13895 SW BOXELDER STREET I
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13895 SW WXEIBER �,
CITYC7F T AR CERTIFICATE OF OC(7JPANCY
PERMIT#: MST95 00031
A Alk DEVELOPMENT SERVICES DATE ISSUED: 02/06/1995
13125 SW Wli, Blvd., Tigard, OR 97223 (Suj) 633-4171 PARCEL: 2S104CD-08600
ZONING: R-7
JURISDICTION: TIG
SITE ADDRESS: 13895 SW BOXELDER ST
SUBDIVISION: HILLSHIRE ESTATES NO, 2
BLOCK: LOT:085
CLASS OF WORK: NEW
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP. R3
TENANT NAME:
REMARKS: PATH I
Final Building Inspection a,qd Certificate of Occupancy Approved
7121/95 by Rick Bolen, Buil(;ing Inspector
Owner:
SKYLIGHT HOMEBUILDERS
Phone:
Contractor:
MUEHE QUALITY HEATING INC.
PO BOX 9
WEST LINN, OR 97068
Phone:
Reg#:
This Certificate grants occupancy of the above referenced building or portion thereof and
confirms that the building has been inspected for compliance with the State of Oregon
Specialty C07 for the group, occupancy, and usejnde� w lch the referenc.s: permit was
issued.
BUILDING INSPECTOR BUILDI OFFICIAL
POST IN CONSPICUOUS PLACE
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CITYOF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13125 SW Hall Blvd.Tigard,Orogon 97223*8199 (503)639-4171 PERMIT #. . . . . . . :
o3':, t171 DATE IS� IJED: 0r./06/95
PARCEL:
j. TE. ADDRESS. . . : 13895 SW BOXELDER S1
,-JE3DJV1S1ON. . . . : HILLSHIRE ESTATES NO. 2 ZONING: R- 7
-CJ(.,K. . . . . . . . . . . LOI.. . . . . . . . . . . . .
BUILDING
I GSUE: DWELLING LINIT5: 1 BAS[MEN a. .
UP WORK. :NEW BEDRMS:5 BATHs:4 GARAGE:. . . . . . . . . . :760 f
IDE OF LIGE. . . :b,F FLOOR REGIUIRED SETBACKS._.._--
YPE OF CONST. -5N F I RST, . . . i Z.'130 sf LEFT. 15 ft RIGHT. : f
:R3 SECOND. . 14-J3 r FRONT. LA ft REAR. .
Uht1E . . . . . . . :E F'I 114BSMENT-0 S f REQUIRE[)-.•-._-__._.__._._....._. ._
1GHT
EQUIRE[)-.,-.---
IGHT. . . . . . . . :33 ft TOTAL-- 356 3 = I-
'J - ,jMOKr DEJECTORS. :Y
I_POR LOAD. . . . :40 ps-f VALUE. . . . . 242749 PARKING SPACES. . .- I
Remar'lis : F-IAI-14 1
PILUM131N(-'i
___..__.___.__--_----_.____._.._--
L' . . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PRLVNTR'-i.
:7 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . .
I ULA/k._HOWL.R3. . . . z.4 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . .
W" I LR CLOGF�TS. :4 SEWER LINE (ft ) . 0 GREASE TRAPS. . . . . . . :0
DI SHWASHE I WATER LINE (ft ) . 100 OTHER FIXTURES. . . . .
