12170 SW PAR 4 DRIVE 12170 EW PAR 4 DRIVE
CITYOF TIGAR D MECHANICAL PERMIT
DEVELOPMENT SEP\iICES PERMIT#: M30/03 00355
13125 SW Hall Blvd . Tigard, OR 97223 (503) 639-4171 DATE IARCELSSI : 2S 11O
PARCEL: 2S i 10CB-02300
SIT E ADDRESS: 12170 SW PAR 4 DR
SUBDIVISION: KING CITY NO. 16 ZONING:
BLOCK: LOT: 011 JURISDICTION: KIN
CLASS OF WORK: OTR FLOOR FURN: EVf,P COOLERS:
TYPE OF USE: SF UNIT LIEATER6 VENT FANS:
OCCUPANCY GRP: R3 VE14TS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES _ 0 - 3 HP 1! DOMES. INCIN:
I PG _ —_ 3 - 15 HP: COMML. INCIN:
MAX INPUT: ETU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING__UNITS OTHER UNITS:
FURN >=100K BTU: <= 10r 10 cfm:^ GAS OUTLETS: 1
> 10000 cfm:
Remarks: Ne%k furnace.ducts mk N
Owner: FEES _
ROSS HOOD Description Date Amount
12170 SW PAR 4 I X11 1 Il
KING CITY,OR 97224 r'er nii I ce 6130103 $72.50
6/30/03 $5.80
Total $78.30
Phone: 5111-��i�;'-5;57 ----
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLAr'KAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503-00-1184 Gas Line Insp
Mechanical Insp
Reg#: LIC 447 Heating Unt Insp
Cooling Unt Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Gode, State cf Ore. Specialty Codes
and all other applicable :aws. All work will be done in accordance with ap;,ro-.ed 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 niles adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
/1
Issued Ey: gv\"�
/ l Perinittee Signature:
Call (503) 9.4175 Ly 7:00 P.M. for inspections needed the next business day
06/27/2003 12:50 5036393771 CITY OF KING CITY PAGE 02
TRI-CSERVICLQCEN1TR Mechanical Permit Application
' City of King City Dat,'received: _ _ Permit
v �f 13125 SW Hall Blvd. Pryjeeedappl.nu.: Expire date:
Clackamas Tlgard, OR 97223 Date issued-. By: Receipt no.:
Multnomah Phone: (503)6391171,FAX: (503)6$4-7297 Case rile no.: Payment type:
µ'ashington Building permit no.:
C O u S r l 5 5 Land use approval: �- L
06 t & 2 family dwelling or accessory 0 Commerclal/industrial O 'Multi-family O Tenant improvement
:1 New construction CO Add Itiort/zlteration/rephwf.-mens O Other
tSCHEDULE
Job address: 1 1 61- S"6 Indicate equipment quantitivs in boxes below Indicate the dollar
Bid$. no.. /;Z/ 'l c Suite no.: value of all mechanical materials,equlpment,I tbor,overhead.
Tax nta /tax lot/account no.: profit. Value S _
Lot: Block: Subdivision: _ 'See checklist for important application infornuuion and
Project name: jurisdiction's fee schedule for reridenrial permit fee.
City/count r Zt — t
Description and localuon of 4ork on premises: ..er •t'. r
*- p� �'..�mrIVIIAWIjr _�� e,, Fee(cc)I Total
Est- date of cortipletionft2! action. Desesiption Iter.onl Re&only
HVA
Air h
Tenant improvement or change of use: :
Is existing space heated or r:ondiboned:'0(Yes ONO �+� outdlin unit CFM
space r u i� �
I Ali can oning(site an
isexistin instJatex ^ Yes ONo Iterationofexistin A
system
of er compressors
State boiler permit no.;
Hp Tons _ BTUIH
\ddras 1 , M� S.L'"��i ^G _ Fvclsmoke da mpeNduct smutecto
kr ers
State.el .12 eat pump(site plat req,iced)
'hone_ �� Fax:(o E-mall: — - sta I replaces urner '
;CSno.: Including dr::«ork/vent liner jfi�Yes
y y 7 _ Listall/replace/relocate heaters- suspended,
_it'V/metro lk. nes._ � - wall,or floor mounted
lame( lease tint): .0 intor a p anr:e o er than fwnace
-CONFACT PERSON Refrigeration:
Absorption units _B'.i.rM
game: Chillers _-.-- —HP
T --- Com ressor _HP
+,ddress: ria onmeuta)exhaust and V110-i-92-FO-0:
:ity: ifState: ZB'" Appliance vent
'hone:4 - Fax:6.1 I: — Dryer exhaust
tHoods,Type Ures. it�c[e�amat
hood fire suppression system L
;ume: _ Exhaus, fan with single duct(ba4h fans)
tailing address 1 ' y _ x aust system—art�roomm��`or C.
Aue piping and distHbutlon(u)to 4 our err)
ty: —_--State: 7Fr'. �� Type: LPG W) Oil
hone ax: T E mail: aril i in ea`Fc i�ddivanal over a out ars
PYa-ez piping(schematic requi,e )
amt: Number of outlets M
ter lisw appppliaaoae o—equipment:
Jdress: Decorative fireplace
State: ZIP: Pe _
gone: FazTV C mall: — oo x,o.e/ eTf i store
Ot c r_
7plirant's signature-. Uate` Ot rr+---
.:me(print—
.ul)urisdieden xtrpr crdi,cards,please Wl)urisdmius ror more inronnnlion. PeM?it fee......................S
'1s1 ❑MasterCard Nortee; rhls permit applicmion PMinlmum fee ............. ..S "_6
erpires if permit is not ob(abied Plan re, 'tw(at — %) S _
fit card number ----L--1-- ryyllltfA l 80 ACS!tl�{er It I[t1t been (�
aapirrt State sulcl:arge(8%).....5 —
Namc o cardholder as sharia ee Tedi,card nceepeed a.t complete.
s TOTAL. ...................... .S
CardhoWet sianalurc Amount a10 16_��,
� n
h �
_ IZZw
O
:1 r!
o
�I C--
PNONE: CUSTOMER: ADDRESS:
JO8 NO.— DATE!
RRA N7!N 7 BELL HEATING NIA"CapF:
E0 30Vd 11I:: JNI11 _AO Ail:) TLLE6E9E05 05:zl COOS IL7./9E1
Ana
CITY OF TIGAl: D ELECTRICAL PERMIT
PE RMI1 #: ELC2003-00411
DEVELOPMENT SERVICES DATE ISSUED: 7/8/03
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S110CB-02300
SITE ADDRESS: 12170 SQA' PAR 4 DR
ZONING: 7
SUBDIVISION: KING CITY NO. 16
BLOCK: LOT : 011 JURISDICTION: KIN
Project Description: JOB NO.03-517
Gas furnace connection
_
RESIDENTIAL UNIT _ TEMP SRVrI_FEED_Ec i MISCELLANEOUS_
1000 SF OR LESS: i 0 - 200 amp: PUMPhRRIGATION:
EACH ADD'I_ 500SF: 201 400 amp: SIGNiOUT LINE I-TG:
LIMITED ENERGY: 4U - b00 amp: SIGNAL/PANEL:
MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L iNSPECTIONS
U - 200 amp: W/SERVICE OR FEEDER: PER INSPE.':TION:
201 - 400 amp: 1st WIO SRVC OR FDR: 1 PER Hr)UH.
401 - 600 amp: EA ADD'L BRACH CIRC: 2 IN F LANT:
601 - 1000 amp: _PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: —– >600 VOLT NOMINAL: _
Reconnect only: SVC/FDR>=225 AMPS: C!.ASS ARizA/SPEC OCC
Owner: Contractor:
ROSS HOOD BOB'S ACTION ELECTRIC INC
12170 SW PAR 4 2700 NE BURTON ROAD
KING CITY,OR 97224 61'E A
VANCOUVER,WA 98662
Phone: 503-639-5557 Phone: 360-254-7200
Reg#: SU" 43225
-- _ -- LIC 53136
FEES _ E1.l: 37-4310
Desc tion Date Amount
Required Inspections
[EI.PRM I'] Fl.('Permit 7 8,03 $60.1! —__
[TAXI H"n State Tax 7'801 $4.81 Elect'I Service
T _ _ - Elect'I Final
Total $64.96
This Permit is issued subject to the regulations contairmd In the Tigard Municipal Code,State of OR.Specially Codes and all other applicable laws. All
work will be done in accordance with approved plans. 1 his 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 by thA 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)246-6699 or
1.800-332-2344.
Issued By: � �. JL.-yL � __ Permit Signature: 1
OWNER INSTALLATION ONLY t� _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: ___—_ _— ___T__ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SLIPR. ELEC'N:
LICENSE NO:
Call 639-4175 by 7:00prn for an inspects-.- the next business day
(1(i/27/01 ffl,"D J4: 44 I P,`, 510:1 51)8 1!160 CITY ()R TIGARD fa ooL,
Electrical Permit Application
Tigard Ltnlc received: �---
City of Tigard ti �... ProlecYappl.no.: H%pitcdmec ---�---`
Addtess: 13125 5N' I full BSE'tl�h^ � � '��� I)nte Icenrri: K} T ucellil nn.
C'irs n/1 i,pnrJ .0 ----- ----
Phone: (503) 639-4171
Fax: (503) 598.1960 C'nsc i Pnyuicnll}I+c.
Land use approval:
I �
1 F 2 family dwelling or accessory U Comms reinl/industrial C MUM •annily U Tenant improveme l:
L)New constwetion U Add iticn/altern(ionlreplacemerrt I 1 1 hhrr: C]Pnitinl
1 1
Job address: 12170 SW Par 4�King City IJldg. nu: ;wile no.: •I'ax nlnp/tax loUriccounl 110.
Lot: Flock: _ Subdivision _._
Project name: jDesci tion and location of work an pretnlses: Gas 1 i i rnace connection.
Psiininted clue nl•cnnt,I+-1 ni/ins eclinn;
I I , . I 1' I
rr �Ia1
,1nb no: _r UJ-517 —
hrrcrlpll"n (21 . (en,) 7binl nn.his
flusincssnunie: Bob s Action Electric Pritmodrnto:•tingle nrmidllfml,i-r
Addtcss: 2700 NE Burton Rd. "Ar' i+•IIInSnnu IncludetnllntbrdRmnOr.
City: loanco+'ver .5tntr.:WA 111': 98662 rrr•si+rIncluded:
I'h_one360-254-7200 Ftl%: 254-8219 h-nmil: 10nr h m less
_ liuch nddninnal 10U arl 11.nr putlinn Ihcreul _ __
CCB no.: 53136 Iaec. bus. lic.no: 37-431C Lhnitedenerpy.rraidcmin►
Cily/metro lic. 1 o,' 00 801 Lindledeurigy,nao•residcnlhrl _?-
_ /3/03 Cnchmanuracluredhomeormodulo•dwelling —
Signnhne of s perviaing elecn:cinn tequlr _ J ,le Sri vice tuullto feeder _
fq+ rlecrnnnie(piiril)
5rrrirrsnt
Kevin 4322S rcederx-Inslnlrrllnn,
allermimi nr relncnlion:
1 1 2141 maps or Iran 2 _
201 gimps to 400 imps
Nnme(prinl): Ross & Anita Hood 401in.i sinrfl0nni+s 2
Maililig address: 12170 SW Par 4 Of nmpslo 100011wl+s
it King City -In�te:.QR IP: 97224 0%er10O(tnmpsnr+ulIA -
viione 639-5557 x: I► -Innit!I urtannrclnnly _ -
1'rmporaty services or feeders-
pwnei hislnllntimi:The tim(rlll:dinn it Iming made on prni,erty 1 awn (nrtrllnllnn,nuernlinn,urrelocndnm
Whichis ItUI ilnt7iicled for sale,lease.lent,nl'a%l'11:111(C❑eCnldilt(L In 2000++Os++i
OIZS 147.455, 479,670,701.-. 101 amps in 400 unips -- -- _
0svnet's si linll1r0: 1.)it 461ia604)unipi 2 —
Brunch clrrnU,-nevv.ailerutilln,
or e%teminn wr pnorl:
IJ;i1t1C; ,4. Fee rot htno•'Ir circ.-its with pusch:isr"f
Address: service 0t feeder ret,each branch cucuil 2 —
SIaIC X11': n. Fee me munch circuits,sithaim pnrthnsc
City, _ - ---— fir setviceto feeder fre,first branch chult 1 46.15 '
I'lu+m'~ rax: rnihil rachhaddilionnlbrrutchcircuit: 2 6.6 13. 3U -
V Ililki� MIle,(SersIce orfeeder lint Ifielfl,10 :
Bach pump m btlpnlian circle
U Service over 225 nnips•ctvwnercinl U llenldr entc!u���1 Fnthsl uurmrlinelr
O ser•iccnver32Uuns q, rutliignf 1t,2 U llazai(lnuslor111 ,1 4 Fes: -
romilvtlsvellings U nuilding over IU VU0 ayu•r,•tern tour ul Signal circurrls)of a hmii►rl evert)I+incl,
na+re re7ideniinl mita in unr structure aheratinn.or exteutimr' —t^ 2
O System over 6W 110117 nnminnl - - —
O Buildinpoverihrrestuties U reeders.4ontomlhornsnte 'tkstriJinn.
'7(A:cupont Inial rover 99 renins 0 Manufactuied suurnires m(f V ruck sorb addllsnnnl intpcctlon osrr Ilse allnnnble In"uy of the"ba^r:
l]Egress/li4htinprlmi r]other: ter inspetlimi
%efs of pions with any of Ihr,above. Imestip:ntan fee --
The above tire not nppllcable to temporary eomirtictton tervlce. (hher
Nen a,
Notice:'Itds pennil npPliculinti pcnlill let,.. . . _ ....$ 60_15
(ritisdicilmtl accept credit cnrdt,please T-1,0011.(rr .!In onn:niml Plnn review rail '!1s) b
q V.,, (]NbsterCmd e%pites irn relmil is not obtained —
cre.0 card+,umber. �_ vvithin 190 dnys after it has been $Into smchm gr IK'"1 ... 4.81 _
pr rife( nccep(ed •olnrlete. TOTAL ........................�
Name ul cltdllo et ns 7110111"an tort' $
(:ardhostrti�nauue _ 4nnuni fit)4"lsr(arvr,+ oo
CITY OF TIGARD 24-Hour
BUILDING Inspection Line. (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
Blip
Received — —Date Requested__ —7-11 AM __ �� PM BLIP _
Location a ����- Suite
7 �MEC -3' Q` 65 _
Contact Person Ph PLM
Contractor —�_ 1Pfh SWR
BUILDING Tenant/Owner , r�-0-�+-� 1�-�272 / �3 77 - �`�37 ELC
-Footing -"'-�
ELC
Foundation __--
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam _
Shear Anchors
Ext Sheath/Shear —
Int Sheath/Shear
Framing --- —" —
Insulation N Nit• _ "� �" �'_TT
Drywgll Nailing " ✓ `
Firewall
Fire Sprinkler —
Fire Alarm c- S 1 ` 11" C t �� �'3 C-I
Gusp'd Ceiling
Roof = - 1 �
Other-
Final
ther FinalJIG
PASS PART FAIL `\ 1
PLUMBING
Post& Beam
Under Slab -- --— - -
Rough-In
Water Service -- — —
Sanitary Sewer
Rain Drains - - — --
Catch Basin/Manhole
Storm Drain — — —
Shower Pan
i
Other:--..,-. - -- -- --- ---
Final
PASS PART -FAIL C /
iIAF�CI ftAL
Post&Beam U "—
;Iough-In --- --- --- — - --
Gas Line ;
Smoke Dampers — -- -----
tzinal>
PASS PART FAIL -�---" - - T— — -- - —
_ ICAL
Service ----- --- — - „_—._-.----
Rough-In ---
UG/slab
Low Voltage ----------- - - --- ---._ .— _ —_—_ —.
Fire Alarm
FinoL- Reinspection fee of$_-- required before next inspection Pay at City Hall. 13125 SW Hall Blvd.
gL_� PART FAIL
SITE Please all for reinspection RE:--___-_..- — — Unable to inspect-no access
Fire Supply Line _ 4
ADA
Approach/SidewalkDate- _ �/ _ Inspector ��� __ �`� c _Nxt --
�,_
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL