10495 SW 69TH AVENUE-1 10495 SIN 69"' Avenue
CITY OF
TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES DATE
#: ELc7102 552
E ISSUED: i0/17
13125 SW Hall Blvd.,Tictard, OR 97223 (503) 639-4171
PARCEL: 1 S 136AC-03200
SITE ADDRESS: 10495 SW 69TH AVE
SUBDIVISION: 70NING: R-4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Install 2 branch circuits: 1 ea. to furnace and AC.
_ RESIDENTIAL UNIT _ TEMP SRVC/FEED_E_RS MISCELLANEOUS
1000 SF OR LESS: 0 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGI`. 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
`�_ SERVICE/FEEDER BRANCH CIRCUITS — _ADD'L-INSPECTIO14S
0 - 200 amp: IN/SERVICE OR FEEDER- PER INSPECTION:
201 - 400 amp: 1st WIO SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: �_ _ _ PLAN REVIEW SECTION
1000+ arnp/volt: > 4 RES UNITS. v >600 VOLT NOMINAL:
Roconnect oily___`_ SVC/FDR—225 AMPS: — _ CLASS AREA/SPEC OCC:
Owner: Contractor:
WORKMAN, BRUCE W AND GLENDA D EVERGREEN ELECTRICAL CONTRACTO
1.7495 SW 69T11 AVE 23861 SE 442ND
TIGARD,CR 97223 SANDY,OR 97055
Phone: Phone: 503-668-4608
Reg #: ELE 3-472C
_FEES
Description Date Amount
Required Inspections
[ELPRMT]ELC Permit I n 1u_' $53.50 —
(TAX)8%state Tax $4.28 Elect'I Finai
Total $57.78
This PPrr- r is Issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws.
All v,ork will be done in accordance with approved plays. This permit will expire if work is not started within 180 days of issuance,or d work is
suspended for more than 180 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 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)
2465699 or 1500-2344. ,
Issued By: permit Signature:
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, Rase, or rent.
OWNER'S SIGNATURE: DATE:—_ _
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. FLEC'N: DATE:_.
LICEN & NO:
Call 639-4175 by 7:00pm for an inspection the next business day
01- 3/1002 15:21 FAX 5035981990 CITY OF TIGARD IN02
Electrical Permit Application
DatcteCcived: p:tmitno:L"�r�,�',,,rJ(,�'-
'
City of Tigard F'rrctlappl,no. Expire date:
ol
01 ,'Ti l.rd Address: 13125 SW Hall Blvd.Tigatd.OR 47^2', Wit:imucd: By L Receipt no.:
Phone: (503) 639-4171 — -- -
Fax: (503) 598-1960 (' l Case file no Payment type:
Land use approval:
I w 2 family dwelling of accc�jsory U Commercial/industrial O Multi-family Q Tenant improvcmcm
U New con:trur:,un J Ariottit nlalterotionlreplacemcnt J Other: _ U Partial
Job address 1 t i c. `�tti` k, 1 AN c �N _ Bldb. na-_ Suite no.: Tax map/tax lodaccount no.:
Lot: 81ock. Subdivision: _
Project name: Description:ural locutior�of workonprremiser: f t.i, I IUL t /Yl(C -
Estimated date of com letion./inspectint, ,
Ell
Jobso! FEW M
an
"--- - -- Dtacrl.�oo Qty. (ca-) TOW nn.indp
Business name:F.1er,�c'eptl OC -trtt__,C,1 T - newrwi.fesfirl-sYrRkorrnsiti{smlhrr*_
Addrert:: �, �;, dwe4kn;tn,iLInc luMAa(tocheJrirao•.
C � Scitte:ZN ZIP: C� •�,;��-� SeniccittehWed ts . 4
Phone: Fex:�� E-mail: IouU eq.rt.or lean_ -_
Fath additional 300 sq.ft.or pon.on ncrrenf
_CCB � ?�1�_ Elee-bug.lie,no: 3-i-tj:;).L Uniiiedenergy,reeleicatlal 2
Ci h,t4lm1 c,no.: — Ltmitedenergy,non-rraidenui 2
Each rornufautured harm or m Aulur dwelling
a"�rure of supmtsir� electrician(required) Uatc Service and/or feedat 2
- —� --�� tvkosorfeedctis-IrtstallatN,n,
Sup.elect name Lrerrtee aro: NJ',1 > ahentlen ar relocation:
200 Crips or ksa 2
mps co ,?0 Crops 2
Name(pont): v uU U t.1 1�r y ��L, -M.! _. —- -
- 401 afupa l0 6W arttpr _ -
Mailingaddfeas: ~_�_ - 601 amps to 1Rw~at 1
Cit SUtc: TZIP Over 1 OW sunpi at vola
Phone: C_ Fax — Nrtotursclonly 1
Owner insosillidon:The Instillation it; being amide on property I own 7'empr:ry a>yt,kes on Eeedara-
which is not Intended for tisk,lease,Mitt.or exchange according to '"d'ilatka,oKrr'Lio"'errWQMflon'
200 anipt or less _ Z
ORS 447,455,479,670.701. 201 ane s to 400 amps _ 2
Ownces tri tulle: Date: 401 to 600 ams z
-- Macs dresills-aew,%Nafatlon,
or extension per pan el:
Narne: r _ ----- ,__ A Fee for branch aitcalts with purchase of
Addit•ss: service or farder foe,each brarwh cimt, -1
City; State; B. Fee for httlnch cirtuiu tai ut purdouc
--- -- - _ of service or feede-tee,first branch circuit: '
Phorw. Fax. E mail _--
F.ac rdiiionel branch dRafr _
Was.(service or leerier ref )t
U Service over all amps cmrlanerrAal rJ Waith uretwilaty each tiftworlRi ationeimit
U Srivi ae over 310 atnit%roting of 1 k2 U ftazardous lMatiofl sl n or our re li hting
fnrrdiv dwellings U Building over lo,000 square free four or Signal eft-W era iiml,ed anergy ponel,
U SVsrrmover 600volts norninal mole residential Units Inenrstructure altcration.oressensions
U Building over ttuee slonea Q F-ceders.400 amps or ate •De./crf tlan.
U tk:cupwtt load river S9 persona Ci Manufacture)rtructumt a kv part Fittit addirlonal brgwmion ever the aflo«sibk In any afUie above,
7 F.gter,alllandnpplan 1,1 tither _-- - -- PainspecUun
SitlMtut srCt of plans with any of the above- Inver adna reeree
-- -
TIM above at-r not appllo►ble to tt Poraao
ry c a11"K6vuer
svice. Other
_.-_.._ above —
�- Peirnit fcc... ........S =f
wit w)wttrlfruas arasP,rt.ae scab.pear tel pr,w.. n.rev rr v rarrrauan. Nadex:This permit application
OVIw 0 MurerC ted expires if a permit to nut ohtamed Plan review(at -___ %) S
COO Lad Mmbn- unthin 180 days afire it has been State surcharge(8%)....s
me accepted wa Complete
"-i•Firee-d7�ear�r�-:u�idr^r:i s�we oa aa�'i iaT----
-- �.arinoaa�rla}�e AaMaat 4MIAbt 5 4 11 M'.
CITYOF 1 'GARD MECHANICAL PERMIT'
DEVELOPMENT SERVICES PERMIT#: MEC2002-00444
13125 SW Hall Blvd ,Tigard, OR 972.23 (503) 639-4171 DATE ISSUED: 10/9/02
PARCEL: 1 S 1 a6AD-03200
SITS ADDRESS: 10495 SW 691H AVL=.
SUBDIVISION: VILLA RIDGE= ZONING: R-4.5
BLOCK: IAT: 601 JURISDICTION: 1-IG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS.
OCCUPANCY GRP: P,3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
FUEL TYPES Y 0 - 3 HP: 1 DOMES. INCIN:
^� 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES-
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 _ AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace gas furnace and a/c.
Owner: _ _ FEES
WORKMAN,BRUCE W AND GLENDA D Description _ Date Amount
10495 SW 69TH AVE [MECH] Permit Fee i 10/9/02 $72.50
TIGARD, OR 97223 [MECH1 Permit Fee 10/9/02 $0.00
[TAX] 8%StateTax 10/9/02 $5.80
Phone: WAX] 8%StateTax 10/9/02 $0.00
Contractor: Total $78.30
A-TEMP HEATING + COOLING
'16000 SE EV ELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: GSU-5014 Cooling Unt Insp
Reg tt: 71878 Final Inspection
This permit is issued subject to the regulations contained In the Tigard Municipai Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adop ed In the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA R
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by ;ailing
(503)246-6699.
Is*ued By: / g
Permittee Si nature: ,
Call (503) 39-4175 by 7:00 P.M. for inspections nec-ded the nekt bushwss day
OCT--07-2002 11:4R R TEM(, HEFTING 5035572990 F.02/03
Mechar"i A-Pen-rdt Appllcati On
--- _ ------- - — Datereccived
cit�y r ,.
y (ill i.1g�Tl� pmjectlappi-no.: - _ _ date:
Ciryof7leard s•tldreas: i31 `Sup Hall 11!'.d, i 0�� Datcissued_ ,- K eceiptnn,:
fio(te' 0,03) `19-4171 ,,••! Payment e
(S(1'; 598.1960 Calc the no-- - _ yn type'
- -
���( ) Building,permit no.'
i,wd rise approval:
U Multi-family ❑'Tenant improvement
2 family dwelling or accessory CI(ernmettiiat/indretriatl v
U New construction 94Addidun/a;tcr.ition/teplacement Q ether:
s
Job address: y tea Indicate equipment quanddes in boxes below. Indicate the dollar
(Bldg.no.: __ Suite no.: value of all mechanical materiala,equipment,labor,overhead,
profit-Value$
Tax map/tax lot/account no.' . iication information and
Lot: Block��bdiyision' See checklist for important apf
Pro ect name; - _ jurisdiction's fee sch.,dole for n'sidential permit fee.
City/county: ZIP: —
T Iwo 11101614
Description a �ationwork on premises:
ndf oral
AIL ---- - -
- Descri Qty Res.on] len, :n ,
Est.date of compwtion/inspection. - AC:
Tenmrt improvement or change of use: Air handlin unit CFM�.
Is existing space heated or conditioned?U Yes U No Aircon i on ns(siteprnrcgmr ) _
Is existing space insulated?O Yes ❑No Altorauoa of existin--g FSC system ^ _
i3oi fi compressors
State boiler permit no.,
Business name: B'IIUH
Address:&= ri �J
'irtrlsmnkeas-rTmp c-TvIuct smo c dewiors
Ci State: ZIP: Heat pump 76 to Ian r utt )
nti rep icefurnac burnef-ML13 u
Phone: -- G/ Fax:sI�' E-mail: - Including ductwork/vent Maar 0 Yes O No
CCB no.: Instal r>;p ace/re of ca het eaten-suipen
Clty/metro lic.no., _ wall,or floor mounted
Vent fors ranee of er an ice
Nnine(please riot):
Absorption units v_ BUM
�� CrChillers_ - HP
Narnr,: :5— Compressors Hf'
_- � - t rormeta , l+t ration:�Z ;6 a
Cit $late: ZIP': Appliancevent
_ - -
Phone: Fax: F nu,il: Dryct exl+aust _._
001 s, ype L res 010-the hairnet
hood fire suppression systcrn --- ----
Name ]f rQ t,��C`jt _ Exhaust fon with sln lc T,--- hath fans)_ -
��- -- � Must s stem a�ta_n_f_rom he- ai,n or AC -
Mailing addttiss _(Q(_(45'5�Q.L—__ - ----- - me�e-utdditir on(up to 4 ou ets)
Catty: F Cur�1 State:���7TT'�i 7 [va NO Oil
I'Ituor: rax: E rn;nl ue /pippin cn a�dlUons ova ou eta
aPiping(sc emeticrequlrc ) —
Numbet of outlets
Name: _. - _ ot&i Rage Sppawce m- pWeiF—
AddTess: --_ _ _ Dccoritiveflreplax _ .__
�nsen- --
City: state: ZIP': �
E-Mail; stovelpe let stove
P)►one: Fax: r
FN '--C(
plicattt's signature' Date: l) _
Tint): p r $
-
Permit fee
Nd rl jr"iraruoro t cetpt c'"t 01"'•ae"e OWI h"i'ar`n°"The MR i"r°�+rtn► Notice:Thisermit application ion
p Pp Minimum fee................$ _
CJ visa a Maste,Card expires if a permit is lint obtained plan tcview(at _ �) $
p:mdr�earl num9a:
—J---- vvithta Iso days atitr it has bear _.
-- ars State surcharge(11%) $
-�tTune of cam ewe-na t�� accepw as Complete. TOTAL ...$
4404617(ISKWuM)
=i,_T-07-2C al, 11:49 A TEMP HEAT I NG 503557299VI P
.A--Temp ticating ung Cooling
Site Plan
Prc���ll'CCi
by.
CIIStomer Nanlce --,AA '6dl—V --- Address;_g0 ,, �' r
z�
Customer �'I1oI�c:� JA
I'voilerly ilomidary Linc
f
Street
CITY OR TIGARD 24-Hour
BUILDING Inspection Line: (503)6,39-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171 ------------
BUP
Received _. _ _ _ Date Requested �a Ja AM _ PM__ BLIP
Location __� --_ ! ` Suite------- – MEC --- ----- --
Contact Person -- _-- LQL&� - Ph( ^) �o S_7' ' �l �� PLNI --.--- — -
Contractor &2 ___ Z�A_ &kZZ__ Ph SWFt
BUILDING Tenant/Owner ____�______ __. ELC
Footing —w _ ELC "
Foundation Access:
Ftg r)rain n: ., ,/� /�,/j� ELR
Crawl Drain —
Slab Inspection Notes: SIT
Past& Beam
Sheir Anchors
Ext Sheath/Shear
Int Sheath/Shear v
Framing
Insula,ion
Drywall Nailing - - -- ---
Firewall
Fire Sprinkler --- '�
-
Fire Alarm '
Susp'd Ceiling — _-----
Roof
Other: --
Final
PASS PART FAIL
P_LUIIABING -- _
Post&Beam
Under Slab
Rough-In
Water Service
Saritary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain -
Shower Pan
301pr
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL --------
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
nft PART FAIL Reinspection fee of 9; required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S � [] Piease call for reinspection RE: _ —� Unable to inspect-no access
Fire Supply Line
ADA l
Approach/Sidewalk DAb- ---- 11wo er
Othor _ �I
Final DO NOT REMOVE this Inspection record from tho Job site.
PASS PAR r FAIL
CITY OFTIGARD 24-Hour
BUILDING Inspec*ion Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST -
� � BUP _
Received --_ _ _ - Date Requested _ �-_ AM __ PM v�._. BUIP _
Location _—�.-a_ -Suite MEC �V
Contact Person 5 � Ph —_ laQ-a PLM
ContractorPh( ) SWR
---
BUILDING -`.� Tenail/Owner -__- ELC
Footing —
Foundation Access=: ELC
Ftg Drain ELR
Crawl Drain - - --
Slab Inspection Notes: - SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear - —
Framing 7—
Insulation Insulation
Drywall Nailing — �1 S's /iv S✓AAr�'—��„�� :i� `•s /�j �1��i,����
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _
Roof
Other: _ - --— — --in �-
PART FAIL - - ,-- --
UMBING
Post&Beam -- - —
Under Slab
Rough-In
Water Service
Sanitary Sowr,
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other. ------- _'�---- -- -- _ -_-
Final
PASSPART FAIL
CH_ -- ----------
MEANICAL
Post& Beam !_ _ ------- --------------- ---- -- --
Rough-in
Gas Line
Smoke Dampers
rn
PASS PART FAIL -- -- ----- _- _�—
ELECTRICAL
Service - --- —�
Rough-In _
UG/Slab ---`- - —-
Low Voltage - ------_ _
Fire Alarm —- --�
Final El Roins action fee of$____,_-
PASS PART_FAIL p required before next!nspectlon. Pay at City Hall, 13125 SW Hall Blvd.
SITE L 1 Please :all for reinspection RE:-_ _ _ Unable to inspect-no access
Fire Supply Line
ADA irspc4Approach/Sidewalk Dab _ Ext
Other. —
Final — 00 NOT REMOVE this Inspection record from the job site.
PASS PART FAIL