11950 SW KING GEORGE DRIVE�I
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11950 5W KING GEORGE DRIVE_
CITYOF TIGARD ____MECHAN:_AL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00465
13125 SW Ball Blvd., Tigard, OR 97223 (503) 639 4171 DATE ISSUED: 08/06/2003
PARCEL: 2S110CA-03100
SITE ADDRESS: 11950 SW KING GEORGE DR
SUBDIVISION: ZONING:
BLOCK: !OT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HL'ATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O ,iPPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS-
FUEL'TYPES _ 0 - 3 HP: DCMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTL) 15 - 30 :P:
REPAIR UNITS:
FIR":- DAMPERS?: 30 - 50 HP:
WOOGAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING _UNITS CLO DRYERS:
FURN >•-100K BTU: <= 10000 cfm• OTHER UNITS: 1
> 10000 cf,•n: GAS OUTLETS:
Rema-ks: Install exterior A/C unit. Do not place��nlnn tltc mimie(t scthacks.
Owner: FEES
RADDLE, DONALD A Description Date Amount
LORRAINE H
11950 SVV! KING GEORGE DR [�1L1'lIJ I'crnnt I rr --� 08/C6/20C -- —�S7250
TIG,�RD, OR 97223 [TAX] R"s.Stan I,t\ 08/06/20( x;5.80
phone. 503-639-3639 Total $78.30—
C untractor:
SPECIALTY HEATING & COOLING
1601 3L RIVER RD
HILL iBORO. OR 97123 REQUIRED INSPECTIONS
Phone: 503-640-3607 Final Inspection
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code .ate of Ore
Specialty Codes and all other applicable laws All work will be done in acc:r)rdance with approvers
plans. This permit will expire if work is not started within 180 days Of iF'suance, or if work is suspended
for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted in the Oregon
Util,ty Notification Center Those rules are set fnr,;i in OAF? 952-001-0010 through OAR
952-OC 1-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503!246-6699.
Issue. By: Permltten Signature:
Call (5 3) 639-4175 by 7:00 P.M. for inspections needed the next u Iness day
08/05/2003 10: 32 5036393771 1_1TY OF KING CITY PAGE 02
TRI COUNTY
SERVICECENTER Mechanical Permit Application jQoillml
° Date received:'; S 03 Permit no. ,j
City of King City �- 4� ` -�"� 6
13125 SW Hall Blvd. ra Project/apps,no.. - Expire date:
Tigard. OR 97223sw ' Date issued: ' By: Receipt no.: T
Clackamas Phone: (503)639-417 1. FAX (503)684-7297 � G' -
Multnoma!t C7 Z Z�� C.-LwFile no.: Payment type:
Washington E3uildin it no
r o „ " r , It , L..nd use approval: _ _ g tra
1
01 & 2 family dwelling or accessory Cl Commercial/uidusmal 0 Multi-family ❑Teriont improvement
New construction O Addition/alo-ration/replacement O Other:
JOB MO1 ' I IT&TRIlln
jol7 ac.dress: 1 S t J tyQ,t/L{p_ IndiC,.te equipment quantitit,s in lxlxes be.loi v btdicate the dullar
Bldg, no.; Suite valutr of all mechanical maNvals.equipment, 'ab c,overhead.
Tax map/tax lot/account no.: prorit•Value$
Lot: I Block Subdivision. *See checklist for important application intb"muier and
Project name /urtrdicrinn'rJee crhP<ful�jr r resiclentivl pertnitfee.-
City/county: '�R /1:� ZIP: -1-LTZ1 t
Description and floc a on of,V01onprremises: TtemUo'n
Fee
Est. date of completion/ilypection: 0""l time QtyRes.ono Reeonly
Tenant improvement or change ofttse: unit Is existing space heated or conditioned?3 Yes Q No ,nutgIs ezistiog space insulated?Ci Yes 0 No f existing HVAC syLtem
' 1 1 ' of ei compressors
Business name: �( f- State boiler permit no.:
AAddress — HP Tons BT[!M
v '�/ Fire/smoke damparWi.ia imOv,dttectom
_Cory: 1 ,V,� _ Stste:(�12. ZII' }Z Z-`1 eat pump(site pip.i required) -- - -
Phone:(n l(u-3(,0; Fax: �p�/-. ,�q 7 i E-mall stalVreplace hrrnace/burner_I
Ccs �u.. Including ductwork/vent liner ClWes U No
ri[y/metro;iCy
nstg rephc0mlocate heaters suspended.
