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15820
15820 SW ALDERBROOK CIRCLE
CITYOF i IGARD MECHANICAL PERMIT
DEVELCPMENT SERVICES PERMIT#: ME^2003-1)499
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6354171 LATE ISSUED: 8/14/(,3
PARCEL: 2S; . 1 DU-00900
SITE ADDRESS: 15820 SW ALDERUROOK CIR
SUBDIVISION: SLIMMERFIELD NO.d TONING: R-7
BLOCK: LOT: 456 JURISDICTION: TIG
CLASS OF WORK: ALT F LOOK FURN- LVAP COOLERS:
TYPE OF USE: SF UNIT HEATER.i: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APDL: VENT SYSTEMS:
STORIES: BOILERS/COMPRES,-*S, HOODS:
_ FUEL TYPES _ v 0 3 HP: 1 DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPU'i: BTU 1.5 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
ODSTOV
GAS PRESSURE: 50 + HP- CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING; UNITS C
f'URN >=100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfin:
Remarks: Replacement of furnace and ;Od (
Owner: �� F EES
NICHOLICH, NAOMI Description Date Amount
15820 SW ALDERBROOK CIRCLE — -----
T�BARD, OR 97214 IMECIIJ I'crmil I-cc 8/14103 $72.50
jT,1.,'jS",i,SratcTax 8/14/03 $5.80
Phone: 503-620-0133 — Total _ $78.30
Contractor:
ALL.BRAND SERVICE
1 107 EVERGREEN
NEWBERG, OR 97132 REQUIRED iNSPECTIONS
Phone: 50-1-537-9939 Heating Unt Insp
Cooling Unt Insp
Reg#: LIC 108191 Final Inspection
This permit is Fsue,. 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
riot started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon yaw
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: L .2 , ' T Permittee Signa'ure:
Cull (503) 639-4175 by 7:00 P.M. for inspections needed tie next bL'siness day
Mt'Clumical Perni1t A ) O �•r Cf1 Received4z ,/ 7 rvttchamcal
�— — C1..1 Date/B /7 J P-rnlitNo.• fjCi
Planning Approval Building
City of TigardAUG l0U Dete/B Permit No..
13125 SW Hall Blvd. Plan Review Otner
Tigard,Oregon 97223 Date/By-: Permit No.: _
Post-Review Lund Use
Phone: 503-639-4171 Fax: 503-598-19 IIUIL Y FTI [)N Date/By: Case No.:
Internet: www.ci.tigard.or.us Cnntacc Juris.: See Page 2 for
24-hour inspection Request: 503-639-4175 Name/Method: — C: Supplemental Information.
TYPE OF WORKCOMMERCIAL FEE*SCHEDULE-USE CHECKLIST
New conStruction Demolition_ Mechanical petmit fees"are based on the total value ofthe work
Addition/alteration/re lacement ❑Othet': performed Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhear)and profit.
CATEGORY OF CONSTRUCTION
— Value: S _ See Page 2 for Fee Schedule
1 &2-Family dwelling �Cummercial/Industrial RESIDENTIAL E UQ IPMENT/SYSTEMS FF E*SCFIEDULE
Accessory Building Multi-Family Descrl Non t Fee ea. Total
Master Builder Other: Heatin Coolie
JOB SITE INFORMATION and LOCATION Furnace-add-on air corn itiom lg•r 1 / 14.00
Job site address: S xz u S«, ��/ cr! L„Ic Lc- Gas heat um 14.00
Bld ./A t.#: Duct work 14.00
Suite#: H dm;tic hot water system — 14.00
ot 1l
Pro•eatne: Rerideutial boiler
Cross street/Directions to job site: for radiator or hydronic system) 14.00
Unit heaters(fuel,not electric)
in'vall,in-duct,suspended,etc. 14.00
Fluevent for any of above 10.00
RSeir units 12.15
Subdivision: Lot#: Other Fuel A dances
Tax MV/parcel arcel #: Water heater 10.00
UESCKWI MN OF WORK i Gas fireplace 10.00 _
11 -4 _ 1 �, ice` Flue vent(water heater/ as fireplace) 10.00
��2'
Log lighter as 10.00 _
'Y �t / � — — Wood/Pellet stave 10.00
Wood fire la':e/insert __ 10.00
-- -- -- - Chimne /li.t._•/flue/vent 10.00
PROPERTY OWNER -- TENANT Other: 10.00
— Environmental Exhaust do Ventilation _
Rnge ahood/other kitchen equipment 10.00
Address' / e 2 0 )w e1/ vb4y,2ic CC Clothes dryer exhaust 10.00
City/State/Zip: -r, •�.�t./ y�_.__— Single duct exhaust
PL..nc: > 3 3 _ Fax: (bathrooms,toilet compartment,,.
APPI.ICAN'P CONTACT PERSON utilityrooms) 6.80
Attic/crawl s ace fans _ 10.00 —
Name: _ _ -- othtr. — 10.00
Address: _ Fuel Piping
Cit /State/Zip: — **($5.40 for Brat 4.$1.00 each additi i —
—� Furnace,etc. —
Phone: Fax. Gas heat pump
E-mail: _ Wall/sus ended/unit heater
CONTRACTOR — Water heater _—
e,i�D 5
Fireplace
Business Name:
Range
AddBB
Cid/State/Zip:Aft be_3 rL'� 91 i1 L Clothes dEyer(gas)
5-13
Phone•' S Fax: Other: "
Total. _
CCB LiC. #:/0 F/I / - " 3 i Mechanical Permit Fees•
Authorized �,/y-43 Subtotal: $
Signature: — Date: Minimum Permit Fee 572.50 S
- � v^— s 1✓J _ Plan Review Fee(25%of Permit Fee) S
<17
(Please print name) _State Surcharge 8%of Permit Fee) $
TOTAL PERMIT FEF. $
Notice: This permit application expires If a permit is not obtained Nithhr •rec roelhodology tet by Tri-CountyBuilding Industry Service Board.
180 daps after It has been accepted as complete. "Site pian required for exterior AX units.
i:\Dsts\.Permit PormsWccPermttApp.dcx 01103
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information }
Commercial Fee Schedule:
Total Valuation: Permit Fee:
11.00 to$5io00.r'0 Minimum fee$72.50 _
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and including$10,000.0.
$10,001.00 to$25,000.00 $148.50 for the rirst$10,000.00 and
$1.54 for each additional$100.00 or
fraction thereof,to and including
_ $25 000.'00.
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof.to and including
$50 IM00.
$50,001.00 and up $742.00 for the first$50,000.00 and
$1.20 for each additional$100.00 or
fraction thereof.
Assumed Vsiustions Per App►I nce:
Value Total
Description Qty (Fa) Amount LI
Furnace to 100,000 BTU,including 955 i
ducts&vents
Furnace> 100,000 BTU including ducts 1,170
&vents
Floor fume x including vent 955
Suspended heater,well heater or Floor 955
mounted heater —_
Vent not included in a Hancermit 445 G
Repair units 805 _
<3 hp;absorb.unit, 955
to look BTU ,.
3-15 hp;absorb.unit, 1,7()0
101k to 500k BTU
15.30 hp;absorb.wait,501k to I mil. 2,310
BTU
30-50 hp;ebsorb.unit, 3,400
1.1.75 mil.BTU__
>50 hp;absorb.unit, 5,725
>1.75 mil.BTU I
Air handling unit to 10,00U cfm 656
Air handling unit>10,000 cfm 1,170
Non-portable evaporate cooler 656 _
Vent fen connected to a sin ie duct 446
Vent system not included in appliance 656
permit
Hood served b mechanical exhaust 656 _
Domestic incinerator _ 170 _–
Commercial or industrial incinerator 4 590
Other unit,including wood stoves. 656
inserts etc.
__g!Erjpmg 1.4 Outlets - 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
i-\Dsts\Permit Forms\MccPermitAppPg2.doc 01/03
CITY" OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: ELC2003-00528
13125 SW Hall Blvd., Tigard, OR 972.23 (503) 639-4171 DATE ISSUED: 8/22/03
SITE ADDRESS: 15820 SW ALDERBROOK CIR PARCEL: 2.S 111 DC-0090n
SUBDIVISION: SUMMERFIELD NO.8 ZONING: R-7
BLOCK: LOT : 456 JURISDICTION: TIG
Project Description: Circuit for A/C
r __OR
UNIT
TEMP SRVEDERS ____ M!SCELLANEOUS
1000 SF R LESS: 0 200 amp_C/FE _ PUMP/IRRIGATION-
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG.
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER _A_ BRANCH CIRCUITS _——� ADD1. INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: `
201 - 400 amp: 1st W/O SRVC OR FDR: I PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIIRC: IN PLANT.
601 - 1000 amp: _ RcVIEW SECTION_
1000+amp/volt: > 4 RES UNITS: > 600 VOLT HOMiNAL-
Owner:
Reconnect only: _ SVC 4
—2_25 AMPS:_ __— CLASS_AR_E_A_JSFEC OCC: _
� �
NICHOI ICH,IJAOMI Contractor:OWNER
15820 SW ALDERBROOK CIRCLE
TIGARD,OR 97224
Phone: 503-620-0133 Phone:
Reg #:
FEES
Description Date Amount
ELPRMTJ ELC Permit 8/22/nt5— Required Inspections
$46.8., --------------
1-rAX)8%Statc Tax 8/22 a $3.75 Elect'I Final
Total $50.60
This Permit is issued subject to the regulations oontained 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 req,.,.es you to follow rules adopted by;he Oregon Util Notification Center. Those rules nre set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct qui tions t UNC at(503)246 9 or
1 800-332-2344.
Issued By: PPrrnit Signatur
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:
Cil:NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ _ DATE:
LICENSE NO:
Call 639-4175 by':00pm for an inspection the next business day
Electrical Permit Application —FOR ' ' '
LY
I Icctn�;'i
Date/By: { L I L )7); ' I'errmt No. 00 J~ p
Cit of Tigard Planning Approval Sign
Y g Date/By: Permit No..
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
w�
Internet: ww.ci,tigard.or.us Date/By: Case No.:
Contact Juris.: See Page 2 for
24-hour Inspection Requcst: 503-639-4175 Name/Method. Supplemental Information.
TYPE OF WORK PLAN REVIEW Please check all that apply
New construction Demolition Service over 225 amps- Ll Ilealth-care facility
-- commercial ❑Hazardous location
�]C Addition/alterati0ll/replace►;1CIlt 1_Q Other: _ ❑Service over 320 amps-rating ole ❑Building over 10,000 square feet.
Co TECORV OF CONSTRUCTION I&2 family dwellings four or more residential units in
vaj I & 2-Family dwelling _Commercial/Industrial ❑System over 600 volts nominal one structure
JJ AccessoryBuilding _ Multi-Famil ❑wild ng over three stories ❑Feeders,400 amps or more
g ]_ _Y�_ _ ❑Occupant load over 99 persons ❑Manufactured structures or RV park
[� Master Builder I LJ Other: — ❑Egress/lighting plan ❑Other:
_ JOB SITE INFORMATION and LOCATION Submit sets of pians with any orthe above.
The above are notapplicable to tem rorary construction service.
Job site address: 'C� c�J �i gyp,R3�►C /-.' FEE*SCHEDULE
Suit( 'r: Bld ./A t.#: Number of I spectlons per perrnit allowed
Proje,.tName: Description — I on• Fee(ca.) Tout
Cross streeWirections to Oh site: - New residential-single or could famih per
J dwelling unit.Includes aito.hed garage.
