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12210 SW NORTH DAKOTA ST
CITY OF TIGARD ELECTRsCAL PERMIT
PERMIT 0: ELC2005-00667
DEVELOPMENT SERVICES DATE ISSUED: 9/9/2005
13125 SW Hall Blvd.,Tigard,OR 97223 503-6394171 PARCEL: 1S134CB-04000
SITE Au"uRESS: 12210 SIV NORTH DAKOTA ST ZONING: R.7
SUBDIVISION: ANTON PARK LOT: 002 JURISDICTION: TIG
Project Description: A/C&furnace.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: /l .
EACH ADD'L 5008F: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 800 amp: SIGNAL/PANEL:
MANF HMI SVC/FOR: 801+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
261 - 400 amp: 1st W/O SRVC OR FOR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amph-olt: >■4 > 00 VOLT NOMINAL:
Reconnect only: SVC/FDR>■225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ANN BORMAN HILLSBORO ELECTRIC
12210 SW NORTH DAKOTA ST 21185 NW EVERGREEN PKWY#110
TIGARD,OR 97223 HILLSBORO,OR 97124
Phone: 503-590-3050 Phone: 503-439-9666
FEES Reg 0: ELE 34-43990
Description Date Amount LIC 134481
_ Slip 41S
IFI.PRMT) ELC Permit 9!9/211115 $53.50
(TAX)8%State Surcharge 9/9/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total :57.78 �—
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all other app�!c ble laws. All
work will be done in accordance with approved clans. 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 rc-uires you to follow rules adopted by the Oregon Utility Notification Center. Those rules ire set
forth in OAR 952-0010010 through OAR 952-001-0100. You may obtein copies of these rules or direct questions to OUNC at 503-248-8899 or
1-800-332-2344.
Issued By: ' /`•V""W-'! Permittee Signature:
a OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease,o.rent.
OWNER'S SIGNATURE: DATE:
t1 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N: DATE:
LICENSE NO:
Call 503-6394175 by 7:00 a.m.for an Inspection that business day.
This permit card shell be kept In a conspicuous place on t!Ie job site untll completion of the project.
Approved plans are required on the)ob site at the tlm4o of each Inspection.
09-09-'05.11;17F�- vt=land�Clft 503-227-4634 T-560 P002/0G12 F-561
•City bf Tigers! C -;;
V
�, Rating pwmn tva.:
1.:125 SW Hall Blvd.,Tigard,OR 97233 TE� (1 �� ��
Phone, 503.639.4171 Fax, 503.398,1960'°?C 1Q�� �rwmk:
InWwtionL„n: 503.639.4175 Dar 8 twh8e2rer
Internet: www.a.tiyard.or.us CITY OF TIGARQ N01M' ieiod b1iPPb•�•••tai •r•rataYa•
PLAN RRVIEW
❑New oonbtruetion Addilion/alterarion/replaeerpcnt Ph*=check ail that apply- �.
C7 Demolition Other: ❑Seryioe over 225■nape,orxnm'1 ❑Har11rdow locstlan
❑Senim over 330 amps-rating ❑Buildng over 10,000 14.fl.,
CATEGORY OR CONS11.Ut�1qN, ^;, of r-WA 2-Mnily dwellings 4 or mon new rmi&m nl
end 2-6mily dwelling C3 CommerciZ ndv.-.1al Accesaory bYp4il14 []System over 600 volts nominal Win in one structure
❑Multi•hmily ❑Master butida ❑Other; ❑Building over Ihroe atonies ❑Feeden,400 amps or more
w . , []Occupant load over 99 persona ❑Manufactured structures or
JOR SITE INFORMATION,KND .O(,
_IAT70N ,4'i.:;.�..:'':� ;• ❑t3pessAtghdrgt plan RV park
.lobno.: Job site adds Oss: ❑Health-care f adlity ❑OIINW. -
Submit,�este or pfsm with any or tat:tlboMe.