GARBAGE D15P. . . il RAIN DRAIN (ft ) . :0
WA1311 11415 MACH. - 1 5F RAIN DRAINS. . : 1
Ml--CHANIC:AL FEES
FUL 1- TYPES— UNJI HTRS. . -0 type a f-k n t by ci at e
VEN rS . . . . . :0 1 IF 1550. 00 JF 02/06/c,'
MAX INPUT-0 i-1U VENT FANG. . :5 3wlyl 180. 00 JF 06
FLIRN 1, 100K :0 HOODS. . . . . . : 1 SWM # 100. 00 JF 02/06/95
FURN ) =lOOK l WOODSTOVES. :0 SPR T $ 790. 50 JF 0c'/06 03)
FLUOR FURN. . . . :0 CLO DRYERS. : I SPLC $ 511'i
- L43 Jr' 01 1.s/9'-
01HER UNITS: I 1351-11L $ 31�. JI- &'- 06 ,')I,
GAS OUILETS: 1 PARK $ 500. 00 JF OE/06/9;:,
$ 46. 00 JF 02/06i ,;,
-,KVLl6Hi HUML- BUILDERS MPL C- $ 12. 00 JF 02/06/9'-,
P 0 BOX .'315 2. 40 JF 02/0('
PPRT $ x'58. 00 JF 1712/06/95
LAKL 0!SWLGO OR 1.) 7035 P5PC $ 1.r'. 90 JF 'D. 0(�i(),
636-2994 EROS $ 88. LAO JF _''-'/06/91,
$ -,8. 60 JF
SKYLIUHI HOME BUILDERS CO E RPL $ 28. 60 JF OL, 06
P-1 0 BOX 21315
LAKE U`jWEGO OR 97035
I'Dhone
Reg 34086 -------------
$ 4152. 36 TOTAL
this persit is issued subject to the regulatio 5 contained in the REQUIRED 1NbF-,E('. r1C.qqE
QUI
figard Municipal Lcde, State of Ore. Special Codes and all other Footing Insp
P'11.imb lol)
applicable laws. All work will be/done in ccordance with approved Fol-indation Insp Framing Insp
Mans. This persit will expire if w i not sta-ted within 180 G-Iost/Deam Stt-LlCt Fireplace Insp
days of issuance, or if work is s% for &are than 1W-dav5. Poch/Beam Mechan Gas Line Insp
L-r- awl Or-ain n s t.t I a t i i, i n
Permittee E;iyriAt�.n-e V-'lm/1-tvrJ5lab Insp Gyp FlQiA: 1 In
PILM/Unclet-f I oor, Rain dt•ailI Ir
lss�,..ted B - - 111sk, Watei, Liilt, 1,
Uaii for i.,spectirn 6,39-•4175
CITY C F T I GARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171
SEWER CONNECTION
PERMIT
PERMIT #. . . . . . . : SWR95- 00:"
639-417). DATE ISSUED:
'.SITE: ADDRESS. . . 13895 SW BOXELDER ST PARCEL: dS11214CD-08600
c31UBDIVIS10N. . . . HILLSHIRE ESTATES NO. ri, ZONING- R--7 PI)
BLOCK. . .. . . . . . . . . LOT. . . . . . . . . . . . . .06j
E14ANT NAME.
USA NU. . . . . . . . . . s FIXTURE UNITS. . .
CLASS OF WORK. . . :NEW DWkiLL 1'NG UN ITS. . ii I
, Ypi-- OF USE. , . . . :SF NO. OF SUILDINGS zI
INSTALL TYPE. . . . :LAUSWR IMP ERV SURFACE.
iqpmarks: PATH I
Hwner: FEES ------
�.SKYLIGHT HOME BUILDLRS type 4110I.Ant, L)y date
i--' C) BOX i2315 PIRMT $ 2200. 00 JF 02/06/9t.
I NGP $ 35. 00 JF 0 i2/0 6
i.-AKIE OSWFGO 0R 97 03 5
1- hone #: 636-2994
(..ont-r&ict;or:
:ON TRACTOR NOT ON FILE
2235. 00 TOTAL..
lieu
REUUIRED INSPECTIONS
This Applicant agrees to comply with all the ruips and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires IN days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the acceracy of the
side sewer laterals. If the sewer is op-jacatea at the Aeasurement
giver, the installer shall prospect fe in all directions from
the distance given. It not so locat e installer shall purchase
a "Tip and Side Srier" Permit and e geticy will install a lateral.
'e r M i t t,tj e S i qnAt Lit,e
it e d
By :
Call for inspection 639-4175
/poc
'ca
and
e
-39
A/
Residentia'► Buildin , Permit Application
City of Tigard v ,I�
13125 SW mall Blvd.
Tigard, OR 9,7223
(503) 639-4171
Jobsite Addiess: I—� r� �� W)iel pf ,-L _
Ir,'Z Office Use 0 l
Subdivision: 141 W(P)1e— tLeyjL= Lot # f S —_
i
Valuation: _V
_ Planck/Rec #_ —
__.__-- Permit #_l?i��t`15
Corner Lot? C N
�;�' Reissue of
Flag Lot? Y tom' --"
Map & TL #
Owner: S)<Z—LlL,^HT 144 I'n E6V)L40)07-j (I
Aoroti�als Required
Address: 12'c 'Z 3)S — Planning
is IZ c_ d I t g( , t'iZ 0)7 lc3 i-
-- Engineering
Phone: L� i ILL Other
Cortractor: _ Items Re. ulred
Address: Sub,- +ntractors
— - — Truss Details
Phone: Other _
Contractor's License #
(attach copy of current Oregon license)
Contact Name & Phone: i �i:!_p.*/ s o,i ,-t H (3t-7- 99 y
Subcontractors: Architect/Englneer• __�L_ � �,
Plumbing: _A k'/ t o i-r- -- - Address: ------ ------ - - _--—— —
Mcr:hanic:,il: L 2 }� E'_ N
(attach copy of current OR Contractor's License) �—
Phone:
JOB D C IPTION: S Pik—
Ieived
ignati_,re & Phone number
R by. Date Received:
P.\WCALACOMDE"t SAPP �r
r'/
Permit# Account Description Amount Amt. Pd. Bal. Due
/IISf .S-vu 3/ Bldg. Permit (BUILD) Sa79U,.-sv
Plumb. Permit (PLUMB)
_ Mach. Permit (MECH)
State Tax (TAX) '-
Bldg: 3 r
Plumb:
Mech:
Plan Check (PLANCK) 93
Bldg: t 3
Plumb:
Mech:
SwR.4�q Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) 35 5
Parks Dev Charge (PKSDC) �_ —
Residential TIF (TIF-R) 11.3 0.
Mass Transit TIF (TIF-MT) Z n 12 0
Co,nmercial TIF (TIF-G) --
industrial TIF (TIF-1)
Institutional TIF (TIF-IS) — —
Office TIF (TIF-O) —
Water Quality (WQUAL) L 8y, 40, �
Water Quantity (WQUANT) 100 - /00
----�
Fire Life Safety (FL-S) UD
Erasion Cntrl Permit (ERPRMT) 190,
�
Erosion Planck/USA (ERPLAN) _ vv'(,l�, 60
Erosion FlancklCOT (EROSN) Z G �f"G G
�r✓ y
TOTALS: (p
�A
PREPARED BY: Jim Byerley , Plans Examiner,
380 A Ave . , Lake Oswego, Ore .
C l i o r 4 : SKYL I 3H"r HOMEBU I LDERS
D
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3 895 Swt3 4ze0c.K
WASHINGTON
DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBIORO,OR 97124
COUNW9 INSPECTION REOUESTS: 503/640-3561/693-441.5
OREGON
NOTICE: This permit becomes null and void If the work or construction for wh!ch It Is Issued Is riot commenced within 180 days. Once construction has stared,
the permit becomes null and void If construction Is Interrupted for a period of 180 days. I certify that the information presented by the Rpplicant and
his agent or agents in support of this permit is true and correct to the beet 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 ti?construction and use
of thin,building or structure will be compiled with whether or not specified on the plans or noted on the plans correction sheets. I a-knowledge that
the granting of a permit does not grant stdhonty 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 to approval by the
Building Department Is solely at the risk of the applicant and ouch use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the Bulld!nq Official. I further acknowledge that a Ilan may be placed on the title of the property upon which the permit Is Issued
specifying that the use or a cupancy of the building or structure Is provisional and revocable unt!I the satisfaction of all Inspection requirements.
APPLICANT'S SIGNATURE
WASHINGTON COUNY`( RESTRICTED
Departrr,ent of Land Use & "Irransportati��n
155EleN'ort Inspectione, #3Section ELECTRICAL ENERGY
155 North First Avenue, #35f)-12
Hillsboro, Oregon 97124 APPLICATION
Information: (:iO3)640-3410 Fax: (503) 693-4412
PLEASE PRINT
Please completesections, . . Permi; No. �b0
1. Location of Installatlo Dace o
Address_I 35tq S SLJu x
City_,�azip Code-. -_-_.-- 4. Type of work:
Map No. � Tax Lot _ f""—"""�""
RESIDENTIAL. Restricted Energy Fee $40.00
Thomas Map Book: mage _ Section ttor all systems)
Direct ons r :'heck type of work involved:
--- — Audio and Stereo Systems"
Comrnercial [ Residential>_j Burglar Alarm
Tena'1t Name Telephone Systems'
(if co nmercial) — Garage Door Opener"
This permit becomos null and iold if the work authorized by the Fire Alarm
permit irr not commenced within 180 days from date of Issuance Heating,Ventilation and Air Conditioning Systems"
of ouch permit or if the work authorized Is suspended or abandoned
at any Vme after work Is commenced tot a period of 180 days. 7yacuum%Letems"
Electrical Permits are non-refundable and non-transferable. Other Y�
2. Contracior application: --
Electrical for_T_C.ni rJ A T(61Aj i C 4y � �CL� COMMERCIAL. Fee for each system $40.00
tra
Address Co�O 5(>X,—-�-�-y o (see OAR 918-260-260)
Date `12 K Job Nufiber Check type of work involved:
Property Uwner __r �- [� _ )dYl —
Contractor's License No. \j 3 :SS eIL-e Boner Controls
Contractor's Board ',,-Ie . No. Clock Systems
Phone No. � '' " Data Telecommunications Installatio.�s
u u`h' Fire Alarm Installation
3. Owi?er application: HVAC
Instrumentation
Print Owner's Narna Phone No, v Intercom and Paging System
Landscape Irrigation Controt"
ddress Medical
Nurse Calls
Outdoo,Landscape I,gluing,
This permit is Issued under OAR 918-320-370. The applicant agrees Protective Signaling
to make only restricted energy lnstailations(100 volt amps or less) Other
under this permit and to do inn following: _--�"-
t. Only use tiectricallicensed persons to do installations where
required. (CertAin residential and other transactions are exempt Number of Systems
from licensing, These have asterisks r). All others need 11cens. J
Ing.)
2. Call for on InspecNon when all the Installations under this pe,,nit 'No license.,;a.a nxtuirec. Licsnsss aro recuired for all other irstallations.
are ready for Insp-pct/on.
3. Purchase separ>..to permits for sit installations that are n-,ready 5. Fees
for lnspe:•lnr;when the inspector Is out to Inspect—der th+s Inter fees $ L
permit.
4. Assume responsibility for assuming that all corrections required
by rhe Inspector are done,and 5% Surcharge .05 7:total above
3. Assume responsibility for calling for a final inspection when all of g ) $
the corrections are completed.
The person signing this permit must be the applicant ora person Total $ �.�.
authorized to bind the applicant.
Signature _ _ Space below reserved for validation.
Authority if other than epplicrint
For inspections call^ �
640-3561 or 6934415
24-hour recorder,one working day in advance of need 4194
y
DEPARTMENT OF LkND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
OAO155 NORTH FIRST,HILLSBORO,OR 97124
ftmt
COUNTY, INSPECTION REQUESTS: 503/640-3561/693-4415
1 OREGON
xxxxxxxxx--
Permit 'Type Residential EliiA I: ical Permit tic-rrnit #
Nermlt. status APPRUVELr Appi.ic 1
bitus Address i 13699) bw
Permit 'Title ;tl� NE;Vd t-'c>mZ_,Lef
1✓ermlt. Descr. , Expi
Vroject '1'it.1r= at~'14 NEW 1'zcy iect, u
Project Uescz .
Parcel Number 2a1'l'1.
Valuation
Lryal Desc•r .
UWnt-,r iNI,L'1_.0"i'lUN 'i" i..;/li.i 1:+7riClt'Il. ct'
Applicant, Name W1.LLAML'i"1'E: LA,L-1_ ( r ;
Applicant A,.Idr . Pu E(-)X Z'U347 ),,','t_4; r:, y'
'i'IUAHL), OR 'j 72>; VC) 1 i :rs t rr i ,y
A )PliC tit PhOne : 6Z4 36J1
f'Pe descriptic)n l.)1'111: Fera.''1 Ir; i I
6quare !'ootage [ Ent er .•q ,
JLLfytct .:1 Electrical Fee_, :
:it.ate :-Iurchcrge of b%
'1'ata.l Eicc:trical t•'ees :
**i
tees Required
Methc,,i Check
CK f,.:I"/ti u
At-iIu:,tI!,,,t ,. :7
'1'otai 145 . /
NOTICE: This permit becomes null and void If the work or construction for which k 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 rf this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Deparimpnt's reliance
upon false and misleading Information may Invalidate this per R. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be compiled 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 gra^#authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted cloy.muds upon my calling for Inspections at various limes 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 to approval by the
Building Department Is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satlefipd and
approval Is,:van by the Building Official. I further acknowledge that a Ilen may be placed on the title of the property upon which the permit Is issued
spoclfylnr that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requiremants.
APPLICANT'S SIGNATURE ��
.,,rbNi�lrt•-wr t•.w.wr.ase+�wa.. ............._.._.,._:...._....._.,�.
WASHCOUNTY ELECTRICAL PERMIT
a�partmeni meni of of '.and Use & Transportation1�
Electricalt.:tior Section APPLICATION
� .55� North First Aver e, #350-12
Hillsboro, Oregon 91124
Information: (03) 540-3470 ' 'x: (503) 693-4412
PermAl
Number _ l ! _ Date
.: ' ' 4. Complete Fee Schedule below
Number of Inspections per permit allowed
Lo.-arson of installa0on -------
#1 ! (dress , .`'!/ ?c' ' �'-�-� �,.1> _( Service included: (terns Cost(ea.) Sum
Building A. Residential-per unit
Cir•. ' t it — Suite No. ---- �,
1000 sq.ft.or less $110.00 4
Name Each additional 500 sq.ft -n
(if cnorcial) --- —�_-- _...._. or portion thereof — $25,00
1�t Limited Energy $25.00 _ 1
Map No.— l Tax Lot - -- Each N anuf a Horse or Modular
Dwelling Service or Feeder _— $68.00 — 2.
Thomas Map Book: Page:__ Section:--__-
Directions_. __ --_-.— ----- . B. Services or Fenders
_— _�--_-- Installation alienations or relocation
200 amps or less _ $50.00
Commercial ❑ Residential 201 amps to 400 amps $80.00 __ ___ 2
401 amps to 600 amps $120.00 2
: 601 amps to 1000 amps $160 00 — 2
2a. Contractor installation only: Over 1000 amps or volts __.__ $34000 2
E lectrical Contractor GJ. jtA,&e fie f jrA A r _& Reconnect only $50.00 .---•--- 2
Address Q Op,r. 'L gn f rj 7_
City_ AO State d ZIP=HD C. Temporary Services or Feeders
Date 141,142 L 5 Job Number 7Y 1 _ Instr.11ation,alteration or revocation
F roperty OwnerK.,i /Ii" -t �, .__- 200 amps or loss _—_ $50.00 _— 2
Contractor's License Nd. _ 3 tr J,3 201 amps to 400 amps r— $75.00 2
Contractor's Board Reg. No. '�o�, 401 amps to 600 amps $100.00 _� _ 2
Over 600 amps to 1000 vk,lls sae'B'above
Signature of Supr. Elec'n — L '- D. Branch Circuits
License No. /,S S _ Phone No. _1,6 7-If ?,�.� New,altorntion 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
fr n1 l ZSwner s FJome v onn To b) The fee for branch circuits wlilhout
purchase of service or feeder fee.
fnaso
-.- --- --------- ';ir5t branch circuit __ $35.00 _ -- 2
��
Each addnl branch circuit— $5.00 2
h•------ -- -- —— Zip -- -- -- E. Miscellaneous (Service or Feede,,not included)
Each pump or irrigation circle e— $40.00 2
The installation is being made on property f own Each sign or outline lighting $4)W 2
which is not intended for sale, lease or rent. Signal circuit(s)or a limited
ene,gy panel,alteration
Owner's Signatureor extension —__-- $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection — $35.00 _
Per hour $55.00
Please check appropriate Item and enter fee In ser,U,,,158. In Plant —_— $55.00
_4 or more residential units in one structure .5 Fees
Service and feeder, 800 amps or more nc
System over 600 volts nominal A. Enter total of above fees $
___`Classified area or structure containing special 5% Surcharge (.05 X total fees) $ _ I/
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. r! Trust Account $ _
Balance Due $ '`I =
For inspections call Thh permit tiecomes null and void M the work ruthorized by the parmh is not commenced
640-35151 or 693-4415 within too days Iron dole of issuance of such permit or if the work authorized is
suspended or abandoned at any time titer work is rnmmenced Iw a period of too day&
24-hour recorder, one working day in advance of need Eledncal permits ars non-ralundable and nontransferable.
