16785 SW QUEEN MARY AVENUE i
16785 SW Que,sn Mary Avenue
\ CITY OF `T'I G A R D MECHANICAL PERMIT
�y �ly DEVEL ®PMENT SERVICES PERMIT #: MEC2002-00556
13125 SW Hall Blvd., Tigard, OR 97223 (503) fi.. -4171 DATE ISSUED. 12/10/02
PARCEL: 2S115BC-17000
SITE ADDRESS: 16785 SW QUEEN MARY AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: V'--NT FANS:
OCCUPANCY GRP: R3 VENTS W/O ADPL: VES-i SYSTEMS: 1
STORIES: n0111.ERS/COMPRESSORS___ HOODS.
_ F U_EL TYPE-S 0 - 3 HP: 1 DOMES. INCIN:
l-PG ^^ _ 3 - 15 HP: COMML INCIN:
MAX INPU I': BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE. 50 + HP: CLO DRYFRS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU. <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install HVAC, AC, venting for WH, and gas pilw q with 1 outlet.
Owner: _ _ _- FEES _
SALLY WERK Description Date Amount
16785 SW QUEEN MARL' — --
KING CITY, OR 97223 I X11 c 111 I'crnnt [-cc 12/10/02 $72.50
IAX1h State 1,1\ 12/10/02 $5.80
Phone: 503-62-4-1499 Total x78.30
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 45 i--IS12 Gas Line Insp
Mechanical Insp
Reg#: LIC 62196 Heating Unt Insp
Cooling Unt Insp
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. A"1 TENTION: 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)246-669?,:;-
Issued
503)246-6699,::Issued By: �'' l-1!_ s` Permittee Signature: '� J
Call (503) 639.4175 by 7:00 P.M. for inspections needed tl-.,i next business da#%
12/06/2002 09:59 5036393771 CITY OF KING CITY PAGE 02
�JNTM
TRIC
• CENTfR tilechlan,cJa1 PE'CI1111. .�pplicataon
sERVICE
— -- ---- Permit no: l' ^ !c -UDS" 6
este received:j' _ � _ ;�-- l•t' t
r City of KingCity �-. \� Prt�jat/apps. no.: Expire date:
13125 SW Hall Blvd. t Receipt no.:
' Tigard OR 97'_'2'3 Date issued: gyt P
Clackamas Phone: (503)639-1171, FAX (503 -fm 2002 C,se file no. Payment type:
Multnomah
t,LashingtonCITY OF TIGARf.) Building rxrtnit no.
Land use approval; _
Q- 1 III QING Q1,31UN
I & 2 Cartuly dwelling or accessory 2 Commercial/indusm.il Multi-fanuly Tenant „nprovernent
New construction 'J AdditiotValtetauon/repiacement fhher: ------
INFORMATION t n
t.
lob aadress: _ S W ectal /'✓ G _ (ndicatc equipment yuantiurs in boxes below. Inds:a,te the dollar
Suite no.; value of all mechanical inaterials,equipment. labor,overhead
pldg. no.. _ profit- Value S
Tax ma /tax lorlticcount no.: �
Lot: Block: Subdivision; _ "Ste citeckl!sr for Important app/lcatfon infornit (e01 andPr))act name: jurisdiction's fee schedule fc r residerrttnl tar rnrr /ir
Gtvlcounty: � • ZIP: 7 �'� t r a
Ilu
t
De paon and Iola n ofv�ork oq premise
G+�t t✓�Pr" /tri� At-64 rmk ___ _ I Ira(d.) Total
Est,data of cam pleuonlinspaaion: Dlat l.'ne f2-•1-fir �estziPdoo _ Ras ool 1114s.only
Tenant improvement or change of u.;4: fir handling unit _ :FN Soo I
Is existing space heated or conditioned?a Yes Q No Air con inning(sire an ret uired)
Is existing space insulated?t7 Yr,5
IJNo Alteration of exjstin AL s stem I
t e.,, t of K/compreasots
State boiler permit no.:
Eiusinessname; la C. �'�I,'_�/ "_ - 1{P Cons BTL
-\ddress: /6-5b 4 $`kl "72 TvG ir"e smoke dampers/ uct smo r detecwro-
y; —state0 ZIP: er eat um (slid pl— an re uTind)
�f,,,,,te: yS 3- Z F1�_ 7t�y[E-mall: Insta /replsce lurnac BTU
urner_ I
including liner C.1 Yes❑No
,CB no.. Z kA _ talVreplace/telocate henters- suspen cd, j
'itv,l metro lie. no.: wall,or floor mounted - f
game(please print): cvc(rN n ua vent ora (lance ocher thannace
Refrigeration:
gZil 7 Absorption units
game: -Tasb+t 0 u+� Chillers
r_,I rosin _ ^lip
�ddrt s: is vir anin7n—W echnust and ve at radon:
State.
