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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-A179 MST
�/ BUP _
Date Requestennd C ' ") - q q2_AM -DM �� BID _
Location ?�� ►Jn.�r�� S I wG�1r Suite MEC
/
Contact Person _ 511 ,,U l/I _ Ph tO Z L,� PLM
Contractor — Ph SWR _
BUILDING Tenant/Owner SLC
Retaining Wall
ELR
Footing Access: _
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN —
Slab
- -
Post&Beam -- - SIT
Ext Sheath/Shear
Int Sheath/Shear -- - -----
Framing
Insulation --
Drywall Nailing
Firewall -
Fire Sprinkler -- - - - - - - ----- - ---
Fire Alarm -
Susp'd Ceiling
Roof -----
Wisc
Final _ ---- ------- ---
PASS PART FAIL
PLUMBING - -
Post B Beam -� -
Under Slab
Top Out
Water Service
Sanitary Sewer - ----- -
Rain Drains
Final --—
PASS PART FAIL
ECHANIC L ' _ ---
Post
ough I �
-------.��-.-
-Smoke Daripet:-'
Dariperc,
ni I --- -- --_- - -
Olt
rg -------- ------ - -------- - _.-
Low Voltage - --- _.�--- --� --- - ---- --
Fir Alarm
PART FAIL _---- --- ---------- --_.. - __—SIM
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ ret4a!red before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( )Please call for reinspection RF _ _—__—_--� _ [ [ Unable to inspect no access
ADA
Approar'h/Sidewalk L
Other �— nate L��_' [nspector �� Ext
Final
PASS PART FAIL DO NOT REMOVE this irispection recorr+ from the job site.
\ CITY O F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC1999-00406
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 09/30/1999
PARCEL: 2S 102BC-00104
SITE. ADDRESS: 12555 SW BROOKSIDE CT
SUBDIVISION: WALNUT ACRES ZONING: R-4 5
BLOCK: LOT: 003 JURISDICTION: TIG
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/CyMPRESS_ORS HOODS:
__FUEL TYPES 0 - 3 HP: J DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: VNOOD :
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
-- OTHER UNITS:
FURN —100K BTU: — 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace existing gas furnace.
Owner: �--~ ---- FEES
LESLIE CARTER Type By Date Amount Receipt
12555 SW BROOKSIDE CT PRMT GEO 09/30/195 $50.00 99-318734
TIGARD, OR 97223 5PCT GEO 09/30/19`: $3.50 99-318734
Phone:503-443-6052 _ Total $53.50
Contractor:
COLUMBIA HEATING+ COOLING INC
PO BOX 230397
TIGARD, OR 97223 ^REQUIRED INSPECTIONS
Heating Unt Insp
Phone:624-2704 Final Inspection
Reg #:LIC 00076359
PLM 34-175
0MGINAL
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. ATTENTION: Oregon law requires you to follow rules adopted in the Oregcn
Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952-601-0080.
You may obtain copies of these rules or direct questions to OUNC by galling (543) G6-9189.
G1 7
fl� :f �
Issue By: /;'�� � Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections named—W40 next business day
F?E,CFIuEL) heck#
Plan Ch _
CITY OF TIGARD Mechanical Permit Application Recd h _ _
13125 SW HALL BLVD. Commercial a-d Residential SE11 t 1999 Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, X304 COMMUNITY DEVELOPMFNI Date to DST
Print or Typeo /� - Permit 4JEF
Incomplete or illegible applications will not be accepte_ Called
r---�- Name of Develow- ro)ecit _
1 Description
Table 1A Mechanical Code _ Qty Price Amt
Job StreetAddrew geMee, -- A) Permit Fee
Address g C 1) Furnace to 100,000 BI
incl idin ducts&vents see footnote 1,2 9.65
Bldg# CRY/Ststs ZIp 2) Furnace010,000 BTU+ �
including ducts&vents see footnote 1,2 12.00
e of
Name(or nambusiness) 3) Floor Furnace _ -
Omer d-ecl P r including vent _ see footnote 1,2 965 _
Melling Address 4) SuspendetJ heater,wall heater
or floor mounted heater_ see footnote 1,2 9.65
`3 'r 5) Vent not included__In applianceermit _ 4]5
CRYfstate ZIP Phons,�-6)4 Check all that apply 'Boiler PuHeat Air
// Xx For Items 6-10,see or mp Cond City Price Amt
Ne (or name of Mualnesa) footnotes 1,2 Comp ••
6)<3HP;absorb unit to
/1 t 100K BTU 9 65
Occupant Melling Address 7)3-15 HP,absorb unit --
100k to 500k BTU 17.65
City/Slate zip Phone 8) 15-30 HP;absorb --
unit.5-1 mil BTU _ 24.15
Contractorren� 9)30-50 HP;absorb --
I I unit 1-1.75 mil BTU _ 36 00 i�Gl11/lf�l --- 10)>50HP;absorb unit
Prior to permit �t9lling p�dross -- >1 75 mil BTU _
issuance,a copy t' ) r�, •tC _._ 60.15
11 Air handling unit to 10,000 CFM
of all licenses Citylstate zip Phone — __ _ _ _ 7.00
are required If r, l}�_ y7�1' �7U+ -12)Air handling unit 10,000 CFM+
expired in COT Qregfn Const.Cont.Board LlcJ Exp Date 11 75
database _ '7�0 /c' .•+'GQ 13)Non-portable evaporate cooler
Architect Nene _ 7.00 _
14)Vent fan connected to a single duct
or Moiling Address �— 4.75
15)Ventilation system not included in
appliance permit 7,00
Engineer [_C�tme zip Phone 16)Hood served by mechanical exhaust
7.00
Describe work to be done - 17)Domestic Incinerators
12.00
New O Repair O Replace with like kind: Yes No O 18)Commercial or industrial type incinerator
ResklentialQ. Commercial _ 48.25_
__ _ 19)Repair units
Addftional information or description of wont: _ 8.40 _
/t.1"Al FF• �� `�A4- �5 ������� 20)Wood stow/gas Mother units/clothe dryer/etc.
7 C _ 7.00
NOTE: For Commercial projects only,Units over 400 lbs require 21)Gas piping one to four outlets +
structural gas talcs _ See footnote 1 _ 3.75
Type of fuel: oil O natural gap,&- LPG O electric O 22)More than 4-per outlet(each) _ .75
Minimum Permit Fee$50.00 SUBTOTAL (x
I hereby acknowledge that I have read this application,that the information 7%SURCHARGE
given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL_
the owner,that plans s'rbmdted are In compliance with Oregon State laws Required for ALL commercial pemdts onl
TOTAL
Signat Owner/Ag It Date
Other Inspections and Fees:
7 1. Inspections outside of normal business hours(mininum charge-two
erson Name phone hours) $50.00 per hour
'V f ` '7 2. Inspections for which no fee Is� eclflcall Indicated (minimum
1 J �;+�7 .� v r Y
I� � � i `--' �! charge-half hour) E50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes,additions or revisions to
1 Provide full schematic of existing and proposed gas line and pressure. plans(minimum charge-one-half hour)$50.00 per hour
2 Provkle drawings to scale showing existing and proposed mechanical
unit,-------- 'State Contractor Boiler Certifiration required
"Residential A/C requires site plan showing placement of unit
I lmechperm doc rev 02/4/99
CITYOF T'G A R DELECTRICAL PERMIT
PERMIT#: ELC1999-00581
DEVELOPMENT SERVICES DATE ISSUED: 9/28/99
13125 SW Hall Blvd.. Tiqard, OR 97223 (503)tW/71 PARCEL: 25102_BC-00104
SITE ADDRESS: 12555 SW BROOKSIDE CT
SUBDIVISION: WALNUT ACRES �V4
ZONING: R-4.5
BLOCK: LOT : 003 �JURISDICTION: TIG
Project Description: Installaiton of one branch circuit. ,lob No. 928-012
RESIDENTIAL_ UNIT TEMP SR_VC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS 0 200 amp: PIIMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS
ADD'L INSPECTIONS _
0 200 arnp: W/SERVICE OR FEEDER: PER INSPECTION: --�
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
_—Reconnect only: SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: —
Owner: Contractor:
SMURTHWAITE, LARRY & DEBBIE '"ESI SIDE ELECTRIC CO INC
12555 SW BROOKSIDE CT 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone:
231-1548
Reg#: LIC 13306
SUP 1556s
ELE 2.6-135c
FEES _ _ — Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DEB 9/28/99 $37.50 99-318690 Elect'I Final
SPCT DEB 9/28/99 $2 63 99318690
Total _ $40.13
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 a4opted by the Oragon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtains of these rules ordirect questions to OUNC at(503)
246-1987 II
I i
PERMITTEE'S SIGNATURE ISSUE6 RY:
OWNER INSTALLATION ONLY
rhe installation is being made on property I own which is riot intended for sale, lease, or rent.
OWNER'S SIGNATURE _ _- — — DATE:
CONTRACTOR INSIALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: .-_-----------__�_____-- DATE:. _----
LICENSE NO: —
Call 639-4175 by 7:OOpm for an inspection the next business day
t t + 1 = 1 t'rt WEST .SIDE ELECTRIC 7.l"r3 735 0E• C P. l�t
CITY10F TIGARD plan Chock N _
Electrical Permit Application
1312 SW HALL BLVD. PP Rec''b By ` /-� _
TIG, 0 OR 97223 Vete Recd
Phan (503) 639-4111, x304 Osla to P.E.
Date to DST
Inspe bon (503) 639-4175 Print of Type Permit R 'E cell"?1-005 g/
Fax ( 3) 5913-1960 Incomplete or Illegible will not be accepted Caned
1. J b Address: 4. Complete Fee Schedule Below:
Name Development e- 44g -v_,-01 Numbe►�cilona r nnit alto..sd
Name((it name of business) Service Included: Items Cost Sum L
Addresti _J _ St�� �tl.�L�C�,� _-C.T. 4a. Reeldentlal-per unit
1000 aq It.or lase S 111 15 4
GI+y�Sta a/Zip j� _� 9��r1 Each eddiRonal 500 sq R.or —
�-y porilon thereof _ S 26.25 1
Comore cis)❑ Residential tip Limited f_rmrgy s 0000
Each Monufd Horne or Modular -- _
28. C ntr9ctor installation only: Dwelling Service or reader S 12 15 2
(Prior to mrrnit Issuance,applicants must provide contractor license 4b.Services or Feeders
Informal n for COI data base). Installation,alle(allon,or relocation
Flectrici I Contractor _ lri,c 200 amps or long t e:25 2
Addres 'f��� 7 e 701 amps 10 400 amps s 55 50 2
City /!/ci�1eZttats C311C 711 7eV 401 amps to 600 amps i 146 10 7
601 amps to 1000 amps _ f 191.50 2
Phone o. 13T' / S? �_ �� Over 1000 smpn or volts 6 303 75 2
Job No Z Reconnect only — S 63 50 2
Elec C t. Lice No /3 -C Exp Date. _ 4c.Temporary Services or Feeders
OR Stat CCB Reg. NO t Exp Date__ Instollstlon allerellon or fainc-0tin
COT Biness Tax or Metro No. Exp Date__ 200 amps or lose s 53.50 2
-- ------- — -
201 amp►to 400 amps 6 80.25 — 2
Signatu of Supr Flec'n / 401 amps to 600 ampR S 107 00 z
Over 600 amps to 1000 volts.
L ICen9e o //� see"b"above.
_lZ.Lt2____ —Exp Date _
Phone o �(�/- �S- yX _ New,
,allor tl on or to
Naw.sllar�tlon or extanalon per panel
a)The fee for branch circuits
2b. F r owner instollstlons: with purchase of so-leo or
feeder fee,
Print Owner's Name Each branch circuit S 5 35 2
Addresfi b)The fee lot branch circults
�_._. _.- without purchose of sorvlce
City - _ T_ State,____Zip or►seder roe.
Phone 0First branch circuit S 37.50
Each additional branch cicull _ _ S 5 35
The Inst illation Is being made on property I own which is not is.Miscellaneous M
intpridec for sale lease or rent. (Sennas or feeder not included)
Each pump or Irrigation circle S 42 75
Owners Sianalure_ _ Filch sign or oulllne lighting --- S 42 75
Signal cJrcvlf(o)or a limited energy
penal,alteration or extension _ 5 8000
3. P n Review section (if required): Minor Labels(10) V^ $ 107 00
Plessil ctleck appropriate Item and enter tee In section 5B. 4f.Each additional Inspection ov
4 or more residenlis!units in one structure the allowable In any of the above
$ervicAi and feeder 226 empa or more Per Inspection 6 50.00 _
Per hour S 5000
System over 600,oils nominal In Plant f 69 00
Clas:'ried area or structure containing apodal occupancy as
described In N E C Chapter 5 S. Fees:
Be.Enter total of above+ass S _
s
Submll 2 eetx of plans with application when any of the above apply 8%Surcharge(05 x total lees) S
tint to ulrid for temporary constructlon services. Subtotal
fib.FOar 26%of bre 6s for
NOTICE Plan Asvfaw It rsauired(Sec 7) t
PERMi 1 BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal t
IS NOT C OMMFNCFC)WITHIN 180 DAYS.OR IF CONSTRUCTION OR ! 1
WORK Ic SU3PENDFD OR ABANDONFO FOR A PERIOD OF 180 DAYS Truel Account N
AT ANY VME AFTER WORK IS COMMENCED Total balance Due $ 90,E
i'du.if�r�irrlrctric Aoc