city/swoop - - TIM above aa.not oppikaVe to temporary cont alon aetvioa
Sult<.aldQ.hpt.no.. Pmjtxt narne: n w '
������ ':;t,` •`'l IrR6•:6CHtDUtl
Cross strtmt/diroctiona to job dte: Nee reaiesatial 41118Le-or mrltl-f*Miy d..e11M=Veit
- IrrrlsAes atlaebert rr1 a
1.000 sq.it or len 145.11 4
Subdivision: I Lot no.: Fa.NM'I 300 f6 or portion 1 33.40 1
Tax m4p/parcel no.: Limited oneW,reaidemial 7 •00 2
;::r .• Limilsd WKW,non-readatilsl 75.00 2ft
C1T10N O
FAch tittnutltartnOd tx tnodvlar
dwelli L rylej mndte feeder 2
"”'• St-im er tmdw l ntaktim,10aratiaa,and/or rdtlntion
200 arrips or len 80.30 2
:OROPBRi1f (nVNdl4 `' r� ?G" :�t°r r:..,..Q IyU-�4"�;`s yunri�,��µ, 201 Mn go 400 amp106.83 2
'~.•, � .� i•�+•». 401 b 600 160.60 2
Name: 601 unpa to I.00o a 240.60 2
Ovor 1.000 Address -or vola 434.65 2
c ity/State/Z1 P: v1 Recon ow. ----
Temporary—k"or the ho lastenatisn,aMeratbe.aarver
Phone: Fsx:( ) relocating
200 or lea I
Owner hwhllation:T1tls installation is being made on prop"diet 1 ower which Is not 201 tan b 400 am 100.30 2
intended for sale,lease,TOOL or ey,:hangs,acenrdin`to ORS 447,449,670,and 701, 401 a to Epp waps 133.73 2
Owner signature: Date. srnnelt dtrat
❑-APPLICANT, :a ..,
-�� a•-tier ■Maratlsa,er exletn r ted
�1"`•:..•• ,,,5;, „� ^;Y. 'I�"•,:.�.,�`n.�ODNTACI' 1'1SI180N�t'.-?•`?� r A.Rae for branch Adults with
aenioe or feeder 11M each
Business name: W 1A bm11aM Cirouh 6,61 3
B.Ma file breaolt a rc
Contest name: Wilho r ssrvi a or fi:ednr Ax:. I
Address: -,at _ 46,83 2
Bach add`)btaeolt eitbutt 6.65 3
City/Stalcop: Mb"Nmwaae fnrvke or 8esda:eat latlhreed
Phone:( ) I rx::( ) or Inisialon eitob 57.40 3
-a-
Sir ar cum"1 53.40 2
E-mail: S pial olteaU(s)x
. i'3:,13`'y'. .:,� il::•T,iin�,:r:i i qpoed.a ion.orC►NTRACOR
.. - extetnien.Deacrlbe:
Buslnessname:Hilldboro Llectric L.L.C. I•aye 2 3
Address: 21 18 5 NW Eva
- ?;cxree>l PKWY_ 946r additional ita on Durr albwabk Is arty of tM Above
j Per Inspation 63.10 —�
o City/StattslZIP: Hillsboro, OR. 97124 - i�vestiptionper hour(Ihr.t+nl — a
Phone:(503) 439-9666 FDf:(5031601-3680 Irtdtutnal anteerl'°'rr 73'75 -j
i - Rt.6(T- _R A1C L ►ERMR pnim
CCB uc.l 34481 _Electrical Lic.-3 4-4 9 9- Suprv.Lk.: 4 9 41 S Stblrn0 ,
Supry.Electrician signature,required: /,�[. Plan reviow(25%of pr+ %
"1- )
Printname:Joey Vii,taeco Date: Saw stsrchtlrtae(8!iorpermNreal
TOTAL PERMIT POR
Authorized signature: -
__ perasa a eaplrer If•pwralt �Nlelaed w1eNa t 80
Print name: Date: • do"aaar 11 Isar beets�as�e
..hM toodio olow IN by 111�crrer b adivi maMaf'8arviw Sand
e.paelletsper'arra810, art.
UWWinS1P-,, ABLC.HmnaAp Ave 12NO �1►.IrttTlt�M41Cl1AYNaa
CITY OF TIGAiRD MECHANICAL PERMIT
DEVELOPMENT SERVICE, PERMIT 0: MEC200500547
13125 SW Hail Blvd.,Tigard,OR 97223 5034394171 DATE ISSUED: 9/2/2005
PARCEL: 1 S134CB-04000
SITE ADDRESS: 12210 SW NORTH DAKOTA ST ZONING: R-7
SUBDIVISION: ANTON PARK LOT: 002 JURISDICTION: TIG
Project Description: Replace furnace, install A/C:,in-tall air cleaner.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO ADPL: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS HOODS:
FUEL TYPES 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: CLO DRYERS: I
FURN< 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN>=100K BTU: <Q 10000 cfm: 1 GAS OUTLETS.
> 10000 cfm:
Owner: �— FEES
ANN BORMAN i7escription Date Amount
12210 SW NORTH DAKOTA ST II
TIGARD,OR 97223 MP.C'Hj Permit Fee 9!2/2005 $72.50 r
[
[TAX] 8%State Surcha 9/2/2005 $5.80
Total $78.30
Phone: 503-590-3050
Contractor:
OREGON HEATING+A/C INC
PC BOX 397
DUNDEE,OR 97115 REQUIRED ITEMS AND REPORTS
Phone: 503-538-2953
Reg 0: LIC 125815
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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 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503-246-6699 or 1-800-332-2344.
Issued By: �� — -- Permittee Signature: -Q, A�Q n _
Call 503-634-4175 by 7:00 a.m. for Inspections that business day.
This permit card shall be kept Ir a conspicuous place on the job site until completion of the project.
Approved plans are required on the j,-)b site at the time of each Inspection.
Sep 01 05 03: 40p Oregon Heating and Fair 503-537-2172 p. 2
f •
Mechanical Pe_r_mit Application ®�
City of Ti Ream i PatnitNo. U
Tigard Z�' —
13125 SW Nall Blvd,7•irrd,OR 97223 Pima Raviri _
Phone: 503.639.4171 Fax 503 599 1960 Date/By e>t TamM
Inspection Line: 503.639-4175Uti Date readyft:i—� rmir: 0 Sar Par 1 for
Internw
Internet: ww .ci.tigard.or.us r, r NatifinUMnlh t SSW.mental leformatko
PLAW
T .� OF WORK r'COM1N 1 ' f)CI RULE -_Usk l:IlbGrl[,Lgrr
Mrrhani AI pa-mit fan'aro based oo the valve of the walk
New construction `, ddition/alt"tionlreplacem mt perfornmd.hAkAte the value(mwlded t( the neatest dollar)of all
0 Demolition ❑Othm ececitanical rnatetialr,equipment,labor.l vera tlttd fit.
�-— Value:S
'CA- 00RY OF CUNS`iKIJGTION "'':i� ,
RS51I1PN1 LAL VQUobylt f l 1 Yb CiZMS lllll� :,
and 2-family dwelling ❑Commercial/industrial ❑Aoce wxy building -
For rpec(al iWarmation urr eheciHist.
❑Multi-farnly ❑Master builder ❑Other. [)ascription _ C Y ?
OWL
[Aj70N AND` O ATIONI i'; Heatl coolln _
Air comditleeft or haat pump
Job site address �O - (rsuirea aYe len ahswG laewlon 14.00
City/State/Z1P: Y 'L 7j �+ i�tQaaoe 100,000137'U( 14.00
}'urtueo IOO,000f�dtttudvaob 17.90.
