Permit i
I' t h I�1 L: /-
# r, PERMIT ,r/
��I lY OF TIGARD PERMI # ° MEC94-0291
COMMUNITY DEVELOPMENT DEP'ARtIVIJJVT DATE ISSUED: 10/21/94
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 16136DB -00900
SITE ADDRESS...: 11623 SW PACIFIC HWY
SUBDIVISION ZONING: R -12
BLOCK LOT °
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 . BOILERS /COMPRESSORS HOODS °
FUEL TYPES 0 -3 HP DOMES. INCIN:
: /GAS/ / / 3-15 HP . COMML. INCIN:
MAX INPUT: BTU 15 -30 HP . REPAIR UNITS:
FIRE DAMPERS ?..: 30 -50 HP WOODSTOVES..:
GAS PRESSURE...: 50-l- HP CLO DRYERS..:
NO. OF UNITS -- -•- AIR HANDLING UNITS OTHER UNITS.:
FURN < 100K BTU :1 C= 10000 cfm: GAS OUTLETS. :1
FURN )=100K BTU: > 10000 cfm:
Remarks: GAS FURNACE
Owner: ------- -• - - -- -. -- FEES --
MITCHAL GENSMAN type amount by date recpt
963 SW WESTWOOD DR PRMT $ 25.00 JF 10/21/94 -
5PCT $ 1.25 JF 10/21/94 -
PORTLAND OR
Phone #:
Contractor:
OWNER
•
Phone #: $ 26.25 TOTAL
Reg #..: --
- REQUIRED INSPECTIONS
This peroit is issued subject to the regulations contained in the Gas Line Insp - —
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This peroit will expire if work is not started
within 180 days of issuance, or if work is suspended for more _
than 180 days.
Permittee Signature:
Issued By: .ZLC/j�
_•. �._ _ -
c
� / Call for inspection -• 639 -4175
� f -e.
I ;I } r•..Ot TIGARD . MECI ANICAL PERMIT Receipt #
_-
L3125 SW HALL BLVD. Permit #
1 . O. BOX 23397 S It In e' i rlS.p•
De sciption
.'IGARD , OR 97223 I'Y` Gi, - t i - c e Table 3A Mechanical Code OTT PRICE AMT
'503) 639 -4175 C 4/7/ �� 1) Permit Fee - - 10.00
Name of Development
j 2) Supplemental Permit 3.00
/l Su) P4C i GiG /ai y
Job address _ 11 Furnace to 100,000 BTU 6.00
Address f 4� -
726 A Incl. ducts & vents
Taxt of . Map No_ 2 , ) Furnace 100,000 BTU + 7.50
Lot Block Subdivision incl. duds &vents
Name (or name of b ) 3) Floor Furnace
6.00
P9/ r / G � �
9,Jr,e I ncl. vent
Maim address Ph 4) Suspended heater, wall heater
6.00
Owner 963 �Sw 41)e-gnaw 0 Q one ) - or floor mounted heater
•
city /state zip a 30 5) Vent not incl. in
3.00
p,272.4^/0, 04 97.20/ S z3 appliance permit
Name (or name of business) 6) Repair of heating, refr ig., 6.00
ilee d% 6S X 72- cooling, absorption unit
Mailing Tess P Mrte Boiler or comp to 3 HP
Occupant 11423 j1 'w 7 '�/ ' `, y" 7) absorp. unit to 100,000 BTU 6.00
ZIP 8) Boiler or comp to 3 HP -15 HP 11.00
,7 O2 G}� absorp. unit to 500,000 BTU
Name / 9) Boiler or comp 15-30 HP 15.00
absorp. unit 1/2 -1 million
Mailing Address Phone 10) Boiler or comp to 30 50 HP 22.50
absorp. unit 1 -1.75 million
Contractor Zip 11 Boiler or comp to 50 HP 31.50
absorp. unit 1,750,000 BTU
State Registration No. City Bus Tax No. 12 Air handling unit to 4.50
10,000 CFM
I hereby acknowledge that I have read this application that the information given is 1 3) Air handling unit 7
10,000 CFM +
correct, that I am the owner or a , • ed agent of the owner, that plans submitted are in
compliance with Stat: �G,'s, + . I ay registered with the State Builders' Board, that the Non portable
14 450
number giv •• E (tt ; x • • State registration please give reason below).
14) evaporate cooler
Vent fan connected
. 15) to a single dud 3.00
16) Ventilation system not 4.50
included in appliance permit
17) Hood served by 4.50
mechanical exhaust
Signature ( owner or agent) Date 18) Domestic type 7.50
Describe work ❑ addition ❑ alteration repair ❑ incinerator
to be done residential 'g non - residential ❑ - 19) Commercial or industrial 30.00
Existing use of _ type incinerator
building or properly C.�5JV✓ %lW � C ✓ "C 70 t� 20) Other i.e., woodstove, water 4.50
Proposed use of heater, solar, clothes dryers, etc.
building or property 1/V.-0// ' // ek,
21) Gas piping one to four outlets / 2.00
Type of fuel - oil ❑ natural gas, LPG ❑ electric ❑
22) More than 4 -per outlet
NOTICE
SUB -TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S% SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25% OF SUB -TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER '
0
WORK IS COMMENCED. TOTAL & rJ
Special Conditions
Date issued by
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON 55 NORTH FIRST, DEVELOPMENT LSBORO, OR 97124
COUNTY, INSPECTION REQUESTS: 503 /640- 3561/693 -4415
OREGON XXXXXXXXX - -> 640 -3470
Page : 1 of 1
Date : 11/09/94
Time : 15:36
Permit Type : Residential Electrical Permit Permit # : 05060613
Permit Status : APPROVED Applied : 11/09/94
Situs Address : 11623 SW PACIFIC HW TI Issued : 11/09/94
Permit Title : SFR - 1 CIRCUIT Completed :
Permit Descr. To Expire : 05/08/95
Project Title : SFR - 1 CIRCUIT Project # : P0045383
Project Descr. : * EROSION *
Parcel Number : 2S1TI - Land Use District :
Valuation 0
Legal Descr. .
Owner : INSPECTION - TIGARD Construction : OTH
Applicant Name : GENSMAN, MITCHELL Classification : 900
Applicant Addr.: 11623 SW PACIFIC HWY Occupancy •
TIGARD OR 97223 Validated by' : EB
Applicant Phone: 285 -6383 Inspector Area :
t•'ee description Units Fee /Unit Ext fee Data
1st Branch W /out Feeder [Enter #] 1 35.00 35.00
Subtotal Electrical Fees: 35.00
State Surcharge of 5% 1.75
Total Electrical Fees: 36.75
* ** Fees Required * ** * ** Fees Collected & Credits * **
Method Check # Receipt No. Date Payment
CASH 000 11/09/94 36.75
T'O'TAL THIS DATE * * * * * * * ** 36.75
Fees: 36.75
Adjustments: .00 Total Credits: .00
Total Fees: 36.75 Total Payments: 36.75
Balance Due: .00
•
NOTICE: This permit becomes null and void if the work or construction for which it Is Issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void If construction is interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents In support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior t• approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all inspection req • re •!- nts are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the • o • - / w ch the permit is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the . tisf: c • n f fi ns ectlon requirements.
i i
APPI!C1 S 1c' AT I
•
•
___Ak WASHINGTON COUN ELECTRICAL PERMIT
WO Department of Land Use & Transportation
Electrical Inspection Section
155 North APPLICATION
155 North First Avenue, #350 -12
• Hillsboro, Oregon 97124
Information: (503) 640 -3470 Fax: (503) 693 -4412 permit J
PLEASE PRINT Number S �� O t% 13 Date f /
Please complete all sections, 1 through 5. 4. Complete Fee Schedule below
1. Location of installation Number of Inspections per permit allowed
Address /J67613 c50✓ pc/Are/9441 . Service included: Items Cost(ea.) Sum
Building / A. Residential - per unit
City 7 64p,_,p /L. Suite No. -
1000 sq. ft. or less $110.00 4
Tenant Name Each additional 500 sq. ft
(if commercial) NA or portion thereof $25.00
Limited Energy $25.00 1
Map No. Tax Lot Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
Thomas Map Book: Page: Section:
Directions B. Services or Feeders
Installation, alterations or relocation
� �
Commercial Ell 200 amps or less
$60.00
Residential 1X► 201 amps to 400 amps $$80.00 2
�` 401 amps to 600 amps 2
$120.00 2
: Over amps to amps amps $180.00 2
2a. Contractor installation onl
Y Over 1000 amps or volts $340.00 2
Electrical Contractor Reconnect only $50.00 2
Address
City State ZIP C. Temporary Services or Feeders
Date Job Number Installation, alteration or relocation
Property Owner 200 amps or less $50.00 2
Contractor's License No. 201 amps to 400 amp $75.00 2
Contractor's Board Reg. No. 401 amps to 600 amps $1 00.00 2
Over 600 amps to 1000 volts see 'B' above
Signature of Supr. Elec'n D. Branch Circuits
License No. Phone No. New, alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase of service or feeder fee.
/ Each branch circuit $5.00 2
0 The fee for branch circuits without
Print � 2 3 s Nam 'G Phone No. purchase of service or feeder fee.