M—
na.: i Ip wall,or floor mounted
ti.amc (please print). V}>. -x a_ O( o4.. Vent for appliance o�ierth fuinace
coNTAcir PERSONefrigentiue:
Absorption units DTIJ/H
Name: ChiII-Irs __ �•�Fie
Address: Com ressors exh
Erv4roamen aust ind gra atil:aLion:
�Ity: state: Appliance rent l
Phone: IFax: E ciutil: Dryer ex aast�— _
1 —l) oor�ype I/II/ms.kttchen/ha•„mst
hood fire suppress^on system
Exhaust fair with single duct(bath fans) _
Aaffing address: _ TXfrAu3t System dart n.tmTeAtli or AU
r�
» -StateT� ZIP: Fuel piping and r tri odea(u,a to outlets)
f w;le _ — Type^___.,•LPG NG Oil
-•3(e 3` I a x. 1 E mail: ire ing each addidonal over 4 outlets
rcc {aping(schematic required)
vame: Number of atutlets
- ---. _ _ _.•__._..�_ - . ._v�,. )thy /lllpplLince or eflnlptltetJ t:
�ildress: -- __ Decoradvc fireplace
State. ZIF Insert -rype
oo stove pe et stove
'hone: X. E-mail: W
Other.
l�piicant's signature _._.� Bate: �'../-�! _ Otherl •
game (print): /�YoI.C�- Dl Ft-•
,,all Juna4irtions srcepi reedit rwds•preps.rill lurlad OUon fpr Tore.nlnrrrutlon.
vsa Cl MlivriGi : Notice! This permit appl4ation Minimum fee ................S .—
dlt mrd number _ W_ _ L trpires i(a permit is not obtained plan reblew(qt _ %) 5
a,p;rM wuhhn 180 drys after it has been
_� State su r-charge(896).....S
r-Fame or Z hotdnr os shown--Red i acrd acrepied ac complete.
__ S IOTA]• ...................... .$
Codholder slaeolure Amount
09/05,'2003 '10: 32 5036393771 CITY OF KING CITY PAGE 03
SITE PLAN
PL
I
PL - -_...---: -- ----- PI.
STREET
Specialty Heating ; Cooling, Iic r
9528 SW Tigard Street --'
Tigard, OR 97223
Phone 503 .620.5643 Fax 503 .598.07 ] 8
Hillsboro Prone 503 .640.3607 Fax 503 .68 i .0793
/A CITY
TV O F T I rVw R^ — ELECTRICAL PERMIT
4 T K �J PERMiT#: ELC2003-00479
DEVELOPMENT SERVICES DATE ISSUED: 8/5/03
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S110CA-03100
SITEADDRESS: 11950 SW KING GEORGE DR
ZONING:
SUBDIVISION:
BLOCK: LOT : JURISDICTION: i<IN
Projoct Descripti.)rn: Instill furnace, plug and wire for A/C
RESIDENTIAL UNIT _TEMP SRVC/F_EEDE_RS _ IMSCEL_L_ANEOUS
1000 SF OR LESS: Y— — 0 - 200 amp: -- --PUMP/IRRIGATION:
EACH ADD'L. 500SF: 20 - 400 arrip SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp- SIGNALIPANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'l_INSPECTIO14S
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION.
2.01 400 amp: 1st W/O SRVC OR FDR: I PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC- 1 IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION
10n0+ arnplcolt: -4 RES UNITS: >600 VOLT NOMINAL:
Reconnect onl,,: SVCIFDR—225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RADDLE,DONALD A HILLSBORO ELECTRIC
LORRAINE 1.1 21185 NW EVERGREEN PARKWAY
11550 SW KING GEORGI HILLSBORO,OR 97124
TIGAR0,OR 97223
Phe ne: 503-639-3639 Phone: 503-439-9666
Reg #: I LE 34-4330
- ---- --- -- ---- - 1.1C 134481
FEESSUP 42405
w
Description�— Date Amount —
Required Inspections
(ELPRMTI PLCPermit - 03 $53.50
(TAXI 8"n Staic"I'm 5;5'113 $4.28 Elert'I Final
Total $57.76
This Permit is Issued subject to the regulations contained in the Tigard Municipal Code,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 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246.6699 or
1-800-332.2344.
Issued By: Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is riot intended for sale, lease, or rent —
OWNER'S SIGNATURE: __- --_ ______-- DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. EL-E(,'N: _.----�_-- -,_-- _-_- -_--__— DATE'_________--- - _--
LICENSE NO --__-__-_----___.----_--
Call 639-4175 by 7:00pm for an, inspection the next business day
Electrical Permit Application ` ` *OFFICE '
— _ Received /1 Electrical �e�
Date/By: 111J 1 �?` Permit Not&-?n 3-a_'_I_7 9
Cit`, of Tigard Planning Approval Sign —t—
g Data/By: Permit No.:
13125 SW Hall Blvd. ! Plan Review Other
Tigard,Oregon 9722 �� \J ; y Date/By: Permit No.:
Phone: 503-639-417 �g S(j Post-Review Land Use
Date/Bv: _ Case No.:
Internet: www.ci.t gard.or.us Contact Juris.: See Page 2 for
24-hour InSpeCtlCRequegttl60j9 Name/Method: _ _ Supplemental Information.
IA�1�V
o 1 11, ARD
'r Lvygg1$1nN
_ PLAN REVIEW(Please check all that appy
New construction ' U Demolition Service over 225 amps- ❑Health-care facility
ation
❑ Addition/alteration/re I lcement Other: commercial [U Hazardous over
10,0
L,Service over 320 amps-rating of ❑Building over 10,000 square feel,
CATEGORY OF CONSTRUCTION I I&2 family dwellings four or more residential units in
a_& 2-FamilydwellingCommercial/Indust:ial ❑System over 600 volts nominal one structure
❑Building over three stories ❑Feeders,400 amps c•r more
�❑ Accesso Buildin Multi-Famil ❑Occupant load r•,er 99 persons ❑Manufactured structures or RV park
❑ Master Builder Z Other: ❑Egressnighting plan ❑Other:
JOB SITE INFORMATION and LOCATION Submit__sets of plans with any of the above.
The above are not applicable to temporary construction service. _
Job site address: 50 LJ ___ FEE"SCHEDULE
Suite#: Bld ./Apt.#: Number of Ins ections per permit allowed
Project Nam Q, tQCS>L Description ply Fee(ea.) rwai -�
CCOSS StTeZt/Dlreet1017S t0 Ob site: New residential-single or mullt-family per
l dwelling unit.Includes attached garage.
Service Included:
1000 sq.ft,or less 145.15 __4
Each additional 500 sq.ft.or portion thereof 33.40 I
Subdivision: Lot#:
Limited residential _ 75.00 2
Limited energy,non residential 75.00
Tax map/parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service rnd/or feeder 90.90 ,
Services or feeders-Inslallatlon,
v.r..J�'�s�tk b _� alteration or relocation:
-- I 200 amps or.less � _ _ -- 80.30
to
201 amps to 409 ams 106,85 2
401 ams to 600 ams 160.60 2
PROPERTY OW60
NER TENANT :ams to 1000 em a 240.60 2_
Over 1000 amps o•volts 454.65 2
Name: Reconnect only 66.85 2
Address: 1 env V.���V�" r!gj A, Temporary services or feeders-Insldl2lion,
— State/Zip: k,�; �� ' le alteration, relocation:
Cit p 200 amps or less 66.85 1
Phone: (0101-ala 101 '` aX: 201 amps to 400 amps _ 100.30 2
APPLICANT CONTACT PERSON 401 to 600 am _ W.75 2
Branch circults-new, dteration,or
Name: _ extension per panel:
Address: A.Fee for branch circu-is with purchase of
service or feeder fee,each brant h circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase of
service or feeder fee first branch circuit ( 46.85 2
Phone: FaX: _ Each additional branch circuit l 6,65 2
E-mail: Y Y Misc.(Service or feeder not included):
_ CONTRACTOR Each pump or irri atiun circle 53.40 2
-- --- Each sign or outline lighting_ 530 2
JOb N0: T, signal circuit(s)or a limited energy panel•
alteration or extension Page 2 2
Business Name: W.11sbr,,-ta EIdJr't(, LUL Description:
Address: `7 l 14 N"Ejer_ rFN QK"_kW I` Ste• I I a
City/State/Zip: ' L ve �I Ct�� Each oAditlonal inspection over the allowable In an of the above:_
Pei
_l �IL _--- I'm ins tion r hour min.79
aX 1I Investi ation fee:CCB Lie. #: 3�yLir. # Other _ --
F.lectri_cal Permit Fees"
Supervising electrici� Subtotal S
si m}�ature required: �� -o _ Plan Review+l5%of Permit Fce S
State Surcharge(8%of Permit Fee S
Print Name:__ Lic. #: ��y TOTAL PERMIT FEE =,_2
_2
Authorized Notice: This permit application expires if a permit Is not obtained within.