Service Included:
1000 sq,ft.or less 145.15 4
Each additional 500 sq.R.or portion thereof 33.40 1
Subdivision: Lot # Limited energy,residential 75.00 2
Limited enery,non residential 75.00 2
Tax map/parcel #: Fach mp•.Jaclum i home or modular d,Telhng
DESCRIPTION OF WORK - service an l/or feeder 90.90 2
--- — Services or feeders-Installation,
_ ■Iteration or relocation:
kn�t�h �l�CUI� - - - ---�� 200 amps or less 90.30 2
._�.__. _ 201 amps to 400 amps 106.85 2
401 amps to 6(10 amps 160.60 2
PROPERTY OWNER EITFNANT 601 arrips to 1000 amps 240.60 2
— y- Over 1000 amps or volts 454.65 2
Name: IVA--W is h J hn `�-r E' Reconnect only 66.85 2
Address: '_ _1-c,) Ai(-- C Temporary services or feeders-Installation,
alteration,or relocation:
Cid/State/Zip: 7—w4leS, �a 200 amps or less 66.85 1
Ph
c-n� 201 amps to 400 amps____-Fax: 100.30 2
.,�-.�53�?�(t�r7 -- — -
401 to 600 amps 133.75 2
APPLICANT 10 CONTACT PERSON Branch circuits- ,newalteration,or
m
Nae; Td KeLk., extension per panel:
A[ A Fee for branch circuits with purchase of
Address: S w
service or fee ter fee,each branch circuit _ 605 2
City/State/Zip: TZ21;1/ ON - 2� B.Fee for branch s rcuits without purchase of
service or fester fee,first branch circuit 46.85 2
� ))I`;
Phone::S -i Fax: —'0315a1?-?e000 Each additional branch circuit 6.65 2
E-mail: a-, / yi't Muc.(Service or feeder not included):
CONTRACTOR Fach pump or irrigation circle 53.40 2
Fach si a or outline lighting 33.4J 2
Job No: Signal circuit(s)or a limited energy panel,
alteration,or extension Pae 2 2
Business Name: Description
Address:
Cit eate/Zl Each additional Ins rreectlon aver the allo'Aable in am of th_e abosc_- -
Per inspection per how(min. 1 hour) --62.50
Phone:
CCB L.ic.#: Lic. #: Othei. _
Su -visin electrician — _ Electrical Pennit .�-
P g _ Subtotal S
sip ture required: _ Plan Review 25%of Pennit Fee S _
Print Name: .#: State Surcharge 8%of Permit Fee S —
_ TOTAL PERMIT FEE S�-SLS 7
AuthorizedNotice: This permit application expires If a permit Is not obtained within
SignatureEY w- =7c- -t Date: ��C 5 190 days after It has been accepted as complete.
,r+ •'Fee methodology set by Tri-County Bulldipg Industr)Ser✓ice Board.
cr(y K
(Please print name)
i:\Nts\Pernrit Fomrs\FIcPermitApp.doc 01/03
Electrical Permit .,pplication - Cite of Tigard
Pale 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: __
F'ee for all systems........................................................... $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
DHeating,Ventilation end Air Conditioning System*
Vacuum Systems*
Other ---
COMMERCIAL WORK ONLY:
Fee for each system.......................................................... $75.00
(SCI:OAR 918.260-260)
Check Type of Work Involved:
Audio and Stereo Systeme
Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
11VAC
I_._I Instrumentation
Intercom and Paging Systems
Ll Landscape Irrigation Control*
❑ Medical
Nurse Calls
Outdoor Landscape Lighting*
0 Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit FormsTIcPermitAppPg2 doc 0 1103
CITY OF TIGARD I spectiort'�.ine: (503)639-4175
BUILDING MST
INSPECTION DIVISIO14 Business Line: (503)639-4171
�,, � I BLIP
Received _ _- _Date Requested_ �-__1.— AM M BLIP
Location �4 p� -=_–� Suites MEC
Contact Person _ Ph ( ) PLM
Contractor ---- Ph(-) 5 3 SWR
ri
BUILDING Tenant/ Z ' cy33 ELC
Footing ELC
Foundation Access:
Fig Drain ELR
Crawl Drain SIT
Slab Inspection Notes: ---
Post S Beam --
Shear Anchors
Ext Sheath/Shear -- - ---
Int Sheath/Shear
Framing ----- -- -- - -
Insulation -_
Drywall Nailing
Firewall
Fire Sprinkler - --
Fire Alarm
Suspd Ceiling —
Roof --� — - - —
Other:
Final _
PASS PART FAIL
PLUMBIN_Q — -- —- - - -
Post A Beam
Under Slab ---- . — ---- --- -
Rough-in
Water Service - -- -
Sanitary Sewer —
Rain Drains -- - ---� —
Catch Basin/Manhole
Storm Drain
Shower Pan --
Other:
Final ------
PASS PART FAIL — —
MECHANICAL ---- -
Post&Beam /
Rough-In —
Gas Line
Smoke Dampers — — ------- — -- -- -
PART FAIL — - —
ELECTRICAL --
Service -Rough-in -- ------ Y
UG/Slab
Low Voltage --
Fir arm
in %inspection fee of s._— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PART FAIL
am Please call for reinspection RE: Unable to inspect -no access
Fire Supply LineADA /
Approach/Sidewalk
Date Ext
- Ins __ -- --- — --
Other:
Final DO NOT REMOVE this inspection record orn the jo site.
PASS PART FAIL