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11735 SW HAZELWOOD LOOP cC C m r O O v r u 11735 SW HAZELWOOD LP CITYOF TIGA®D MECHANICAL. PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2003-00718 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/17/03 PARCEL: 1 S134BO-01700 SITE ADDRESS: 11735 SW HAZELWOOD LP SUBDIVISION: ENGLEWOOD NO.2 ZONING: R-4.5 BLOCK: LOT: 105 JURISDICTION: TIG CLASS OF WORK: OTR — FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R", VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS_COMPRESSORHOODS: __ FUEL TYPES — 0 3 HP: DOMES. INCIN: L.f'G — - 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE. 50 + HP: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITSOTHER UNITS: 1 FURN >=100K BTU: <= 10000 cfm: �- GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of gas insert into existing fireplace and gas piping Owner: ----------- FEES ------__— POIRIER, MICHELE M Description —^ Date — Amount 11735 SW HAZELWOOD LF' IMI;CtIJ Permit Fee 12/17103 $72.50 TIGARD, OR 97223 (TAX]8%State Surcharl 12/17/03 $5.80 Total $78.30 Phone: — "! Contractor: PIONEER GAS FURNACE 3615 NE BROADWAY PORTLAND,OR 97232 REQUIRED INSPECTIONS Phone: 503-2495t►nIt Gas Line Insp Mechanical Insp Reg #: LIC 36102 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Lades and all other applicable laws. All worts will be done in accordance with approved plans. This permit will exp?ie 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 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 ( Permittee Signature: Issued By: gcf4 - -—`-- Call (503)639-4175 by 7:00 P.M for inspections neede the next business day oareur....i 11;,c:ianical Permit Al.) icatiou ' ' Received Mechanical Date/By: /1;i- /�10 - Permit No.: CI of Ti^ard Planning Approval Building `J Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Past-R.vie•v Land Use Date/By: Case No.: Internet: www,ci.tigard.or.us Contact J4Pi See Page 2 for 24-hour Inspection Request: 503-639-41756 Name/Method: '? ItfI Supplemental Information. TYPE OF WORK v �+ COMMERCIAL FEE*SCHEDULE-USE CBF,CKLIST New construction _Demolition Mechanical permit fees*are based on the total value of the work Addition,'alteration/replacement Other: performed. Indicate the value(rounded to the nearest dollar)of all rCATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. 1 & 2-Family dwelling Commercial/Industrial Value: S _ See Page 2 for Fee Schedule Accessory Building_ I Multi-Famil RESIDENTIAL EQUIPMENT/SYSTEMS FEE-SCHEDULE Description Fee es. rotal Master Builder I [:] Other: Heatin Carlin JOB SITE INFORMATION and LOCATION Furnace-add-on air conditionin "• T— 14.00 Job site address: Gas heat pump 14.00 Suite #: Bldg./Apt.#: Duct work _ 14.00 _ Project Name: H dronic hot water system 14.00 Residential boiler Cros; street/Directions to job site: for radiator or h dronic system) 14.00 Unit heaters(fuel,not electric) in wall in-duct,sus ended,etc. 14.00 Flue/vent for any of above 10.00 Subdivision: Lot#: Repair units 12.15 ----- Other Fuel Appliances Tax map/parcel#: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 )iu Ji (,U �,�V_ Flue vent(water heater/gas fireplace) 10.00 _ Lo lighter as 10.00 L �' -- Wood/Pellet stove 