Signature: — Date: _ 180 days after It has been ac, pted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
^' (Please print name) v
i\Dsts\Perm:,Forms0cPen.atApp.doc 01/03
I?lectrical Permit Appliration - City of Tigard
gage 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check T•pe of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
CCarage Door Opener*
Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
COMMERCIAL WORK ONLY: _
Fee for each system.. ......................................... ........ $79.00
(SI:F-OAR 918-260-260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock Systems
Fats Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
E__: Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
[� Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit FrnmsTlcPermitAppl'g2 d(K 01/03
MB/01/2003 12:55 5035393771 CITY nF KING CITY PAGE 02/02
t
li .
KING C191- Y
15360.>,W: l 16th.avenue,King City,Oregon 973_114.269^
Phone:(503)639•-10A2•FAX(503)6139.3771
i
Notice To Contractors Working In. King City
DL,e to an inter,overnmen.al agreement with the City of Tigard, many bir;;lding related permits
for projects in King City are issued and inspected by the City of Tigard.
If your per.nit application DOES NOT REQUIRE PLAY R.E'VIEW. sirr,ply complete thN
apprnpnate application legibly and submit it to the King Cit-} staff. The King Citi-,taff will
collect all fees and fax the application_to the City of Tigard. City of Tigard staff%,.ill then create
tl
the permit, issue the permit, and perform inspect -,rs. Please indicate on ..e perr-nit application
whetheryou would like the Tigard staff to call you wheaa the permit is reaciiv for issuance or
whether you prefer it to be mailed without any notification. Any incomplejte or illegible
application will be returned to King City staff for correction and no proces!ling cvill occur until a
complete. legible application is received.
I
If your permit application DOES REQUIRE PL.-NLN REVIEW; this form )must be sinned by a
King City staff person. King City staff Aill simple sign this formindicatln;, land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639-4171 Ext. 304 should you have any quest ons concerning submittal
requireme,,ts. Ali permit fees will be assessed and collected at the City sof I igar.l.
The Cir, of King City hereby authorizes applicant to pursue permits at the City of Tigard
B,_lildir22 Department for the follo�tiin¢ project: ._ _
located at:.
King City .Representative
I DSTS KC.II.ST DCII
CITY OF T'IGARD 24-Hour
BUILDING Inspection Line- (503)639-41:S
INSPECTION DIVISION I? usiness Line: (503)639-4171 MST —
PUP
Received __Date Requved - —(J=�,�� AM_ PM _ JP
Location — �_�_� ,Z� Suite i�L ���' CC� .. --- _., Q-,-
Contact Person _ ?h PLM
Contractor
BUILDING Tenant/Owner _ _ __- CIBC d
Footing ELC
Foundation A
Ftg Drain _cess:
Crawl Drain ELR
Slat Insp'&Jion Nates. - SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
-- ._..
Framing -
Insulation ---- ------ - �- ---- --
Drywall Nailing
FirewallZ. '
Fire Sprinkler_
Fire Alarm
Susp'd CeilingRoof
Other:
Final
PASS PART FAIL
_PLUMBING__
Post—& Beam
Under Slab
Rough-In �—
Water Service
Sanitary Sewer
Rain Drains -.--
Catch Basin/Manhole
Storm Drain --
Shower Pan
Other.
Final -- -- -----
PASS PART FAIL -
C�iIECHANI
Post kgea - - _ ---
Rough-In 1�� ��"
Gas Line (,�
Sm a Dam r _
-PASS PA_RTFA —
CTRI L
Sery ce
Rough-In
UG/Sidb - ----
Low Voltage
FiLe Alarm —
fin90
u Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL_
_ ( - Please call r reinspe tion RE: _._ Unable to Inspect-no access
Fire Supply Line ►//
Approach/Sidpwalk Dae --- Inspector-�� L�� -
PP t - �EXt -
Othol
DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL / �7 f •