estdate of com letion/ina tion: wel each ne/trenin
Doting ain(no,Tn.ft.)
anufacturedhome util(ties
Business name: CpILtwi iC 6. n a oles
Addtegs: t �`� n n cone-tor
City. i State: !> ZIP: Z'13 .� unitary sewer(no. lin. ft.)
Phone: Fax: E-mail; Sturm sewer(no. 1 .)
CCB no. g S Plumb. bus.reg.no. •��I7// Water sere ce(no. in. ft.
City/metro lic no.: T- Fixture or item:
�'�" — Abso tion valve
Contractor's reprosentadve signatuce. .
Print rutme ^ _ �, Uate: - ack flow reventer
ackwater va ve
Basin- avatory
Names;,,^ I,,,ib Clothes was er -�
Address: �`✓�'-�'- ishwasher
Cit — drinking ountain(&)
_Y Suite: ZIP:_ � Ejectors/stump,
Phone:&2U 27dFax: E-mail: Expansioiltank - `—
ixtwe/sewei cap
Name(print): N uy�,�, oor ctlns%foor sinks/hub
garbage s sal
Mailing address. /S-�(o cam"" sw & --
' '
City: _IL; _ ^ State: ZIP: ose bibb
Ice maker
Phone L Fax: E-mail: Inlerse for/grease tra
Owner mainfenanee only;The actual installation 'me s)
u til be tnade by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447, Sink(s), basin(a), (ays(s)
titter's si nature: bate: um
u shower/s ower pan
Name: Urinal"
- - r c oset
Address: wate _
Other:Water IPS Ote
Phone: I Fax:
rat all jurisdictlom accept ehdh cards.plewe can jurisdicUon ror mroe inronrWlon. Natire;Thtt penrtir appriraMinimum fee ................$ _
t;on
]Vlo 0 MasltrCard Plan review(at %) $ _
expbes if a permit is not nhraGrad -
radit cord number State surcharge(8%)..., $ _�.` '
Etpir within l80 dnyr after U hos been
accepted as cont TOTAL........................$ _ �_
amC of cardholder aft f awn oft eredil card p complete.
_ — x
Cardholder ai�alure Amount
SY7t616 NM�t-1 tit
CITY OF TIGARD 24-Houl
BUILDING Inspection !ine: (503) 639-4175 MST -_ --.
INSPECTION DIVISION BusinessLine: (503) 639-4171 SUP
) -
Received ____ Date Requested ( t l AM.. PM �'" - BUP ---
Location
MEC �'�"�/
Contact Person � Ph( ) `l �!`� PLM
Contractor — Ph(_ ) _-.___ S W P
BUILDING Tenant/Owner _ __ ELC _—
Footing ELC —
Foundation Access- ELI3
Ftg Drain �.-
Crawl Drain SIT
Slab Inspection Notes: -
Post&Beam
Shear Anchors
Ext Sheath/Shear ' --
Int Sheath/Shear
Framing _ -
Insulation r2-
Drywall
2Drywall Nailing —
Firewall —
Fire Sprinkler
Fire Alarm
Suspd Ceiling
Roof
Other:
Final ---- _
PA PAT FAIL
PL MBIN _ - -----
Under Slab — — —�
Rough-In
Water Service — —
Sanitary Sewer
Rain DrainsZZ
Catch Basin/Manhole
Storm Drain �— —
Shower Pan -
OU_ :
Faim FAIL
Pos
Rough-In ---- ___
Gas Line
Smoke Dampers
IASSPART FAIL -
E t i 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 cell for reinspection RE:_—.—_ _ Unable to inspect-no access
Fire Supply Line /
ADA
Approach/Sidewalk Dst�.— �_�1_/U L Inspsctor ---- -- - --- —Bxt _
Other:
Final - DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspectirn Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-41/1 MST _-
BLIP --
Received ___ -_ _-___ Date Reque$ted � _ AM— PM 8UP
Location _ �I Suite MEC
- - ( `) "'1 -71 - 1� PLM '12` �'ZJ .2 QL U
Contact Person _, _ Ph
Contractor — Ph(— ) - SWR -
BUILDING — Te nantiOwner _-_ — —_ ELC _
Footing ELC
Foundation Access:
Ftg Drain
Crawl Drain ��
SI-b Inspect i otes:
Post&Beam
Shear Anchors
Ext Sheath/Shear
(nt Sheath/Shear
Framing
Insulation
Drywall Nailing --- -----------
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling - --- - -
Roof
Other: - - - ----- -
Final - `r
_PASS PART FAIL - -`
Post& Beam
Under Slab
oug
a r ervice _— ----- r,
Sanitary Sewer
Rain Drains -------- --
Catch Bnsin/Manhole
S orm Drain --- ----
Shower Pan
i -----------
_PART_ FAIL --- - --- ---- -- —_
CH "I
Post& Beam --------- -_------ - ----- --_ — -�-- _-
Rough-In ---- - - -- --
Gas Line ---
Smoke Dampers - ---- ---------__.. ------__-- __
Final
PASS PART FAIL ----- -- - ---- ----_^ - — -�_—.
ELECTRICAL
Service---------- ------�.-.-----_�.- .— --.---- -------_
Rough-In _ ------- - ----- - — ---
UG/Slab
Low Voltage -- -- --- -- - -- ----
Fire Alarm
Final n Reinc,-action fee of$ required beforo next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: F� Unable to Inspect-no access
Fire Supply Line
ADA /�q
Approach/Sidewalk Dam_ Inspector Ext
Other: _
Final DO hi T REM)VE this Inspection record from the Job site.
PASS PART FAIL