Suitc/bldgJaptno-:� 1�projectname: — t t�� 14.00
Cross street/directions to.iob site: Dad work 14.00
_ --- —
Hydro ni:bot water 5M=
14.00
Residential boiler(radiatir or -
14.00
Unit heaters(Mei-type,not electric),
- -- in-wal induct tmaLmd4 etc, !0.00
FluesNeat for any above 10.00_
Subdivision: Lot no Other. 10.00
Tax map/patcel no.: Other fuel a _ _
PP sees
,mss, Walsh beater _ 10.00
4t', .• z),.. 6 1, �r+�"�`.1Q- " "4 `'s Gas nteplace 10.00_ —
F1 ie vent for water beater or gas
fireplace
LID 4ht-jfi!�L 10.00
11 a Wood/Penet shwa_ 10.00
Wood lacelivaee _ 10.00
t birune AjnedguN•ems 10.00
-10.00
Name: Eavirensn utal absufft and vastllade 1
--- Range hood/other kitchen
Address: l � 10.00 --
City/statrJZIP: L' Qs a e» 10.00 -.
_ _ — Single-duct admit(bedroom,
Phone ] lr Fax ( ) toilet coTpartirsauts,utJM «wma _ 6.80
AtkJc - 10.00l ace ro?,
Other 10.00 —
Busi tes namel l Fuel
Contac'nam—e:�3 �� _ 55.40 for first four;$1.00 for tach additional
--- - — Furnace,etc. _ --
Address: e3as hea��R
City/state2lF- I� WaIV amended/unitbeates ---
Water heater
Fax:: -
Fireplace
E-mail: --
- G CTOR. Hardt
D
cue
�r ar _
ell_----
' Rosiness name l nn Nl. _ Other.
U Address MLrG'F1l1111t? L JP�6It1Z!lot
ZA
^yam 3ubtotai
City/5tetc!Z.lP: - o -
-- ..t_"�1-- 7------ Mitrimctm petmh fe;(572.50)
F'-
one:` Jj�(- �. I Fu / _ plan review(25%of 1 armit fee)
_—A- -State surcharge(g_%of l stmt fee)
,__-- - ---_ --_- - TOTAL PERhU'f FRE
�r ! [tib pvsB application eras b H a parse h not mp Obtained wklM 1M
Authorized s ntre: l4tl(lltSl n gyp►11 Lp.INIa1� "L days toftw y a,u Casa y Bend free rtry S
Print name:— �� , D • Fee on rAeelolop sd M Td-County BeIW es rntarstry Service Bond
l�dhautll'umimN.QG►cm:Nw.dea tial) ma9.mRI Tr(IIIa7R'AMW�
Sep 01 05 03: 41p Oregon Heating and Air 503-537-2172 p• 3
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CITY OF TIGARD
BUILDING DIVISION PERMIT#: MEC2005.00647
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 9(212005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/14/2006 TIME: 7:09AM PAGE: 105
SITE ADDRESS: 12210 SW NORTH DAKOTA ST '-LASS OF WORK:
SUBDIVISION: ANION PARK LOT#: Q02 TYPE OF USE:
PROJECT NAME: BORMAN
DESCRIPTION: Replace fumace, install AIC, install sir cleaner.
OWNER: BORMAN, ANN PHONE #: 503590.3050
CONTRACTOR: OREGON HEATING +A/C INC PHONE #: 503.538.2963
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 015541-01 503538.2953 Y ¢/v 9'72_
3
Corrections/Comments/Instruct;ons:
C
u
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CA FOR INSPECTION [] ADDITIONAL FEES ASSESSED
Inspector: .------ Pj1f& Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT M: ELC200&OW67
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 9191M
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 91114/2005 TIME: 7:09AM FfAGE: 104
SITE ADDRESS: 12210 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: ANTON PARK LOT W 002 TYPE OF USE:
PROJECT NAME: BORMAN t
DESCRIPTION: NC&fumwe.
OWNER: BORMAN, ANN PHONE M: 5035903050
CONTRACTOR: HILLSBORO ELECTRIC PHONE•: 503439.9666
Inspection Request Scheduled For: .Late: 9114/2005 Pour Time:
Code # Inspection Description Con'irm # Contact # Message
199 Electriral final 015541-02 503-538.2953 Y
Corrections/Commen±q/Instructions:
YPASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ Date: Phone 0: (513) ?IS-