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12120 SW Alberta Avenue
/ CITY OF TIGARD —, MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002-00097
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/11/02
SITE ADDRESS: 12120 SW ALBERTA AVE PARCEL: 25103BC-02700
SUBDIVISION: CANOGA PARK
BZONING: R-4.5
LOCK:
OCK: LOT: 001 .JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
'TYPE OF USE: SF UNIT HEATERS: VENTFANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS.
STORIES: BOILERS/COMPRESSORS HOO[)S:
FUEL TYPES 0 - 3 HP —�- DOMES. INCIN:
I-P(' -- 3 - 15 HP: COMMI_. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 5C + lip: WOODSTOVES:
FURN < 110K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: — OTHER UNITS:
" 10000 cfrn: GAS OUTLETS:
Remarks: Replace gas furnace, insl.-ill exterior A/C unit. A/C unit n;ust nui be insatlled within the required setbacks.
Owner: — —�
FEES
BUCHHOLZ, KARL PAUL JR Type By Date Amount Receipt
t;A R O L LOU -----_
12120 SW ALBER(A PRMT CTR 3/11/02 $72.50 272002000('
TIGARD, OR 97223 5PCT CTR 3/11/02 $5.80 272002000(;
Phone:503-521-9061 Total -----$78.30
Contractor:
COLUMBIA HEATING + COOLING INC
8900 SW BURNHAM
TIGARD, OR 97223 REQUIRED INSPECTIONS
Sas Line Insp
Phone:624-2704 Mechanical Insp
Reg #:LIC 76359 =final Inspection
PI-M 34-175
This permit i; issued subject to the regulations contained in the Tigard Mi.rnicipal Code, State of Ore.
Specialty Codes and all other applicahle laws. All work will be d+)ne in accordance with approved
plans. This permit will expire if work is not started within 180 days -)f issuance, or if work is suspended
for more than 180 days. ATTENT ION: Oregon law requhas you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questicps to OUNC by calling
(r;n,i)7ctR-c11 Rq
Issue By: E' Permittee Signature:
Call (503439 4175 by 7:00 P.M for inspections needed the next business day
MechanicalPermit Application
_._____� ---•----- Datereceived:
City if Tigard ProjecUappl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd,Tigard,CR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.
Fax: (503) 598.1960 Case file no.: Payment.type:
Land use approval: — Building permit no.:
*NLI &2 family dwelling or accessory U Cofnmercial/industrial U Multi-family 0 Tenant improvement
U New construction '0-Addition/alteration/replacement U Other:
Job address: /z L2_ ✓iRCe Indicate equipment quantifies in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax IoVaccount no.: profit. Value$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county:_ , , ZIP:
Description rid I cation of work on premises: _ I t
1!k t Ju.C4l WLA' Fee(ea.) lotal
Fst.date of com etion/inspection; ilexri niun QI , Res.only Res.only
Tenant improvement ur change of use:
Is existing space heated or conditioned?U Yes U No Air handlin unit _CFM _�
Is existing space insulated?0 Yes 0 No it ron atoning(site plan required) -
teras ono existing HVACsystem
Boiler/compressors
Business name: -J. t4ezz I 't -- HP _Tons J.n4 State boiler permit no.:
� BTU/H
Address: g9p0 SLIJ "?Li 1,,1 e" it smoked npe�rs ruct.smoke etector% --
City: `�' State:n/L Heat pum TTen required
Phone: (e i - ;Vit'J I Fax: E-mail: nsta ep ace urnnc, urnerg v,
Includin-KURTWOTIlvent liner Yes O No
CCB n7 ; _ natal rep ac re ocate eaters-suspen e
City/meett ro tic.no,:: 2 Z wall,or floor mounted
Name(please.print): /t-1; c f i i ! /o h r f) y— ens ora on:
thanf
a other urnace— —
`71-'6c �lgerat on:
Absorption units BTU/H
_Name: ���l�.) ✓JC+1ct�9E I f4 Chillers_—__—__ _----- HP
Address: �� f Cure HP
Cit Slate: nv ronmenta exhaust and vent al on:
City: %'tZ_ ZIP: Appliancevent
-/Q11
Phcne: j�J. Fax: E-mail: — ryerex Aust --`—floods.Type1/11/res itc en azmnt
hood fire suppression.system
