15965 SW QUEEN VICTORIA PLACE i
15965 jW QUEEN VICTORIA PL
KING CITY
mss, 1,M00 S.W. 116th Avenue,Bing City,Oregon 9,224 Phone:639.4082
COMMUNITY DEVELOPMENT
APPLICATIC,N FOR BUILDING PERMIT
(Instn ctions on rev:rse)
DATE 93
1. NAME OF APPLICANT: �.r'✓/� T'/� '- �/'/iJ Phone No. 459zf'.�r177
ADDRESS: l�—L 2�2'
ADDRESS OF PROPOSED IMPROVEIr43V'T C'�.c� -
2. TYPE OF MANGE, IMPROVEMENT OR CONSTRUCTION FOR WHICH PERMIT IS REQUESTED.
DESCRIBE BRIEFLY - ATTACH TWO COPIES OF PLANS OR DRAWINGS Cr'
PROPOSED PROJECT' %N. _/x s -
3. NAME AND ADEPESS OF CONTRACTOR D bV
PHONE No. LICENSE NO.
I
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJECT WILL BE NOTIFIED BY THE CITY.
5. APPLICANT r, HER/HIS REPRESENTATIVE MUST BE PRESENT AT THE: PLANNING CCMMISSION
MEETING NEXT HELD ON
REPRESENTATIVES MWg ___.PHONE NO.
(The Ring City Planning Commission will consider only those applications received at least five (S) days
prior to a meeting.)
SIGNATURE
APPL I CATION RECEIVED BY 7� / � �r,�4 _ DATE " � 3
APPLICABLE FEE RECEIVED $ TOTAL L(i t-A
PLANNING CCtIMISSION DECISION: Approved_ — D?ied
p e
CONDITIONS ,L -U-k
"lppV/ 71A
lications ar for sir months 0511
Signature .` Date "
NOTE: Ors on 8omebuilders Law requires that ail persons w o cootract fo work on eir residence be
registered with the Builders Hoard which maos the cont•ict:: is bonded a insured on the job site.
For your protection, be certain your cont*.actor is registered tir calling City Ball Ph: 639-9082,
NOTE: A permit must also be obtained .om the City of Tigard Department of
Camnmity Development Yes Pio
CITY OF TIGARD INSPECTION REPORT
The above listed project has been inspected and approved.___denied
Date Carment s— ----
Signature_
(&r,i.P_din 9 .vvS P1P c to i. pf za,&e. np tru o►tz ( 1) copy to King r%t J)
CO 2-81
CITY OF T I(r'1'A RD _._.. MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002 00161
,.� 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED221102
PARCEI.. 25110CC-12200
SITE ADDRESS: 15965 SW QUEEN VICTORIA PL
SUBDIVISION: KING CITY NO. 3 ZONING:
E LOCK: LOT: 035 JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE: OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W10 APPL: VENT SYSTEMS:
STORIES: __B_OII_ERS/COMPRESS_ORS _ HOODS:
FUEL_TYPES _ 0 3 HP: T^ 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS _ OTHER UNITS:
FURN >=100K BTU: r_ 10000 cfm: _ GAS OUTLET S:
> :.fm:
Remarks: Furnace Installation.
Owner: `FEES
STRICKLAND, DAVID H O TRUSTEE Type By Date Amount Receipt
STRICKLAND, LORENE S TRUSTEE PRMT BB 4122/02 $72.50 KING CITY
15965 SW QUEEN VICTORIA PL 5PCT 73 4/22/02 $5.80 KING CITY
KING CITY, OR 97224
Total $78.30
Phone:503-645-1871 — —
Contractor:
JACOBS HEATING +A/C
4474 SE MILT VAUKIE AVE
PORTLAND, OR 91202 REQUIRED INSPECTIONS
Mechanical Insp
Phone:503-234-7331 Duct Inspection
Reg#:LIC 1441 Final Inspection
This permit is igR,11PH- Subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189.
Issue By: !' �_ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
04/22/2002 08:20 1036393771 _ _ .-.� CITY OF KING CITY PAGE. 02/02
I'.O1
tt+ V� tr
Aechanical Perndt Application
�
//,`� 'fl Daterceeived ,1'j�_ Pemus � �a,L�/iy� Of Tigard �yi � 'lobIllProjecitappl.no.: Fs ire due:
('7rvey'rtRo••! Addre'Ss:13LaSf+W,iieN-H4+d-i �(�K 97223 -- •.