A r re ss First branch circuit I $35.00 =� 5 l 6 2
-73-2;71172,12 ., 977-3 3 Each add'nI branch circuit $5.00 2
City State Zip E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
The installation is being -d- on property 1 own Each sign or outline lighting $40.00 2
which is not inten d f•r a.'-, lease or rent. Signal circuit(s) or a limited
/ energy panel, alteration
Owner's Signature ' s - '° or extension $40.00 2
I F. Each additional inspection over the allowable
in any of the above
3. Plan Review sec pion (if required) Per inspection $35.00
Per hour $55.00
Please check appropriate Item and enter fee in section 5B. In Plant $55.00
4 or more residential units in one structure 5. Fees
Service and feeder, 800 amps or more 1
System over 600 volts nominal A. Enter total of above fees $ 35_ Oct ,
Classified area or structure containing special 5% Surcharge (.05 X total fees) $ / , 7 5
occupancy as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. Li Trust Account $
Balance Due $
For inspections call Thls permit becomes null and void if the work authorized by the permit Is not commenced
640 - 3561 or 693 -4415 within 100 days from date of issuance of such permit or if the work authorized is
suspended or abandoned at any time after work is commenced for a period of 180 days.
24 -hour recorder, one working day in advance of need Electrical Permits are non - refundable and non - transferable.
8/94
DEPARTMENT OF LAND USE & TRANSPORTATION
MI WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350 -12
155 NORTH FIRST, HILLSBORO, OR 97124
1. COUNTY, PHONE: 503/640 -3470
OREGON INSPECTION REQUESTS (24 hours): 503/640 -3561 or 693 -4415
Permit #: 05060613 Project #: P0045383 Status : APPROVED Page 1 of 1
Applied : 11/09/94 Issued : 11/09/94 Expires : 05/08/95 11/10/94 06:08
RESELEC
Permit Title SFR - 1 CIRCUIT OTH 141
Description 5 - - ■(.5 Begun: 11 /09/94
Job Address 11623 SW PACIFIC HW TI 3
Owner Name INSPECTION - TIGARD -(..-/ Region D
Applicant Name : GENSMAN, MITCHELL
Phone number 285 -6383 Valuation: 0 Approved
Inspector Comments: Rejected
I VR- RESULT'S
7e2/04eL . T,E „r A 4
v�4 6 , -Au W' REQUEST ERROR!
Inspected by: _.4 \_ . r 0 - Date:
Inspection Requested:
* Cover & Service 0-3 E AP DN IVR
11/10/94 RI TK B 111 OR AFTER 3 I
* Cover '404 E AP DN IVR J
11/10/94 RI EB
,r� c. i s - . - , - ; ,I
2: ' , • 1 1 , , • ' - . .
, . . • • ' , 1 . . . .. .
1
,„
,
• . , , • . ' I• DEPARTMENT OF LAND USE' &'TRANSPORTATION
• LAND-DEVELOPMENT SERVICES` DIVISION #350 =12 , - . • -
, WASHIN
- ;1 NO RTH FIRST, HILLSBORO,;OR 97124 •-
■
PHONE: , 3470
OREGON ' , ' INSPECTION REQUESTS .(24 hours): • 503/640 -3561 or 693-44
. •G" rifii I £' Ti• 0. '6%0 61' a. .1'•' : 0 ' t=. T U 5 r ^ - s L'i j E - .r _ , _
••ff�� y � 7 _ ' U � ♦ . '�: _ - {�.,. • �', , 04. .] _ , �-_: � � "i= ::1'l.l_1 _ ,� � l: l� f _ ,l# i a Ya . _ ;�. ' � _„
'w s ?i:t ,��,!0�9 r94 _:,�1E,:' �'��1/U4/'�14 E 3�r, 1?' alt O5/0 8/'9'!. .• 1 .I 1 i] / 9', 01 .4'
'1-'e_ :="':'f1;1'. 73 t,.' .•• •, k. — 1 f_'. - r, Ti 2 0-T- h • •Tae:. _ b - t'i ,ire r - S'',:,•• tin `'7.i 0!;/-9 -
�76T? 'Y:= E-:_ :11623 1W e;3 t';T F Tt." 7.-f 'I'" . • -' ,
()VI .. i 1 ? S_F -.. •:;.'.'1 ION - `�' 1 e ; 74.hIt 1: - _4 ? on _ .