10.00 Wood fireplace/insert _ 10.00 Chimnev/liner/tlue/vent _ _ 10.00 JETPROPERTY OWNER TENANT Other: 10.00 Environmental Exhaust&Ventilation Address: Range t-ocd/other kitchen equipment 10.00 5 G taC Clothes dryer exhaust 10.00 City/State/Zip: -T i irP iL G h Single duct exhaust Phone: Fax: __ (bathrooms,toilet compartments, APPI ICANT ,CONTACT PERSON_ utility rooms) _ 6.80 Name: Attic/crawl space fans10.00 — Fuel Piping Address: �+ -- Other: 10.00 City/State/Zip: _ _ **($5.40 for first 4,$1.00 each additional Furnace,etc. '• Phone: Fax: _- -- - Gas heat pump •• E-mail: Wall/sus ended unit heater •• CONTRACTOR Water heater • Busir,ess Nanle: 1101✓L�. Gia SGiaS i C Fireplace •• Address: 5 I =,J. (:, 3XL�lu 1�sJ Range .• _ BB _ Cit /State/Zip: i- 4 L'AO _ OIL 07.13Clothes dryer(gas) Phone:2L ,,?�l( I Fax: Other: CCB Lic. #: Sa) to P_ Total. Authorized _ Mechanical Permit Fees' Signature �' `"' � Date: I 17 _ Subtotal: S Minimum Permit Fee$72.50 S J Plan Review Fee(259 of Permit Fee S (Please print name) v State Surcharge 8%of Permit Fee) $ TOTAL PERMIT FEE S Notice: This per mit application expires if r.permit Is not obtained within 'Fee methodology set by Tri-County Building Industry Service Board. 140 days after It has been accepted as complete. "Site plan required for exterior A/C units. i.\Dsts\Permit Fomu\MecPerrnuApp.doe 01/03 Mechanical Permit Application - Cih• of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to$2,000.00 Minimum fee$72.50 _ $2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30 for each additional$100.00 or fraction thereof,to and including$5,000.00. _ $5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and$1.80 for each additional$100.00 or fraction thereof,to and including$10,000.00. $10,001.00 to$50,000.00 $23 1.50 for the first$10,000.00 and$1.35 for each additional$100.00 or fraction thereof,to and including$50,000.00. $50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and$1.25 for each additional$100.00 or fraction thereof.to _ and including$100 000.00. $100,001.00 and up $1,396.50 for the first$100,000.000 and $1.10 for each additional$100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. is\Building\Permit Forms WecPermi'AppPg2 09.01.03.doc c CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Liebe: (503) 639-4171 BUIP Received .Y/� V•r Date Reques/ted AM PM BUP � ' a( � /-�Suite Location 1! �' � � � d.�.c �a��� .— - Contact Person ��p � - Ph( :ZJ�) � � Contractor _ Ph(-- } SWR BUILDING Tenant/Owner __- ELC Footing ELC -- _--- Foundation Access: Ftg Drain �3 -� ELR __-_-- Crawl Drain Slab Inspection Notes: SIT - Post&Beam — Shear Anchors {� - -- __ - --- --- Ext Sheath/Shear O ' " )w6 D Int Sheath/Shear Framing -- -- Insulation Drywall Nailing ---- Firewall Fire Sprinkler - -- ---- - - - - Fire Alarm Susp'd Ceiling Roof Other: - - - - - - Final PASS PART FAIL PLUMBING Post&Beam Under Slab -- Rough-In Water Service --- Sanitary Sewer Rain Drains -- - Catch Basin/Manhole Storm Drain — T -- - — Shower Pan Cather: Final --- --�_ -- — _—_— PASS PART__FAIL MECHANICALS Ptr�4�1R}�f"Lair Rough4n,rl' � - --- —-- — as Line ) moa ampers -_ _ -------------_-__ 46ART FAiI -- ELECTRICAL Servico Rough-In UG/Slab ' Low Volt,ige Fere Ala,m Final Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS_ PART FAIL SITE Please call for reinspection RE:----_-_ -___ Unable to inspect-no access Fire Supply Line ADAApproach/Sidewalk Dataz-.- � / `�Y Inspector '� -- Other ------ �-._-- Final DO NOT REMOVE this Inspection record' from FAe J{ b site. PASS PART FAIL /A� CITY OF T'I GA p D ELECTRICAL PERMIT [DEVELOPMENT SERVICES PERMIT#: ELC2004-00666 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/19/2004 SITE ADDRESS: 11735 SW HAZELWOOD LP PARCEL: 1S134BD-01700 SUBDIVISION: ENGLEWOOD NO.2 ZONING: R-4.5 BLOCK: LOT : 105 JURISDICTION: TIG Project Description: Replace panel. RESIDENTIAL UNIT — Y TEMP SRVC/_FEEDERS _ MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL.: MANF HM/SVC/FUR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER ----BRANCH CIRCUITS _—� ADD'L INSPECTIONS 0 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 am-. 1st W/O SRVC OR FDR: PER HOUk: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: I 601 - 1000 amp: _ PLAN REVIEW SECTION_ 1000+ anrp/volt: > 4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: _ SVC/FDR—225 AMPS: __CLASS AREA/SPEC OCC_: Owner: Contractor: POIRIER,MICHELE M KELSO ELECTRIC INC 11735 SW HA7_ELWOOD LP 545 SE 3RD TIGARD,OR 97223 HILLSBORO, OR 97123 Phone: 503-579-2527 Phone: 503-648-6360 Reg #: LIC 116254 FEES SUP 4270s ELE 34-433c Description Date Amount jI:LPRMTI ELC Permit In 111 $60.30 Required Inspections� ITA xl 8%State Surcharge I() IQ 'un. $6.42 Rough-in - - Elect'I Final Total $86,72 This Permit is issued subject to the regulations contained in the Tigard Municipa erode,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 adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-U01-0100. You may obtain copies of these rules or direct questions to OUNC at(503) 246.6699 or 1.800-332-2344. Issued By: Permit Signature: OWNER INSTALLATION ONLY _ The installation is being made on ;aroperty I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ _ DATE:._ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: '.iCFNSE NO - ----i-- Call 639-4175 by 7:00pm for an inspection the next business day FROM KELSO ELECTRIC INC FAX NO. 50364198211 Oct. 15 2004 03:54PM P2 leC rcal_Perrtft Abner �,.d rlty of Tigard rPlenTrtns;pptavil six, _--- Test Form yet ►Y'- +r No, .3126 SW Mall Blvd Alyn Rn9ew Other ----- ?►'tiled,Orojou 99213 Aou/byPetmnNo, _^ — PMte; 103.639.4171 Fax: 503.593.1x60 .v turd ,Tia ' — —i _ 1RtCII]et• MVNW.CI.tifatd,r]i.us allo;contt,% loris-' Saerase2Inv —� 24-hour ILSIliction Roquw; 503 639.4175 Ncndtlothai: __ y 9upQlcmu■ Infvrtaatiao. ', rrit, PLJI�t��aw 4w 11 '.!, 'y1E3i� Pldtrt' lfeelC'a]tl' afr (v! rj "t . + •--1 New COtISCrl3Ctir)r3 DCRSDllri011 4 Ser--lac over 27,5 arnye• i esith-ue lity — clomer rtial I HL&Wdou lo:ativn AdditiOn/Literatiottlra lacernen I t]•hEC: U Scroce oVw 720 srnps•rattrn of u11dfi=Durr 10,000 equare tt 4th 1 bier.,fpatily dwrlhaja four or uwnt resldentlel woD in II l & 2--anily dwel4na Cor=crc3YLndustri&1 ID Systarn over 600 volt!,mmincl one ttrJdwc Builduhp over Huse nar rs ❑Faodenps a,100 sattnrs AocW?M Builtiin Multi-Fadi OceLTwa IoW over W pmrzons ©mmufactund t7votuns or Av pork Master 1301Ctr Other: EV=a/lIghU{plan I ❑Other: I JOB s.rm 2TgV,MATsubmit ten orplaa►with any of tko above, ' Job Sf azddtxs: TI-17-7 I allomoy art ntoa Ileablo tq gmnewty nstwattonenla �?z�r.' •'r,�" .'IIrLr E` r a I,.tel Strict;k: Bid ./A lYumbsr Of t got atlo par Droit All t Prcicet Name: mon ___ t.... sew Cross street/Dizwtions toOb site; New rasimads"int;ie or mesio-rimay par ie dweli!as ualt Includes attatbod Carate Service lnchrded: l R. r , �---JytSr 'a suSdion. T.ut# 1clTuee entrLY,r041aRt�1 1�_-___- 7 ' T t!X Ria aazcel Lath w=uhaaaad hoax nr m'idultr d•.nlliet :.,}';; ttviet a or ftrda o Meat exf�adal-initatUatioa, sluratloa or"logasr 00 Irmb or tensRQ.�U 2 -- _ !Ori 401 4ffm to 00 ant ?1Rpr1^[i aw 1msN vA1, 7 •:a ' 1 ': er_os111 tis roto t,4 e x ,n t I b,i _ j Addrm: Trrrtaorary undta er en•Inftallatleac ,_City/StaWZip: _ — ineamN6 or relaeatloa: dd13 I l Phone: Fa7t: 9,snea to•ao n"�II 10Q),0 ESE 401 to 600 am -- -_-- _ 13175 N3II11:; Hraeth elrertb-new,altertttoa,or vtcasion Per ptnaia Adt�l CSS: A Fcc br brvnr►t chults rich pwahlu Jr taviceorloedertelta_,gh renolroirwrt _ 6.65 t I Ci ter!$t Ste i21p A.Fie for banal cacvty*Vwwt purrhaae e f Phost. .Fax: ut1>Kd¢bsLlltts�cutsiielts E-mail: Mite fa�ette�r ne I i n t' d 6S ;r.:. NJRAC i• t a;' ;_,', :ad+ rtrrt n mrn;e JobNo: NDSei nrattJM ii ht' V - clM-- tjar a tend wanly pane Plusinm Namti: t (Jr Address: °a°" ham—. �r woo.., - Superv,tsing I ever the anowebl Is orthe$bore: �Cicy/Stuc/Zi ba � _ -.�.._.- .- Phone. C) Fax: Rall rttI�wlwCCB Lic.fF: 1 I(.a etc. M: �C'_ �/ 'eloctriocan 1, ('I== '' ' �' g F 3: ;:z•L'. �'.-�si.�t�t;rreeauirad: �VU.. � -_•� u to S in Lo �Pri;g Name: � I� ., "--,_-- h - ew v.o De is Sit te, o Y.at: otmit et_ FTOTAL PLRl1IIi iFFE rtaGtm " is pure applkatltae cacdrrr a pen+lit is not ebesiaed r(thte Stynantre Dare ttO cte)'a etret It It=been socad a ta "raphe. •Fee net!►eAoloay sot by T'ruaty xU1Id1hg radu.try&6evics 134ard. p at potha) TObP mr+�n Jr rrr•. - e CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST -------....-- -- INSPECTION DIVISION Business Line: (503)639-4171 Received - Date Requesled _ le' 2 AM--. _. PM _ __- BUP Location _.. _._ ..� Suite__— MEG — Contact Person Ph( )� `- 7 PLM _- Contractor '- WESDI — Ph ) 6y� - 636© SWR BUILDING Tenant/Owner ^_ ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: G� SIT Post&Beam -_ — Shear Anchors t r� ����� i G C Ext Sheath/Shear t� Int Sheath/Shear Framing Insulation Drywall Nailing Firewall �_.�'1 '✓_�-. f�.�.�N���"' Fire Sprinkler Fire Alarm Susp'd Ceiling -- ---- Roof 1 Other: -- -- - - Final PASS PART FAIL PLUMBING Post& Beam Under Slab ---- Rough-In Water Service ------- Sanitary -Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain -" ----- " Shower Pan Other:---- Final ther:___Final PASS PART FAIL MECHANICAL -- Post&Beam — Rough-In -- Gas Line Smoke Dampers -- Final PASS PART FAIL -- ----- ELECTRICAL Sery o gh-In ��� UG/Slab Low Voltage — larm irum"-I SS PART FAIL El Reinspection fee of$—_.__ —.required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. S L1 Please call for reinspection RE:_ Unable to inspect--no access Fire Supply Line ADA I CJ/yV,M ��CC� t l� F•{ J Approach/Sidewelk Daft__ -� Inspector Exp Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL