16870 SW MATADOR LANE 16870 SW Matador Lane
f r ,
CITE( OF TIGARD _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIr#: Mt.L2oo2 00520
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/19102PARCEL: 2S116AD-15200
SITE ADDRESS: 16870 SW MATADOR L14
SUBDIVISION: KING CITY NO. 17 ZONING:
BLOCK: 19 LOT: 012 JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: 1 VENT SYSTEMS:
STORIES: _BOILERS/COMPRESSORS — HOODS:
FUEL TYPES _ - 0 3 HP: - DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODyTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
JRN < 100K BTU: 1 _ AIR HANDLING UNITS OTHER UNITS: �
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 3
> 10000 cfm:
Remarks: Install gas furnace/ductwork, vent for water heater. Gas log set and gas line with 3 outlets.
_owner. r v-- FEES =-�--
MARY SWENSON Description Date Amount
16870 SW MATADOR LN 1%11 ( I11 PC1111i1 Fee 11/19/02 572.50
KING CITY, OR 97224 1 1 AN 18", 11/19/02 55.80
----- Tof al � $78.30
Phone: 503-620-194"? —
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503-050-1 14.1 Healing Unt Insp
Reg#: LIC 447
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 1 P9 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregor Utility Notification Center. ,nose rales are set forth in OAR 952-001-00
Permittee Signature: ' 4
ISsuod By: ----
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
11/19;2002 19:11 5036393771 CITY OF KING CITY PAGE 02/02
ERtiIUaNTFR _Mechanical Permit Application 1
Citof Kin Cit ♦ Date received: �/ �) G1- Perm no :� ' ..19
City g EG E I V E D
�Pmject/applV"-II/
' Ex ire date13125 SJ\jp
Clackamas data-
Tigard Date issued: BY'L, Receipt no.:
Multnomah phone: 503)639-t 171, F (503MV-48 2002 C,tse rile no.; Payment type;
washln on 1 y Zuu�.
C �
Washingto
s � CITY OF TIDAFID Building permit no,:
Land use a ovttl:
to I & 2 ranuly dwelling or accessory ❑Cotnmercial/industrial D Multi-fancily 7 Tenant improvement
:-I New construction O AdditiotValteration/replacement O Other:
COMMERCIAL 1SCHEDME
Job address: &Z6 —_ Indicate equipment quantities in boxes below Indnaw the dollar
Bldg. no.: ��Suice no.: value of all mechanical materials, equipment. labor,overhead.
Tax map/tax lot/account no.; profit. Val Ile$ _--
Lot: 11310CL. Subdivision: *See checklist for imporant r.it lication inirtwiation and
Project name: jurisdiction's jEr Schedule fo► e.ridertml pwrmit fee.
City/county: ,'
Desc=ription and loclition o �w�r�k on prem.lses: .vsf„t./1.�,Fs
Fer(d.) Total
Est. bate of comptetion/Inspection: Description Qty. Res aw IRes.oniyl
tenant improvement or change of use: AC:
Air handling unit (..'FM
Is existing space heated or conditions l. J111 Yes O No ;r con Uoning�jq!pr u�iied)
Is edatirg space insulatei°�JYe: _lNo A r condi of extsAC syritem -
IMIDWANICAL CONTRACTOR
otlrb r%compressors i-
> State boiler permit no.:
3 usiness name: _ J��f � __ _ tiP Tuns S1VM
_ ll-'
E14
-
+ddtess: f�'� U �; � ve/smoke�ampers/duc� tsmo ee CtecroraState:Gq, ! eai pum (site plan required)
'hone:G-3G-/1PV_ ,Fa E-mailstat rep ere fumacr urner„Ty+� 1 J �y"� � L� os'e• °M Includin ductwotic/vent liner ®Yes U Nn Dd
:CB no.: `7rY,,7 `� T )arta rep sce/tslocate eaters- uspended,
ity/metro tic. no _ _ _ wall,or floor mounted
;ume(please print): ent fora Rance o erto-Minn ice 6; A0
Brat nt
Absorption units _BTU/H _
amc: Chillers _ _HP
ddress --- - Com ressors _HP �y I
_
----- ---
State: ZIP; Environmentalexhaustno vent n oa:
Appliance vent
tone: -- Fax - E-mall: Dryer exhaust i--'
Ixlds, Type U IUrei. ttc�ttl�raZnar
hood rue suppression system I
Exhaust fat with single duct(buh fans)
ailing address: 7C� Exhaust system apart from hentuip or AC
Fuel pipingand distribution(u ro 4 out eu)
p
etc �4�7
_ Sta21P: -I LPG �_NG_ Oil ( 'G ,S y0
one; Fax: E- 1: Fu Q each ad idon-cover a outlets I _
Process piping(schematic require'di
Number of outlets
me: �6rr-TCted appliance a it'equTp-ments
;dress: Csecorative fireQlace
Mate: ZIP: nsert--ty _
ane �`- Fax: E•m ll: Other.
thstore/pe Ct Hove
714cant's signarure• Date: ' Other, _
me(print).
ll prnv ivicas wespl credit cards.please veil lurixdtcueo r ••bre intorrmlion1 ti'otPermit fe t .- .................S _
so C]MaslerCasd I uc; This prrmit applicadon Mitvmun fee $
—
nerd -L erptres if a permits not obtaxed Plan revic w(at - 5b) S
nvmher r•itAin 180 dayr er i1 has oven
a State surcharge(8%).....S
Nm
ac at eardholder as shown oe ercdrr card decepted ascornptete,
Cardholder xilnswre Am wnl' J
— s.so�1�I tr00tCCIM
CITY OF TIGARD ELECTRICAL PERMIT
/ \\ PERMIT#: ELC2002-00322
DEVELOPMENT SERVICES DATE ISSUED: 12/2/02
13125 SW Hall Blvd..Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S116AD-152 00
SITE ADDRESS: 16870 SW MATADOR!_N ZONING:
SUBDIVISION: KING CITY NO. 17
BLOCK: 19 LOT : 012 JURISDICTION' KIN
Project Description: 4 circuits to connect furnace and to disable ceiling cabs- heat.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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- SIGNALIPANEL:
MANF HMI SVC/FGR: 601+amps --1000 volts: MINOR LABEL (10):
—_�
SERVICE/FEEDER BRANCH CIRCUITS _ ADD'I_INSPECTIONS
0 - 200 amp: WISERVICE OR FFEnFR: 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: J .=4 RES UNITS: >600 VOLT NOMINAL.
— Reconnect only: _ SVCIFOR >=225 AMPS:_ —_ _ CLASS AREA/.SPEC OCC: _
Owner: Contractor:
MARY SWENSON BOB'S ACTION ELECTRIC INC
16870 SW MATADOR LN 2700 NE BURTON ROAD
KING CITY, OR 97224 STE A
VANCOUVER,WA 98662
Phone: 503-620-1947 Phone: 360-254-7200
Reg #: SUP 43225
LIC 53136
FEES _ ELE 37-43!C
_ Description Date Amount Required Inspections
II I I It�1 I I I I'rinni 12/2/12 $66.80 --M —
I
12,2 01 $5.35 Rough Elect'I FilFi
nal
Total $72.15
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Specalty Codes and all other applicable laws.
All work will be done in accordance with approved plans This po,mit 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 952-001-0100 You may obtain copies of these rules ordirect questions to OUNC at(503)
246.6699 or 1-800-;32-2344.
Issued ByL,l.' l� < «. i�., . _ Permit Signature:
_ OWNER INSTALLATION ONLY
The inshallation is being made on property I own which is not intended for sale, lease, or rent
OWNER'S SIGNATURE: ___ —_ DATE: _
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N:
LICENSE NO: _._-- ---=------ ------ ---- -------------- --_______--m._____
Call 639-4175 by 7:00pm for an inspection the next business day
011/27/01 Ii'131) 1.4:44 1 Wk 503 508 1 (i I rL..'('�1V 'I'IURP ( )002
Electrical Permit AjipWr'inf9bn
UP tie lAV461-- I tale teeek,erl: 1,
City of Tigard BUILDING DIVISION prulecUappl.flu.; Expllc Into: `^-
Address: 131'25 SNI I Intl f11vd,'}ignrd.1312 97223 r t)nfe Issued: H p hecei+t no.
Cirgn/7'i,t,,nrd ,`j 1/`, )' T I
Phone: (503) 63')•4171 n G'lJ -
Fax: (503) 598.1960 P4%� C' ac file no: Puylncnll)I+c'
Land use approval:
TVPE l
I &2 ftuuily dwelling or nccesscny U Conlnu rcinl/industrial ❑Niulti•I'antily U'lcimm improvement
U New collstivefion U Acid itic n/alImiIimheplacement U lather:_ —_ U farlinl
Job nddres,s: 16870 Matador, King City _
Fi3i=dg.no.: Snhc no.: Inx map/tax Iot/nccounl no.
Lot: Block: Sul./llivision:
Project name: DescIi4tion nn(I location of work an premises: 4 circuits to connect furnace_'
I_ tinlnted cLltc+,I'rt,m,Irtirtnlinsprclirnl: o disable ceiling cable heat _
ONTRACTOR
,loll no: _ 02-943 err SII
IlrscrlpNun (jl). (en.) 'fnlel 00.10x1,
f3u.4illc59lt(llllc: Bob lect
s Action Eric Ne,errddeoflnl•sin�lrnrnudll-G+ndlyt+er
Addiess: 2700 NE Burton Rd. If A" _ dnelllnQnnh.Inrludesnllnrhrdpmnee.
C'ily: Vancouver stale:WA i 111: 98662 ' cenlrrh+rh+drd:
360-254.7200 2 4-821 loon u. 'IrsS _ 1
1'honc, Max; }:•mail; _ :1___�.____ -- ----- -__---
liach,+dtlydnnal SnU sq.fl.lir purlion dtcrcul
CCB n(,; lilec,bus, Iic,nu: 37-4310 -
53136 _ i,fmlledenerpy,resiricnlini
Cil)'/nICUo lit'. lo.: 00003861 I_I..IlrJcnrlpy,non•tcsidcnlinl
„ _ 11/27/02 Cnch mmmubreulrrd home lir ntodulnr 4,ramp;
- _ 5etvice nod/or feeder 2
Slgnnhne of supervising.2_ iclnn(telµlired) hole --
r ,Scriirranrfectrrx-Inslnllnllm,,
Sup elecl.nnnte(prinl) Kevin BrosellVnsenn: 4322 5 0Ile rnlloo fir relnrnfinlr:
( 200 limps nrles+ 2
Nnme(print): Mary Swenson 201 amps lo4urtnn+ps 2
_— —_-- 401❑nips to fi(l0amrs
Wiling address: 16870 Matador _ 601 ampsln 1000fit npII -- _
City' Kin Cit Sln(c: OR %%IP: 97224 f.)ser1000nugxorsolls 2
Phone: 620-1947 Reconnect only _I
1'rmrnrnty ertslrrs lir freden-
pwna inslallnliun:The instnllalimt ir, being 111110C on pruperll I own btslnlinllun,nllernlJnn,fir rrincnnun:
,.,fill It in not itllended fol'Snle,lease,Icnl,(elexchnllfC aCCOrdl11�I11 2(10 unrrs n1 Irss
(JK;' 447,455. 471), 670,701,•. 301 loops in400amt,< --
Uwnef'S
— hntnch thrulfs•Ilcw.nllervilon,
lir exlenstnn per pnorl:
Nome: _ __•_,�_. M A. Fee fur htmnch circuim with pmrhase of
A(Idrem. service or lender ree,esrh brnnrh ci,ctih 7
(:ity:
— S1RIc: ill': it. ler rot btnnch circuits wililout lilt sr
—. -- — — of Service lit feeder ree•firs)branch c•irt lift 1 16
}'bane' f'ne: r Ilt�il Enchnddllluildblmlchcircuil: .6 19
A111c,("SerNce or feeller nal Inelrtded):
I':u:h un+ mini nlinntiicic
0 Sen"iceover 12Stonps•crsnrnercfal u ItEnwi•enreracility p _
OSetAiccut•ert1u
12ng,s•ralhtporIt,2 Ullnrv4ousit+cnu„n f-.athsfpnnroatlinehphm,p
family(IwCIIiIIts Ulluildingover luUUnsyuurefeel four of Sigualclit uiitstnl0fin+ilyde„er[ypancl,
U System over bleu volts non,lnnl nese tesidenlini ndts in(site slruclurc ailernliml,lir extenlfurt' —__ — 2
17 Ouildfnpoverlluresluries U r-ceders.400toof+sornu,+e 'tttscri lion: — —
U occupnot load over 99 retsnns U manuracltrretl suucrotes lir It 'park r.neh addhlenal insrecllnn liter Ihr nllm,nble hr nut of the nbn,e:
U Cpress/liphdnprlat 1J Other. pet insretli(sn C T
!�3n11wH sets of plans 1►1111 any of 11u,lillove. Inveslipatinn fee _—
Vie above sire not npplicnble to imnpornry conarncflon tervlre. tether ---�--
___._ Penrtil pec.....................1 66.80
Nur all pnlsJicdnrts srcept reedit curly,Jill'lit call inrlsdicuun far more in hnnu6ot+ Notice: (ills permit npplicnlltut -Pian review(;it 'Ib)
-
a"in lerCrod expires if n peunit ie not obininetl —
O hnsl
_.`. [� vvidtin 180 dilys nftel it flax been Stale culchmge (81"'+1 ,....4 --5.35 -
CtedU tart number. —___.___—_. .---- tires
accepted us complete. TOTA t. .. ....................tt 72 t 1-5___ _
Name of cnrdhn er ns
CmJhntdet iiin;dlift .lnouul rfn gr.ls 1(ap+1.v,rlt
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION BusinesF Line: (503) 639-4171
BLIP
Received -_ -__ - -___-. Date Requested_ —__ ~ ' AM—✓PM BUP
Location �_� _�_� _d Suite ___—_ . - MEC n r 50 G
Contact Penson ____ _ _— Ph( ) sw—1 I g _____ PLM
Contractor _— - — Ph(. ) SWR
BUILDING TenanVOwner wY�'��� "'� ELC
Footing CD D �� FLC �
Foundation Access:
Fig Drain ELR
Crawl Drain
Slab Inspection Not,.s: SIT
Post&Beam _ ---
Shear Anchors _ ��
Ext Sheath/Shear yj
-
Int Sheath/Shear
Framing rol'-Z -
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 - --y-- --- - _--
Catch Basin/Manhole
Storm Drain ' __7z-
Shower Pen
Other: `T
Final
PASS PART FAIL
MECHANICAL
Post& Beam -- -
Rough-In
Gas Line
Smoke Dampers
42;. FAIL
CAH,.._- __
—.._.--
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm I
S,i APAgT FAIL u Reinspection fee of$ ____ required before next inspection. Pay at City Hall, 13125 SW Hall Plvd.
111
SITE F-] Please call for reinspection RE: —_-- Fj Unable to inspect-no access
Fire Supply Line
AOA 1 /� 7767�
Date lC1--- It,apector - - Ext
Approach/Sidewalk _-
Other:
Final DO NOT OVE this Inspection record from the jab site.
PASS PART FAIL