. LIF': Appliance vent -- _ _ ---
'hone: '�� Fax: t: mail: ryer exhaust
t oo&"vpe U Illres.kite a.Irlat
hood vire suppre,lion system
.ame; /a''f Exhaust ran with single duct(btuh fans)
tsUin address: u-tee Exhaust system tin trom htiatirit or AG— 1
Y_ ue piping and distribution(u;i to J outlets)
State; Z1P_--_-_- T LPG k_,%40.` Oil
hone s '/ Fax: E-mail, tie! i in each addiuona over out ets�—
ocew piping ischemattc requ it ed)
Number of outlets
ther feu a?pltancY o� r equl'P neat:
Decorative flrrplace
ZIP: _ Insert ry —
E•rrail oo stogie/pe et strve
none: Falx; Other. _
plicartt's signature: — Date: 12- Other: _
acre•( tint). '�"s r_�ro
Permit`ee......................S
,,;,w�.rlclYonf xecol aodli cardr.pkareeeJl iurladuaun i,v mnre,nrormmtan ,Notice; Thit permit applicamm � -i S
tit:.-mum fee ................ _
i�
3.%,f isterc-Vel txpLeer if a permit Lit not obtained
f Ian 1•e�few(at , Sb) S
�
t =rd number: -UhLr eys 1,10 dafter u has be ,t
xv�rei S,nte suL•cha.rge($5b).....S �O
;v,,me of cot elder is oow%as redo cwd etCtprtd a.e totnplatr- TOTAI. ............. .
E
cmdnolder Signature: s Amount 444617 fb,eo COM
CITY OF
T I G A R D _ PLUMBING PERMIT___
DEVELOPMENT SERVICES PERMIT #: FILM2002 00 76
13125 SW Hall Blvd., Tigard, OR 972?3 (503) 639-4171 DATE ISSUED: 12/101'02
SITE A; DRE-S' 16785 SW QUEEN MARY AVE PARCE,: 2S 1 15BC-17000
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING M 1CH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 WATCH BASIS'S:
FIXTURES_ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS URINALS: 5REASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 11
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install expansion tank,water heater and hydronic pump &co;' _
FEES
Owner:
Description Date Amount
SALLY WERK — —��-
16785 SW QUEEN MARY IPLUN1113, Permit Fee 12/10/02 $72.50
KING CITY, OR 97223 1 IA X I W ,,~talc l ax 12/10102 $580
Total $78.30
Phone : 503-624-1499 -`- - —
Contract,e)r:
PETE'S QUALITY PLUMBING
20985 S. SWEETBRIAR RD.
WEST LINN, OR 97068
REQUIRED INSPECTIONS
Phone : 503-557-8450 Rough-in Insp
Final Inspection
Reg #: I IC 122359
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
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699.
Issued By: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
12/06/2002 09:59 5036393771 CITY OF KING CITY PAGE 03
TRI-COUISISERVICE CEN tK Plumbing Permit Application
Date received:10 k)_. 'y- Permit no.: (•/r i -�`17�'
f City Wf King Cit YBEC ��/��} Sewer permit no.: Building permit no
1312 S Hall Bl
Tigard,OR 97223Prolecl/appl.no.: Expire riate• —_
Multnomah Phone: (503)639-4171. FAX: (50"84 11172002 Date issued: Y. ' �eReceipt no..
Washington GITY OF TIGAKG Case Ole no.: Payment type:
o U N r , . band use approval: _._tea, t l,lt� r►nN _
o
I & 2 family dwelling or accessory U ComrneretaUindusu-lal J Multi-family >'i enar t improvement
ZI New construction ZI Addition/alterano;>/replacement '] Food service 0 Other
address: �67�s Sw i-,Me.�f, aiy. Z _Drsc:lpNon Qt . Fee w Tow!
24"y dwell n�tNtly:
uidg. no.: Suite nNew t-and 2
0,: (lndudes 14X)R.for earth ntlH y connectbn)
TI ax map/tax lot/account no.: SUR (1)bath
i (mot: Block: Subdivision:
~Pr eo c) t name: _
City/county: -)'' C y^ ZIP: 1 a2 ch additional bath/kitchen
rD scripdon and 1��cation of ork o pr noses: Site utillHea:
-eaf �lnTo p4"-4r Catch basin/area drain
Est, date of com ledonAns tion: /2-/2• ell each liaeltrenc virgin
in
(n
drain o. n.ftJ — —
Manufactured home utilitie i
Business name: +; e's to r'` anhoIas —
Address: '?01'r connector
City: inSanitary sewer(no. lin.ftJ
Phone: . , Fax: E-mall: tone sewer(no.lin, ) — -
CCB no.: �zz"�S �1 Plumb. bus.reg,no: '3-3 WN P� alar service no. in.ft.)
Fixture or Item:
^City/metro lic. no.. - 9 Absorption
' Absorption valve
Contracux's representative signature: _ Back flow preventer
Print name: -:17�vscn p N N te: 12-6-a"? backwater valve
Basinsflavatory
Name- _5q.rol^ el(4 C Q Dishwasher er -
Address:
City: State. ZIP:
actor/sump
Phone: 5�2-o�el Fax: Email: Ex ansion tank
Fixture/sewin cap
Name(print): q. 1/ Roara r dls/amour sink+/ttu�
Nailing address: Hose—bib spa
City: - -- State: ZIP Ire maker
Phone: rceptor/gt-eaee tnp
Owner lnstalkWon/residentfitl maintenance only: The actual traWladon mcr(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(c0rtVnerCial}
emplavee all the property T own as per ORS Chapter 447. ink(s). asin(s), ays s)
Owner's s! nature; _ _ Date:
U s/sitowec/tower pan
Ji-
Urinal
Name: ater closet
Address: _ Water heater —
City: State ZIP: _ Other
City: ,r� "TC071
Phone. [Fax: E-mail: Total
_ Minitrlum fee -............S
.4ji all;uritJluions maert mwo eard.i,plaaxe call Jurkell Uoa for mora infor wo"n Notice: T/t(t perwit applieaticrn c7b) S
IV f'a ]Maiter[ard erpiret if a permit it not obtained Plan rt,view(at __
rodli card number. l -/ within 1,40 days after it kas been State 9 srchrchNrge(8%) .. 5
FNoires TOTAL ............. . ...._S
accepted as eompti'r. ( G
Name)f cardholder as%hown on credit Aid s f t o
Cardholder jillin Lire Animal 4404616 WDOOCpnl
CITY OF TIGARD 24-HOUr
BUILDING Inspection Line: (503)639-4175 MST -
INSPECTION DIVISION Business Line: (503)639-4171
Received -7 J'jp
__Date Requested M�,.,� _ BUP _
Location MEC U Q aL �• .��'
Contact Person — Ph( —..—_) ( PLM _,
Contractor__.— — Ph(__ ) SWR
BUILDING Tenantl wr r _-- . .leay-/�f99._-- ELc - ------__
Footing
Foundation ELC
Access: -
Ftg Drain ( 7 l '� FLR -- -
Crawl Drain
Slab Inspection Notes: SJ -
Post& Beam
Shear Anchors ,
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ----
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ----------
Roof
Otl,nr.- - ---- --- —
Final
PASS PART FAIL
Post&Beam
Under Slab
Rough-In
Water Service -- ---- - ----- -- -
Sanitary Sewer
Rain Drains ----- - -- -----�-- - — --- --
Catch Basin i Manhole
Storm Drain - - - -�- -
Shower Pan
Other.
PART FAIL - - -- ---
ECHANIC -
ost& Beam --- -— —--------------
Rough-In --- -- -
Gas Line -�------- - --
Smoke Dampers — ------. _ _
PART -
CTRICAL
Service
Rough-In
UG/Slab - - -- T-� ----- - -
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 HE:___ __- _ _ Unabin to inspect-no access
Fire Supply Line
ADA
Approach/Sidnwalk Data l _l1.ulnapectrir-._. -- _-- --Ext -----
Other: _
Final DO NOT REMOVE this �nspectian record from the job site.
PASS PART FAIL