8/94
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES
PERMIT#: MEC2002 00587
W . DATE ISSUED: 12/18/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104CD-08600
CITE ADDRESS: 13895 SW 9OXELDER ST
SUC DIVISION: HILLSHIRE ESTATES NO. 2 ZONING: R-7
ELO^K: LOT: 085 JURISDICTION: TIG
CLASS OF WORK: CTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/0 APPL: VENT SYSTEMS:
STORIES: BOR ERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HF. COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30- 50 HP: WOOMTMFS-
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace and install a/c.
Owner: FEES
SHUEY, NEIL E + DONNA M Description Date Amount
13855 SW F30XELDER ST IMLCI-I1 Ilennit I cc 12/18/02 $72.50
TIGARD, OR 97223
TAX)R%51itrr l;tx 12/18/02 $6.80
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
F.O. BOX 230397
TIGARD, OR 972.23 REQUIRED INSPECTIONS
Phone' 624-2704 Heating Unt Insp
Cooling Unt Insp
Reg#: LIC 76359 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started vAthin 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to fallow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By. �j Pr rmittee Signaiu"R1
Call (503) 39-4175 by 7:00 P.M. for inspections needed the next business day r
L'
^\ Mechanical Per mit Application
Date received: / Permitno.:�(C
City pf. Tigard Project/appl.no.: Expire date:
Cay of Tigard Addreft: 13125 SW Hall Blvd,Tigard,OR 97223 —
Phone: (503) 639-4171 Date issued: By: Receipt no..
Fax: (503) 598.1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
7LUJ2 family dwelling or accessory U CommerciaUindustrial U Multi-family U Tenant improvement
w construction ' Addition/alteration/replacement U Other: _� -
JOB SITE INFORMATION i
Job address: 3 L) o Indicate equipment quantities in boxes below. Indicate the dolkii
Bldg.no.: Suite no.:_ value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: - profit.Value$
Lot_ Block: Subdivision: _ •See checklist for important application information and
Project name: - jurisdiction's fee schedule for residential permit fee
City/county _4. A AZIP: t
Description and location of work on premises: ► 1I I t l
�� C/Yl 4 �ai11�- ff C. Fee(ea,) I'otnl
Est.cite of comp) ion/inspection: _ Descrlpdon t Reg. Rc�,onl
Tenant improvement or change of use: -- 1Tnc: _
Is existing space heated or conditioned?U Yes O No An handling unit _ CFM
Is existing space insulated?U Yes U No Air conditioning(site plan required)---
Ahcration o cxtsting syaeni
doi-compressors -{
Business name: SNL A State boiler permit no.:
HP Tons BTU/1-1
Address: -tr smo c amper uct smo a detectors`
City: �+ • Vtitate_ ZIPA PvyiP-:9 Dump(arae p an require )
Phone:L,?q.9•/g!yjtax�T-?�OX7 E-mail: nsta rep ace furnac urnc /
CCB :to.: -- Including ductwork/vent liner U Yes Q No
Install/replace/relocate .eaters-suspend" ,
City/metro lie.no.: _ , 7 _ _ wall,or floor mounted
Name (please print): 1?")r'G A a c ! ,lo/SG/tG/L, Vent for a Lance other than furnace
t C e gerat on:
Absorption units _, BTU/H
Name _IPA 61- QA Ab V ,Q NDeu��g �/ Chillers,-- — HP
Address: T Cotn ressors HP
---
— Environmental ex aunt an rent e.t on:
Cit
y -!� State: ZIP: Appliancevent
Phone: p Fax: E-mail: ryerex aust
Hoods. ypc ies. tc a azmat
Name: '7 hood fire suppression system
_ D it/IV J__ ,f rI e� Exhaust fan with single duct(bath fans)
Mailing address: 'y 1 �L o c x gust system aL rom heatingor A
City: /� � State: ZIP: �,Z 4 uc pip ng an tris-tri ut on up to outlets)
Phone: type: _LPG NO oil
e7 Fax: E-snail: --
fve i in each additional over 4 outlets
Process piping(schematic required)
Name: Number of outlets
------ Ot e.I sl�i app ance or equ pment:
Address: Decorative fireplace
_City: `w V State: i Z- -(P: Insert-type -
Phone: I Fax: I mail: oo stov let stove
t
Applicant's signature- -1-21 cr-Date:/? -/Z-U z Other:
Name (print). .` ,�',q/b ----
Nd all judxaedoru Mew credit cards,plea"cat]jwisdicdon for more infoamsaon Permit fee....................$
OVisa OMasterCard Notice:•Ilii]pemtit application Minimum fc. .........,
Creellt end tarmba:- expires if a perntit is not obtained $
Expires _ reiUtin Igo drays eRcr it has been Plan review(at 96) $
am oldu u i rl'o_- on c i cuN— accepted as co-plete. State surcharge(896)....$
$ TOTAL .......................$ '
717 3-C—
Cardholder 61 um "-- --Amouai
110.417 01MCOM i
Columbia Heating & CooAng, Inc.
P.O. Box 2.30397
Tigard, OR 97223-0397
Phone: 503-624-2704
Fax: 50.3-598-027,9
CITY OF TIIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
j eUP
Received _ Date Requested L �' � AM � _PM __ BUP _
Locationg�xZ 2� ,. Suite— - MEC —= G 0
Contact Person _ --�—.._— Ph(_j PLM -- --
Contractor _-__— _-- Ph(- ) _ _ ___-- SWR --__---
BUILDING Tenant/Owner _. __-- --.---.__ _ —_-,--- ELC _
-- ---------
Footing Et.0
Foundation ------------- ---- --
Ftg Drain Access:
ELR
Crawl Drain _ -
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors --- ---------- -
Ext Sheath/Shear
Int heath/Shear
Framing
Insulation
Drywall Nailing _- - - - ------ — ._-. --- -- - - --- --
Firewall
Fire Sprinkler -- _ ----------- - - --.-_-- -- -- -- -
Fire Alarm
Susp'd Ceiling - - , ---- - -- - - - -
Roof ------
Other: --
Finali'
PASS _PART FAIL - - ---_ ------------------ - -- - -
PLUMBING
Post&Beam
Under Slab --- - - - - -- _ _ -------- - - ---- ----. -. ---
Rough-In
Water Service - --- ----— -- --- ---- _... ------- -
Sanitary Sewer
Rain Drains - - - ----- ------- - ----- - �__ --- -— -------
Catch Basin/Manhole
Storm Drain - --- --- - -- - ------ - ---- -----— - -- -
Shower Pan
Other: -------- --- - - - --- - -_� _ ----- --
(=incl -.�-...—.__.._.._.
PASS PART FAIL -- - -- ------ --- —-----
MECHANICAL
Post& Beam ------- ------_-
Rough-In
Gas Line
Smoke Dampers ---- ----- ------- - ------ --- - ---
.V
f-PAW PART FAIL - -- --- --- -- ---
RICAL -
Service -
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of$-_ __-_-_ _ required before next inspection Pay at City Hall, 1312.5 SW Hall Blvd
PASS PART FAIL
SITE Please call for reinspection RE _ r� Unable to inspect- no access
Fire Supply Line
ADA
l /
Approach/Sidewalk Date __ _L_ _�_ _� Inspector((( __12?_ Ext -__.._..
Other:-- ----- /
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION NOTICE
s Inspection Line (Rec-O-Phone): 639-4175 Business ?hone: 639-4171
Inspection: _-_ —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Undarslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Lint. Insulation -Mech.
Underflr. Insul. Shear Wall / /Gyp. Bd. -Elect.
Date Requested:_ — C7�L7 l `` lime: AM __-_.PM
Address: '43? �— 5�%� !��?C e /off-V tf�-
Builder: Permit
THE FOLLOWING CORRECTIONS AAREERREOUIRED:
Inspector-&- Date:—.O
kAFPROVED ____DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.