11t.lnas-(+rl►�>$.39-+rrt `Jj 1L�.' �� DWI 1 issued•
i..aapproval: 6y aeoel no.:
1
F�rtx: ('aHY!'Z9RT�JOIT—' Case of�no:nd use.apprapproval: C
�` �1 ,�/r Bufldingpermit no.: paymenttype:
;1 A 7.family dwelling,or accessary 0 Commercial/induurial U Multi-darnlly U Tenant impronrbent
Nrw coustrucnon J Ad,litioNalteration/replacement U(hbet
"I'a`ldttsu : �it J ` 4 _� , Indicate equipment quantities to boxes helow, Indicate the dollar
Bldg tw.: suite tw.. --� value of all mechanical matelUla,equipment,lallor,overhead,
Tax MRAKx lodhccount no.: profrl,Value S _-
Uw 19loek: ��ubd virion, - •See chot*list for important application information and
Nmjectname jurisdiction's fee schedule for residenual permit fee.
01#06uni- �Wwwlllwm mm WWII
-- -
Uescriptad Io4don of rk on prrmisrs: -- W
- C Fee(ca► Tota!
P�111`15 loom 11
61tr.date ofonmplerionN ion: - Da�rt/Ibtyr - Rot. � IKea.od
Tenant improvement or change of use: - 'IVAC'__.
Air handirn�unit _ CFM
Is r.xisung spscx hearts+,or conditioned?V Yes O No
is rxisting r _, u.sulated7 U Yeti O No -iii c man__nnin (siteRunt-"uu ) _
terTndfee n —. ---
rst'�A�i ryslun
--
13#Awaa nam: Sutr.1x11101 peiml no.
�''' 111' Toru__,_BtU/I l
Addrear _% t smrel-oce(tmm unsmo e e tors
City: St a Z1P:Crj leiaipu�ike - -
Fax: -
nstr111' aceTwnu-;tAurnei
Phone• .� f�.snail: rip _ _-
g — —• lnduding duCf*" /vent liner res U Nn
Ci hnetm Irc -•�- - estd�lepiace7reTmbt�rtea-svape�n
_'- - _
will.or floor mounted
Nuae lase tint). CLIC) 1,.; eat a appliance a of t 9`nTrnace
Alm"onuolts._. —._ f!Tlt/)i
Nit111E (7tillerc __ _ Nf
Addmss: - t'o 1rcalors Nl' �_
��, Mlgldl M a rYi 011:
C1t : T - state: `T A pfianvevent
Phooc: Fax: E mail, mex aust -
Rix-h-Ty-p-eT(%r-4,k5t asniat
hontl(Im suppression tvurm
Hartle' CA Farraust tan airh ample ducr(hall1hns)
Mallin address. 1 �.r� Inhnu■t t uQm t fromTear -
Cit Stat �1P1�7."-
- In- y f oa use 1 n,1r ci
�:.. Tylw ---LF't� _ NO Oil
Phone: Fax: r--mail. Nuel pip_ 'n eacgua tlonAl ov�aTcii
ease (x.trmanl:,grist
Names iutnDer of rwtlars
or rquipwriH:
Address: _ Uccnr■tiv I■ o
Clty: - �wte ZIP insctl
Ila x w0cmutove4mile Ive
Applicant's siga U!@;
r'
Nome(prior): 4—. --
Net N}r tons■otrf[tr aradr..,Ii pow gall}.+,dct4r R•ieo1.u�rormMlori }fie mit fee.. ................,s
Notice thiilicdinn
U Visa 0 Matlwcwd sperrrltappMinimum fix.........•.....f
taprrro tf■(rrrnlll is not c/lltaine�f
cradt caro tarnr4er._..._.._ _--.__ _ —_I-. / Plan trvievr(at �,t!r) s
rtP1n, wdhin 1Ro day&after it lla■been Slue■urcharge(11%).—S
- -Elfterc'r0iufelsi.'iKi:,.o s Surepted av complete TOTAL ....... . ���•_
CITY OF TIGARD 24-Hour
BUILDING Inspection Lire: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST - -
BLIP
Receiver: - - Date Requested �`�1 AM_.-. PPMd BLIP _
Location __- _ �' (��la?.r1�1 �1�-�-C ite �L"�' MEC
Contact Person Ph( ) 2 3 y -7.3 3j PLM
-- -
Comractor . _(7 -- Ph(.-) - -- - SWR _
BUILDING Tenant/Owner - _ -_ _ ELC
Footing
Foundation E LC
Ftg Drain
Access: 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
SS PARTFAIL
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:____ --------- ---
Final
P _ PART FAIL
MECHANICA
Post& Beam - - -- -_ --
Rough-In
Gas Line
Sn%tmDampors _
Fih
ASS PART FAIL - -- -- - ---
Service -
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection lee o' required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
FABS_ PART FAIL
SITE Please call for reinspection RE:_ _ �� Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dab - 2 Q of Inspector Ext
Other:
Final - DO NOT REMOVE this hiSpOCtlom record from Ithe job site.
PASS PART FAIL