Name: __—jJ �- 4 i, Exhaust fan with single duct(bath fans) —
Mailing address: 7 Exhaust system a art rom heatingor AC
City: i �, , Stater, ZIP: Z are piping an st ul on up to out a ss)
Type: ___LPG NG Oil
i Phone: z ) lry Fax: I E-mail: are piping each ad T,lonal over 4 outlets - --
rocesspiping(schematic require ) _
Name: Number of outlets
---- _ _— ter RiJ appilince or equ pment:
Address: --__ Decorative fireplace
City Stat Insert-type
---
Phone: � I Fax E-mail: stov pe etstove -
Applicant's signature: _ �j ,� Date: Y.� t
Name(print):
Nd tit j Hviicaant accept civat cards,pteem can jurisdi,ti.for moa information Permit fee.....................$
J Vie& ❑MasterCard Notice:This permit application Minimum fee................$
Credit card number expires if a permit is not obtained
-- ---�-- - -F.xpireel within 180 days after it has been Plan review(at
State surcharge(9%) .. .$
Nam of cardholder u ahawn on chit cud accepted as complete. —
Cadholder tignaturo — — Amount 4404617!6W/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 2 FAMiI.Y DWELLING FEE SCHEDULE:
TOTAL VALUATION: — FEE' _ Description: .___ --_---"l"--- — _ Price Total
51.00 to 35,000.00
Minimum fee$72.50 - — Table 1A Merhanical Code Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the firs.$5,000.00 and 1) Furnace to 100,000 BTU
dln ducts S
$1.52 for oath additional 5100.00 or ._In�clu-� vents 14 00--- ___--
fraction thereof,to and Including 2) Furnace 100,000 BT(I+
_ $10 000.04. including ducts 3 vents 17.40
-- ---
510,001.00 to$25,000.00 $1,48 50 t..r the first 510,000.00 and 3) Floor Furna.;e
$1.54 for(arh additional$100.00 or _ Including vent _-- 14 00
fraction thereof,to and including 4) Suspended heater,wall healer
1 $25,000_00___— or floor mounted heater _ v _ 14 00
$25,001.00 to$50,0(T.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional$100.00 or 6.eU
fraction thereof,to and including 6) Repair a^Its _ — -
_ $50 000.00 - _ _ _ 12 15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Alr
$1.2C fo each additional$100.00 or For Items Y-11.see or Pump Cono
fract,o_n_th_ereof. - _ _ footnotes_below.__ Comte --
7)<3FIP,absnrb unit -
ASSUMED VALUATIONS PER APPLIANCE:~ to 100K BTU - --4 _- 14 00
----- -- -- A)3-15 HP;absorb
Value Total ,
unit 100k to�00k BTL _ 2560
f escr�6on_ Qty _jE?Q A_moun_t g)15-30 HP;absorb _
Furnace l0 100,000 BTU,including 955 unit.5-1 mil BTU - 3500
ducts 8 vents I ---- ---- ----- - --
-- - - -- -- -..._._.__. 10)30-5(;HP;absorb
Furnace> 100,000 SITU Including 1,170 unit 1-1.75 mil BTU _ _ _ 52.20
ducts&vents --. 11)>50HP:absorb
Floor furnace InGgv
udinent 955 - unit IOH mil B r, _ 87 20
floor mounted healer
Suspended heater,wall heater or 9`s 12)Air handling unit to 10,000 CFM
_ _
Vent not included in applicance-__ `-145 --- -- -- l 10.00
Hermit - --- 13)Air handling unit 10,000 CF 4+ 11 20
Repalr units— _ 805
<3 hp;absorb unit, 14)Non-portable evaporate cooler
-- - -955
to 100k BTU -- 15)Vent fan connected to a single duct tG 00
3.15 hp;absorb.unit, - - 1.700
101k to 500k BTU 680
15 30 hp;absorb.unit,501k to 1 2,310 - 16)Ventilation system not int.luded in
mil.BTU appliance permit _ -- 1000
30-50 hp;absorb.unit, 3,400 17)Flood served by mechanical exhaust -"
_
1.1.75 mll.BTU --- 18)Domestic inrinetators 10 UO— -
>;0 hp;absorb.unit,- - - 5,725
>1.75 mil.BTU _ _ _ 17 40 _
I Ai handling unit to 10,00E cfm _ 656 19)Commercial or industrial typr Onei tor
r1u handlin unit>10,000 cfm _1,170 _ - 69.95
----- 20)Cther units,includin wood stoves
iJu,1• ortable eva orate r;ppter 8t; g
-P----�__..-,- L.-_ _ _
Vent fan connected to a single duct 446 10.00
-—- - -- - --
Vent system not Included In 656 21)Gas piping one to four outlets
-a liance permit A -A _ - 540