•AID •p ',1 r" f..:1.2'... 1: , .1 Y. . G N r ? r11\i , 1 I T• C ' : n r , •
'Pl?_,n %- r " 285 -63. Val aa_L.ioI-,. - U - A: a-- '�Y•`i . •
Tsl�� - )ecI:_ (�i�i`tatlE ).t . , • •E4' i ,3: 1. I3_. ___
j _ r
•
•
•
•
k.: �'.ry; _r.,. - 4 r. A.- ON, "V
, 6 ,
1'; � /'_ � ._ 1Z,I - - ‘ ' <.'' 2135.76,2 : 1v1.1 'r•HEL'L+ , i' •
i, / 1toi'° : : 'b .. •,P I - ,,
•
•
AN
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350 -12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503 /640 -3470
OREGON INSPECTION REQUESTS (24 hours): 503/640 -3561 or 693 -4415
:Permit #: 05060613 Project #: P0045383 Status : APPROVED Page 1 of 2
Applied : 11/09/94 Issued : 11/09/94 Expires : 05/08/95 11/18/94 05:31
RESELEC
Permit Title SFR - 1 CIRCUIT OTH
Description Begun:11 /09/94
Job Address 11623 SW PACIFIC HW TI
Owner Name INSPECTION - TIGARD Re•_i -•
Applicant Name : GENSMAN, MITCHELL
Phone number 285 -6383 Valuation: 0 Approved
Inspector Comments: Rejected
IVR- RESULTS
REQUEST ERROR!
Inspected by: Date: it-a- 71
Inspection Requested:
'* Cover 0404 E AP DN IVR
11/18/94 RI JM
11/16/94 RI MJF 285 -6383 MITCHELL
11/16/94 DN KP DNIVR LUT5 I BS
11/10/94 RI EB
11/10/94 DN WJB DNIVR LUT2 I BS
INSPECTION NOTICE
City of Tigard Building Department
' 13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec- O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: 409 i' 41 / I 14 d' • / .. 4 &_ - .e ,ii f /
Footing P1.•. Underslab / Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line ' (fNAL>
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb. I .115Z____ Plbg. Underfloor Water Me
Line Gyp. Bd. -ch) JL
/ /
Date Requested: !/ l f /9 y Time: AM PM
Address: /f3 fia-c . / Permit t -�� �r
B = ‘5 - 3e - 3 /YIi. ! .
THE FOLLOWING CORRECTIONS ARE REQUIRED:
.....
d 6- ..t ___
Inspector: Date: I /1/ - ! - % /
APPROVED DISAPPR D APPROVED SUBJECT TO ABOVE
Call For Reinap.
/ 2424:e-de-4-)j-
T, 6 INSPECTION NOTICE
City of Tigard Building Department
13125 SW Sall Blvd_ Tigard, Oregon 97223
Inspection Line (Rec- O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection: 'L1' A - =
Footing / Plbg. Unde ' lab ark Rough -in Appr /Sdwlk
Found. Plbg. Top Out (Gas Line FINAL:
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water ` Line Gyp. Bd. -Mech.
Date Requested: /1 /3 /9 '( Time: AM PM
Address: / 0 / s, 1 ._. __ 0 I[./ Permit (AFC 9y - Da i l
Or
THE FOLLOWING CORRECTIONS ARE REQUIRED:
/ . b AA,S,12,_ v' l C.31/A- 4 1 £ l/■..c)...c7 :e,
cp r'</•l Le.. Q. -f • S - C5-Cg
l ( i ____7:A.,,S \.)- vv.../........, A-- czi2 S\ _Qs) .1/4.) 0---.0(1
„..:1Z \ 6 ...,,;... \ -V --7,_
.r 01..---- GQ._ u.--1 N..-9-r- -t,,._
0 S
I% - „SJ'.._4t‘- vw f
s c�z.s lac, �s s �...r- .` 1.es S AA
1v
- ` a # CLAD -11-test- •
Inspector: Date: I (--3 —414'
APPROVED
DISAPPR D APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
Q....
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line.(Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Plbg. Underslab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out C----Gast.+ T i A:D
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb. --
Plbg. Underfloor Water Line Gyp. Bd. '
Date Requested: ////O / / Time: AM PM
Address: /162 a. 3 P f it .� y Mej- Permit I: l ?(..t.0...1
Builder: CJ
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1 C .t.S Is<s �� \ O'..3 q
L 1.34 4o r - �; I ` 0 ‘. S
- 2- -I rk \r-c • *L.1 k/ • ,- k—c--,,
/ ` ` -,./.._ c , " \ J k - ,
( !. \ &- \
(J (1..e...., _ �J Y
C --c-v■ ...--kr1/4.._ __--,'. t" Q 9--/ -C___AN.r -- 0--_,. L-z--,/N. -
c i. Inspector: V v -,, Date: ' / ` 0 4
APPROVED DISAPPROVED ✓ APPROVED SUBJECT TO ABOVE
''.--R \ Call For Reinap.