Hood served b my echanical Px"1_au ! _ 656 - 22)More than a-per outlet(each)—
tori
Domestic ir•dneralor 1,170 rtllinirrlum_ _Permit Fee$72.50 SUBTOTAL:
Commercial or industrial'ndnerator a
Other unit,including wood stoves, 658 T " 8•/.State Surcharge inserts,etc._ _ _ __ $
Gas piping 1-4 outlets 360 _ " 25Y.Plan Review Fee(of subtotal)
Each additi•)nal outlet e3 $
- Required for ALL or)rnmercial permiLS only
TOTAL COMMERCIAL — — $ — —TOTAL RESIDENTIAL PERMIT FEE:— �$ —
VALUATION:
Othor Inmmg19mr _prtd Fe":
1 Inspections outs,dn of normal business hours(minimum charge-two hours)
$72 50 per i,our
2 Inspection;.fa, Aiirh nr,fee is spoGfically Indicated (miniml.in charge-half hour)
$72 50 per hour
3 Adaitionai plea re claw required by changes,advitions ur rev cions to pla.s(minimum
charge-one-half hour)$'2.50 per hcur
'State Contractor Solitr Certification required fnr uniht>,Mk STU.
"Res!Aenllai A/C reouires title plan showing p!scament of unit
i:\dsts\fonns\nnch innsdoc 10/11100
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CITY V F TIGA R D _ELECT RICAL PERMIT
DEVELOPMENT SERVICES DATE1 IS UIED: 4/10G20?-00161
'13125 SW Hall Blvd., Tiqard. OR 97223 (5031639-4171
PARCEL.- 2S1038C-07.700
SITE ADDRESS: 12120 SW A!..BERTA AVE
SUBDIVISKPJ: CANOGA PARK ZONING: R-4.5
BLC%;K: LOT : 001 JURISDICTION: 1 lG
Prolect Duscription: Install 2 branch circuits: A/C and furnace.
RESIDENTIAL UNIT--- _ TEMP SRVC/FEEDERS _ _MISCELLANEOUS
1000 f;F OR L ESS:— _ 0 - 200 amp: � PUMP/IRRIGATION:
EACH ADD'I. 50CSF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 491 - 600 amu: SIGNAL/PANEL:
MANF HSA/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL i 10):
SERVICE/FEEDER�� _ BRANCH CrRCUITS
_. _ ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEL?ER: PER INSPECTION:
1 201 - 400 amo: 1st W/O SRVC OR FDR- 1 PER HOUR:
401 - f00 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION _
1000+ arnio/volt: >=4 RES UN'fS: -� GO; '.r+1LT NOMINAL:
Reconnect ons: __ SVC/FDR >=225 AMPS: CLASS ARI=A/SPEC OCC:
Owner: Contractor:
BUCHI IOLZ, :KARL_ PAUL JR OWNER
CAROLLOU
121:0 SW ALBERTA
TiGARD, OR 97223
Phone: 503-521-9061 PhwiW:
Reg tfi.
FEES _ Required Inspections
Type k3y Date Amount Receipt Rough-in
PRMT CTR 4/10/02 $53.50 2720020Wall Cover
Elect'I Final
5PC'T CTR 4/10/02 $4.28 2720020000(
�— Total $57.78
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 perii,;t will expire K work is not started within 180 days of issuance, or if
work Is suspended for more than t80 days. ATTENTION: Oregon law requires you to follow rules adopted by 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
Fermit Signature. Issued By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ _ _ DATE:
_CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: r. ; ' i�h- DATE: _
LICENSE NO:
Call 639417E by 7:00pm for an inspection the next business day
Electrical Permit Applica.tiiola
Date r..cel%ed: j o Pe:tmit no.L .� X�
City of Tigard Pruject/apt I.no.: Expire date:
city,v-,gard Address: 13125 iW Hall Blvd,Tigard,OR, 97223 Date issued: By.1b I Receipt no.:
Phone: (503) 639-4171 1 — —
Fax: (503) 598-1960 r7i��J Case file no.: Payment tyite:
Land use approval:
L� I &2 family dwelling or accessory U 0-immercial/industrial U Multi-family U Tenant improvement
U New constnictiou U Ad(Iititm,'alter itiorl/re})laccmeni U Other: U Partial
i
Job address: 1Zr� ["fl _ 71y, rnti : t lo I Tax map/tax lot/account no.:
LAW BI ck Subdivision:
Ptnject name: Description and location of work on premises:_1 "r k_l-i L� (kC` t c T
i
date of cons letion/ins action: T� - (- r�
Job_no:_ 0 L I rJC-I1 _ —�.. Fn Max
Business name: IM_cripvion Qty. (en.) 'I oral no.lnsp
—--- New resirknl "gic m multi-famlly per
Address: dNellinp roll.Includes of tacbed ganige.
City:— State: VP: aerviceincluded
Phone: Fax: E-mail: 1000 sq.ft.or less _ 4
-- Each additional 56 sq.ll.air portion thereof
CCB no.: �EICC.bus.IIC.no: H mited energy,residential 2
City/metrollc.no.: Limited energy,non-residential _ 2
_
Each manufactured home or modulo dwelling
Si nature of supervising clectrici.ut(required) Date - Service and/or feeder 2
Sup.elect.name(print): no: Services or feeders-Installation,
alteration or relocall-,is
200 amf,or less 2
1 201 amps to 400 amps 2
Name(.print): l t,\y�j 401 amps to 600 amprj _ 2
Mailing address: ) 110 Q W %�(-,- 601 amps to 1000 ams 2
City: Statej, Z1P: 7 13 —Over I(W amps or vrohs --- — 2
Phone:.C:/ Q iii/ Fax: ]:-mall: � Reconnectonly I
Owner installation: s'he instailation is being made on property 1 own
Temporary senir.nor feeders-
which is not intended for sale,lease,re L r exchange according to tasfallallon,alteration,orrelocar'rn:
ORS 447.455,479,670, 01 200 amps or less _ — 2
,j 1 L, 4 2 201 amps to 400 amps __ 2
Owner's si nature: Date: /�_ 401 to 600 ams 2
Branch circuits-new,alteration,
or extension per panel:
Name: _ _— A. Fee for branch circuits with purchase of
Address: service or feeder fe each branch circuit _ 2
City: Stale: ZIP: B. Fee for branch circuits without purchase
of service cr feeder fee,first branch circuit. 2
Phone: Fax E-mall: Each ad'itional branch circuit.
Mise.(Service or feeder not Included):
L)Service over 225 amps-commercial U Health-cite facility Each pump or irtigation circle _ 2
G Service over 920 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feel four or Signal circuit(s)or a limited energy panel.
G System over 600 volts nominal more residential units in one structure alteration,or extension' 2
O Building over three stories U Feeders.400 amps or more •peri tion:
U Occupant load over 99 persons U Manufactured structures or RV park Faeh additional Inspection over the r4o"able in any of the above:
U Egress/lightinpp!an U thher — Perinspection - —��---
submit_sets of plaits with any of the above. Investigation fee
The above are not applicable to temporary const nlctlon service. Other
- Permit fee..........,. ...
Not all)nrisdictlow aep eccredit cards,please call)udOction Iot noxe ImR,rnndnn. Notice:This permit application """
U Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
Credit card number__ _ __ 1 1-- within 190 days after it has been 'hate surcharge(8%)....$
Expires accepted as complete. TOTAL . $ �-
Name cardholder w shown oo�cr►(1 card
S _
— --- Cardholder signature �� Amount 4411-4615 WXYCOMI
ELECTRICAL PERMIT FEES: LIMITED ENERGY PE''RMIT FEES:
Complete Fee rhedule Below: TYPE OF WORK INVOLVED -RESIDENT IAL ONLY
Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: _ Items Cost Total
Check'Type of Work Involved:
Residential-per unit
1000 sq.ft.or less $145.15 _ q ❑ Audi,)and Stereo Systems'
Each additional 500 sq.ft or
portion thereof _ $33.40 __ 1 ❑ Burglar Alarm
Energy — _ $75.00
Each Manufd Home or Modular
Dwelling Service or Feader $90.90 2 ❑ Garage Door Opener'
Services or Feeders ❑ Heating.Ventilation and Air Conditioning System'
InsHlation,alUmation,or relocation
2u0 amps or less $80.30 _ -- 2
201 amps to 400 amps $106.85 2 ❑ Vacuu.n Systems
401 amps to G00 amps $160.60 2
601 amps to 1000 amps _ $240.60 2 ❑ Other
Over 1000 amps or volts A_ $454.65 2
Raconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOI_VEU -COMMERCIAL ONLY
Installation,alteration,or relocation. Fee for each system.......................................................... $7500
200 amps or less $66.85 _ — 2 (SEE OAR 918-260-260)
201 amps to 400 amps $10030 2
401 amps to 600 amps $133.75— 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
sae"b"above. ❑ Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel Boiler Controls
,a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit _ _ _ $665 —_ 2 L] Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑
or(Peder fee. Fire Alarm installation
Fimt branch ciroult / $46.85 ❑ HVAC
Each additional branch-;ircull i $6.55 - c
Miscellaneous ❑ Instrumentation
(Service or feeder not Included)
Each pump or Irrigation circle _ $53.40 ❑
Each sion or n,rtiine lighting _ $53,40 -` Intercom and Paging Systems
Signal circuit(s)or a limiter energy
panel,alteration or extension $7500_`_ ❑ Landscape Irrigation Control'
Minor Labels(10) $125.00 _
Each additional Inspection over ❑ Medical
the allow-ble In any of the above ❑
Pet inspection - $62.50 _ Nurse Calls
Per hour _ _ $62.50 _
In Plant _ $73.75 __ ❑ Outdoor Landscape I.Ighting'
Fees: ❑ Protective Signaling
Eno or total of above fees $ ❑ Other
8%State Surcharge $
_---Number of Systems
25'!46 Plan Review Fe-)
Sea"Plan Revi"P section on $ ` No licenses are required Licenses wt:r-rnilred for all other instella;ions
front of application -
Fec S:
Total Balance Due
rr-�, ----- Ental total of above fees
El Trust Account N 8%State Surc.ha�ge
Tetal Balance nue
All Now Commerclai Bul:dings require 2 sets of plans.
iAdsts\fnrmc\elc-fees-doe 08/30/01
CITY 4F TIGARD 24-Hour
BUILDING Inspection Lite: 1503)539-4175
INSPECTION DIVISION Business line: (5,13)1139-4171 MOST
Ftereived Date Requested
�L Z A `--� F�4 qUl, —
Location _.. �� L�' L' ;LIL._ -�Sure_ —. _— MEPC rc7.1 — o(2U t1
Contact Person Ph PLM
Contractor 'JPh ---_—_ SWR -------
BUILDING _— Tenant/Owner — ELC
Footing —
Foundation
Ftq Drain [Inspection
cess:
Crawl Drain _ --�"'� , I r--'L' ELR
Slab Notes-K!�—_—�w +` �� _ •&
Post&Beam
Sheer Anchors _
Ext Sheath/Sheer I LC--
Int SheathiShea,,Fran. in(
Insulation
Dqwall Nailing �3„ -GyIr1.E?_,_( d /
Firewall M
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof �' ��^v'G� C_.�.
Other: _.------
Finel - � �/�, �. �J )'"G..✓1 C...e.-� Cl...�C.�,ti.,..�
PASS PART FAIL -
PLUMBI_N_C, —
Post 6 Beam ---- --- -— i-- --
Under Slab
Rol.gh-In
Water Service
Sanitary Sewer
Rain Drains _—
Catch Basin/Manhole
Storm Drain
Shower Pan — —
Other:
Final
FAIL -- --
M CHANICAL� 1 --- ------- _—
Post& earn i —
Rough In
Gas Line -'--�
Smoke Dampers
Final' —
ART FAIL --- -- _ _
ervice —
Rw.rph-In
UG/Slab --------
Low Voltage
Fire Alarm —---••—
FInal/ [PART FAILnReinspection fee of$_._._ reyuireo before .-xt inspection. Pay at City H0, 13125 SW Hall Blvd.
P
51 ___ (� Please call fcr einspection HE: Unable to'nspsct—no access
Fire Supply Line
ADA
Approach/Sidewalk Data—�� --�L��, Inspoter
Other. I ---- --� — - am —
Final - DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL