16398 SW 72ND AVENUE ADDRESS:
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CITY OF TIGARD BUILDING INSPECTION NOTICE
inspection Line (Roc-0- hone). 639-4175 Business Phone: 639-4171
Inspection:"
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Undeislab Mech. Rough-in Fireplace
Post/Beam Struct, Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
UnderfIr. Insul. Shear Wall
Gyp. Bd. IAct
Date Requested: " \ `moi 4' Time: AM PV
Address:
f�
Builder.Q�4�CL'r? &��j y 2' ( � Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
7
]jam
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Inspector: /r Date: A ,
APPROVED `DISAPPROVED _APPROVED SUBJECT TO ABOVE
`Call For Reinsp. 1 i�
ELECTRICAL PERMIT (/
96- 047
CITY OF T DATE T I SSUEDI:C01/24/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PARCEL: ES 1 13AA-001 r2)IZI
io� -`�B bW IC-111D AVL
UBDIVISION. . . . : ROSEWOOD ACRE TRACTS ZONING: I--L
oLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :A
Pr,o,j ect Description :
___RF_SiDhNTIAL UNIT----- -------TEMP 5RVC/FEEDERG---.-.. _-__._._--MISCELLANEOUS.--__...
1000 SF OR LESS. . . . : 0 0 - 000 amp. . . . . . . ; 0 PUMP/IRRIGATION. . . . : 0
I:..:ACH ADD' L 500SF. . . : 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : iii
LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL.. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 6014dmpS--1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
-----BRANCH CIRCUITS---•---- -•---ADD' L INSPECTIONS-.--
0
NSPECTIONS- -
0 - 000 amp. „ . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
01 - 400 amp. . 0 1st W/0 SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC : 0 IN PLANT. . . . . . . . . . . : 0
u01 - 1000 amp. . . . . : Qr ____.___._-----__.___.FLAN REVIEW SECTION-------------------
t
--_---.------.
101Z�IT+ am p/ 0 > --4 RCS UNITS. . . . . . . . : > 6t?r0 VOLT hlClMINAL. .
Reconnect only. . . . . ; 0 SVC/FDR > = 225 AMPS— : CLASS AREA/SPEC OCC. :
Ownet-: •----_- _ .--..-__._.__.-_.__._._-___._..__._.._.-..-....._-_._...__.__-__ .-_.._..._.._._..___-._.. ___.___ rFE,T
PACIFIC FOODS type Amount by date r^ecpt
i.E , jt� '.�W 7,ND AVE P R M T $ 35. 00 CJS 01/;:4/96 96-c752-
SECT $ 1. 75 CJS 01/24/96 96-275241
T'I GARD OR 97003
I 'hUne #;
r-)TLAS ELECTRICAL E 36. 75 TOTAL
+403 SE ROETHE:
-------- REO U I RED INSPECTIONS •------
1ILWAUN.IE OF, 97-267 Elect' l Ser-vire _
'hone #1: Elect' 1 Fina:.
This permit is issued subject to the regulations contained in the
igard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
pplicable laws. All work will be done in accordance with
approved plans. I�4is periit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
.han 180 days. Issr.ted By ~-
___-__--.. ________.___._____.._OWNER INSTALLATION ONLY--_--__-__-_
1he installation is Lleinil made on property I own which is not intended for
Sale, lease, or rent.
OWNER' S SIGNATURE- DATE:
--_-•---._-_.__-__--__._._CONTRACTOR INSTALLATION
T GNATURE OF SUPR. ELEC' N: C*.f..L�G _ DATE:
.1LENSE NO:
Call for, inspection - 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # yE 7 •�`/i
Permit #Z;�/ Z.. On
Phone (503) 639-4171 Date Issued _i iii 9G _
CITY OF TIGARDFAX (503) 684 7297 Issued by r l�,,: r
TDD No. (503) 684-2.772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee .Schedule Below:
Name of Development Oregon Business Park-1 Number of Inspections per permit oilowed
Address 16393 S;1 72nu Avenue - Bldg. V, Service included Items Cost(ej) Sum
City/State/Zip1 i gal"d OR 97223 4a. Residential-per unit 4
1000 sq 11 or less $11000
Name (or name of business) Paci f i c Foods I Each additional 500 w 11 or 1
portion thereof $2500
CommerciaC Residential❑ Limited Energy $2500 _
Each Msnul'd Home or Modular 2
Dwelling Service or Feodsr $f3f'0C
2a. Contractor installation only:
Ab.Services or Faeot+rs
Installation,alteration,cr retecafton 2
Electrical Contractor At ja s Elect r i c a l 200 amps or less sso oo
Address 4403 SE Roe he Road-- 201 amps to 400 amps ,_ $8000 _-
City '?1 l•1dU :1 e Stat&R ZI 97267 401 amps to MO amps $12000 — 2
P 601 amps to 1000 amps $18000 2
Phone No. 51 • — rOver 1000 amps or voBs $34000 2
Contractor's License No. 3-2C Rcccnnecl only $5000
Contractor's Board Reg. No._11532 dc.Temporary Services or Feeders
// ��/�� / Installation.allerahon,or relocation 2
Signature of Supr. Elec'n_ I/ / Vl� 200 amps or less $5000
1
License No. 2532u1 amps o 400 Amps S7500 2
1S Phone NO.659-2212 401 eml,ato60onmps _ $10000
(Ner 600 Evil to 1000 volts --
2b. For owner installations: see W nbove
4d. Branch Circuits
Print Owner's Name _ New alteration or extension per panel
Address a)The too for branch circuits with
City -_ State. Zip purchase of eervlce or Awder An.
Each branch circuit $500
Phone No. n) the fee lot branch circuits without
The installation is being made on property I own which is purchase of service a•feeds ItN.
First branch circuit 1 $35 00 3 5. Q i]_
not intended for sale, lease or rent. Farh additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation mole __ $40 00 2
Each sign or outline lighting S1000
Signal cimun(s)or a limited energy 2
Please check appropriate item and enter fee in section 58. panel,afleration or extrm4iun $4000
:= 4 or more residential units in one structure Minor Labels(10) $100no
_ Service and feeder 225 amps or more
v System over 600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
r as described in N E C Chapter 5 iter inspection $1r no
.— qr hour $c on
—1 In Plant $55 GJ
r Submit 2 sets o1 plans with application whe•rs any of the above
apply. Not required for tempotury construction services. $. Fees:
NOTICE 5a. Enter total of above fees $
5%Surcharge(05 X total fees) $ 1717L
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ARANDONED FOA Plan Revtew if required(Sec 3) $ _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account 1r $
Balance Due $ 36.75
rr`mmftV4i tgm app
CITY OFTIGA'r � PLAN CHECK APPLICATION
CffyRD �L .� _
COMMUNITY !DEVELOPMENT DEPARTMENT oR140M PLAN CHECK rf �- Z �-
13115 SW Hel Bird P.O.[lox 2X107.TlgeM,Oregon 0722 (6Q1)630,4176 PERMIT l,s- jQ- 70
DATE ISSUED
JOB ADDRESS: /;�'' ti " _ /' _ TAX MAP/LOT
SUB: LOT:_ LAND USE: Y�
VALUATION:�i•• - -� SETBACKS: FRONT: REAR: LEFT: RIGHT:
WORK CLASS: HEIGHT: /Z-t± TOTAL AREA: =0 + 1-3 Z- Y(,• e
USE TYPE: FLOOR LOAD: /UO 1ST:
CONSTR TYPE: V NEAT TYPE: Gr9S 2ND:
OCCUP GROUP: 2 DWELL/UNITS: — 3RD:
OCCUP LOAD: _ NO BEDROOMS: --- BASEMENT:
NO STORIES: NO BATHS: _ GARAGE:
IMP SURFACE:
APPROVALS REO' SPECIAL NOTES ITEMS REQUIRED
PLANNING: ( O . REISSUE OF: LIST SUBCONTRACTORS:
ENGINEEKING: LAST REISSUE: BUS TAR:
FIRE DEPT. : FLOOD PLAIN/ CALCULATIONS: _
OTHER: SEN LND.: TRUSS DETAILS:
PARKING PIAN: _
I.ANDSCAPE PLAN:
PLAN CHECK BY: OTHER: _
COMMENTS:-
AC -
OMMENTS: ACCT DESCRIPTION AMOUNT
OWNT-R 10-432 Building Permit Fees
WA-HE:_f C T 10-431-600 Plumbing Permit Fees s
ADDRESS: -„Jr -t, 10-431-601 Mechanical Permit Feef
10-230-501 State Building Tax (5 0 s j
10-433 Plans Check Fee 1.3
PHONE: w ^_ _�,r •:; , 30-443 Sewer Connection (20x) t
30-202 Sewer Connection (80x) 3
CONTRACTOR 30-444 Sewer Inspection t
NAME: /,,'.,L, l kt2l_) .51-448 Street System Dev. Charge (SDC) s
ADDRESS: G r, 52-449-610 Parks I System Dev. Charge (PDC` t
52-449-620 Parka II Systerr, Dev. Charge (PDC) s
i_ •7 rt %4 31-450 Storm Drainage Syst Dev Chrg(SSDC) S
PHONE:_ �, �, ) 10-230-505 TRFD (95x) nJ S
a 10-435 TRFD (5Y) G � s
ARCH/ENGINEER 10-230-506 Washington County Fire 11 (95x) s
y NAME: )Zct�1G-435 Washington County Fire E1 (52) s
ADDRESS: C, c _ ,r4- 10-220 Amart/Wedgewood
TOTAL s
PHONE: 2'.'. -t ✓-T ra
J PREPAID
RFC #
BALANCE DUE S
APPLICART SIGNATURE �r /
\ -ied By: Date Received:
v
i'.u.iiix 1JJ`J r
CITY OF TIGARD PLUMBING --U25 3q Hill Blvd.
nePERMIT
ver
pplicarlls bald Ckegon R-aistntion to conduct' a plumbing Tigma CR 977
634-4175
Or must be property owner/operator not hiring Outside help.
Name of Dewbpment k f- n v f-Lzn r l
1"I s 1 ' 1 L 0 1 n, f Plumbing Permit No. _
Address Oelialptbn -'
Job6 3`l 7 + ` ORS 011-2t-010 QUAN. PRICE AMT
Address
Tar Lot Map.N&
FIXTURES
t1tC Mock Subdivision ---- — - --
Sink 7.50
ante or name of buslinass) lavatory — — — 7.50
T,-t or TiVSlwwer Comb 750
MSWV Address — - -
_ C Showw only 7 so
Owner City/State ZIPwater Cknet 750
N L L, 11.2I Dishwasher -- --- - -- 750 - --
Photo Garbage Disposal --� _ ISO -
l4liff".
ame WashkV Mactune 750
FiOor Drain --- 750.
Address Phone Watac Hater +cn
lkcu ant in 1` 1 T v>b Yl P n R SS Lawvlry Rain Tray 1 _- 7 50
P City/State Lo
Urinal 7 50 _
none Other Fixtures(Specify) 750 y
L- • 1ZC)w141;R1]f 50 7.
aatt - _'1 i
l R t A i Ici 750
Cantaackw /Stab Zip __ _ 750
It I1:G 1 A MISCELLANEOUS
City Buis Tax No Seww 10 100' 30 00
17 c -----
o�-- state s a Sawa-ea Addit 100 1 500
(Rssdenhal) Water Fervia 1 st 100' - 2000
I her"ad-owledge eM I have reed tiia ap*cason,if►af ow kntormsow Wales Service so.A"2M' - - - 1500~
00w ts correct.e+M 1 am registered wfei I*Sub Builders Board,and also Slorm A Rain Drain t sl.100' — X0 00
he-a Stat PkRrtbkng fomes e►et ow n rnbers gwen as corea that all
okimbing woAt wN be done in a0oordar"with sppricable Vm%k ru of Orr Sturm&P`Jn Drain Ad011 100• 1500
gon Revised Stafulsa Chaplsrs 417 and W3 and app1C11bN 006"and that -- -
AAobae florins Sped t8 00
no help will be enpbyed unless kerned under ORS O m(It exec pt.hu . -
StaN regisaradM ple{ae give re&w"bet<7wli. Battik Flow Pnrver*ai
HCWEOV#?&-M -1 hereby cerWy that 1 am ew ow w of ew property ds- Device Or Ar*4lo6Aion Devoe 780 1,S
vrbed above,al wlOd IocWkx 1 propose to meks a pkanbkig kotsNadon for Any Trp or Was*Not
my oven use and this prop"isnot.being conalruded for sale.lease or rent Conrocl d 10•Fature y.10
raid sawn )s0 _
Irmo.of FAN.Phortrrw 40 00 Pa Nr
Repuesled inspeotbng 10.00 Per Hr
Ade of Pbrrlbkig
I
on E,dsorig Sldg, 15 00 min
SfCiNATtN4E
now New Sldg.or lAAid.Addlllon 26.00 mw
- - J
Haiti Umin,-Qi�
fatal
Deecrt m waft naw[] addition O aflaratlon repair C7 )uel_1 irr� 15.110
residential fl rwn• al -- -
Exho use toOMTOTAL
- --
tftAltir,lp or property_ - �q
PfQP*Wd Loo Of
bLAft or
PAP+f1Y
T'dtMl
TMs psmN Or>opftlew ulf2 orad cold 1 wow a aonMtiorot►stfti►wrtaad r not corer
lttsnosd fllrwl itib Alwsiw a aarndrtn a 1rolRls sllspsM�d or fbatdonad ler
e parlsd d q0�st ante Erna liar warts�oollefrnosd•
A01AL 0009NnOW
Osla baud ___-- - - by --
.• P 400 1 1 M �.
PLUMBING IiN.RMIT
CITY 4F TIGA RD PERMIT NO. : P11-1380275
CITY ARD
COMMUNITY DEVELOPMENT DEPARTMENT ISSUED : ti�DATE : /i'r'/EaH
13125 S.W.Hall Blvd.,P.O.Box 23397.Tigard,Oregon 97:23,(503)639-4175 PRIM, PMT.ND, 038022/
JOB ADDRESS: 16399 SW 72ND AVE
T'AX MAP/LOT SUB: PAC744US T L..'T' : BK :
I-AND USE:
ITEM: NO: NO:
WORK (.:LASS: ALTERATION WA'T'ER Ci._OSr-. T' TRAI-,
USE 'TYPE.: COMMERCIAL URINAL BKFLOW PPVNTR
CONS T .'T'YPE : L..AVORATORY 'TRAP PRIME-.-P
OCCUP.GRP . ; 'T'UB til-IDWEP GREASE 'T'RAPS
E)?:SHWASHER
GARBAGE DISPOSAL
NO. STUR:I:I:S : WA`:ihI:I:Nt MACHINE
DWELL .UNITS : LAUNDRY 'TRAY BLDG.DRAIN (DIA
FI 00W DRAIN
SINK SEWER (FT)
WATER I••IF::A'T'E:R STORM/PAIN (h"T
OTHER
FIE:MARKS :
replace wafter mer vice, late* 880207
t�a r(x►n t, : X CN r•c:►-F c:+r•m ,to a.(:I
F"T�F'S
I:�cuc^tr c,lm f. 1:4: OMIT tp:55 . 00
O
W "111 law tl•t ,*2960
N F (artlIlLrtcl ccr• 97'r.WA FIXTURES
R I:'-4 (JNE: (30:3) 224-2333 STATE TAX $1 .75
R
OTHE'A
C PEINI••IARDT JOHN E
C 14L I.NHARD T' PLUMBING
N
T PUBO X i'29
R Newh iwr4;1 011- 991138-I
C PHONE (303? 620•-3754
O !i'f F261'T':1:t:)N NO . 1870 TOTAL-: $36.73
R
L RECEIPT NO
This permit is issued subject to the regulations contained in Title 14 REQUIRED 114SPECTIONS
° of the TMC, State of Oregon Specialty Codes. zoning regulations
tA and all other applicable codes and ordinances, and It is hereby PL••B . UNL)ki:ASL..AB
,. agreed that the work will be done In accordance with the plans and POST & SEAM
specifications and in compliance with all applicable codes and WA'TI.P LINE:
.J ordinances. The issuance of this permit does not waive restrictive PLFT TOpOU'T
covenants Contractor and subcontractors shall have current city
• business tax permits. This permit will expire and become null and PAIN DPAT.NS
Lt vcid if work is not started within 180 days.or if work is suspended or F I NAL.
—' abandoned for a period of 180 days any time after work hes
commenced 11 shall be the responsibility of the permittee to assure
all required Inspections are requested and approved.
r
_.s2e ,
Permittee Signature
C:AL..L. FOR TN5rsH'C:'T'T'ON 639.. 11J.-In
Issued By ---- _�— --- --- --- --
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CATY OF T'��
RDP1F
rHANICAL.. PEPM1. I'
NO. : Ml*--*6@O69r,?
MYOFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT DA*T1H' ISSUED : 4120100
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 PPIM. PM'T' .NO 8802,70
J014 ADDPl':*!-,)S : 16398 SW 72ND AVE
I AX MAP/1-01' 2S113A8 SUB: PA('-TV,1US'T I..T : DK :
I AND USE:
I OT S.TZE:
ITEM NO: NO:
WOPK CL-ASS : ALTEPATION FURNACE. <:LOOK AIR HANDL-A <10
USE 'TYPE: MIMMERCIAL.. F1,111NACE :LOOK-J- AIP HANOLP 1OK
CONST .TYPE : VN F1.1PNOCE EVAP .COOL-ER
OCCUP . GPP . : E)2 Hf--:A*TEP VEN'T' F*AN
Vl*--N'T' VEN'T . SY51'EM
"I-R/COMP (31-4P HOOD
NC) . STOPIFS : :1, 19ILP/COMP 3--1.5HP 3'.N(',INF.:-*i:1A'r(:)r-1(l*.)c)m
DWELL. .UNI'rss : BI R/COMP 1.5-301-11P I NCIINERA1*01Q,(COM
FUEL. 'TYPE 11 P/COMP 30-50HP PPF-)AIP UNITS
MAX . :ENl'-'U7* 6000000 13LP/C'OMP 50+11-11P I cvrHER
DMPPS7 GAS F)TPTN(.*�, MYTI ET'S :1.
HIM-1 PRESS? YES
I OW FIIESS,?
FEES :
0 PACTPUST PEPMTT $1.0 . 00
W PI-AN PEV:rF
.W
N
r: FIX"TURES $31 50
R J'AX
$2. 18
U*THF.P
IS
0
N BECKS :1:NDUS*T4-11AL-
T 71.9786ESW PROSPF--X.'1* 1..N
A UILI 0 I'll 41L (:)1.. 97007
C PHONE: (303) 6-19--3308
T
0 PI-4*G1S'TPAT1O1N NO. bec.-kis tlfc16.56
R
PF.--'CEXP'T' NO.
This permit Is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes,zoning regulations REQUIPED INSPEt.'TIONS
and all other applicable codes and ordinances, and it Is hereby GAS L.JNE
agreed that the work will bs)done in accordance with the plans and nOLJGH—T.N
specifications and in compliance with all applicable codes and FJ NAl-
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have Current city
cc
husiness tax permits This permit will expire and become nLII and
0 void if work Is not started within 180 days,or if work is suspended or
LL!
__J abandoned for a perled of 180 days any time after work has
i.ommenced It shillpe the responsibility of the permittee to asgurr,
all uired inspect ns are requested and approved.
41, u,,,ed,,inspect
I'LL-
s�rm '14—As"furef �AI..I.. FOP INSPE.#::`TTON 639-1175
III$sued By:
S;EPARA PERMITS RFOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
'Plt,-x% C COZ L-
Receipt#
CITY OF TIGARD MECHANICAL PERMIT Permit# 8 l el
Description
Table 3A Mechanical-ode QTY PRICE AMT
City of Tigard —
13125 S.W. Hall Blvd. 1) Permit Fee o 0 10.00
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 1) Furnace to 100,000 BTU 6.00
incl.ducts&vents
) Furnace 100,000 BTU 1 7.50
L-11
incl.ducts&vents _
Name of Developrt nt - 3) Floor i umace b.00
XP����
! i.1---` '�)\j- incl.vent W, -- -
.Job Address — 4 Suspended heater,wal!heater 6.00
0,!dress
----> ivy ) or floor mounted heater
if 3�'X .S.✓ ":z
Tax Lot Map No.AW 2 5/'-IJ A.0 5) Vent not Incl.in 3.00
Lot Block Subdivision _ appliance permit
Name lot name of business) 6) Repair of heating,refr ig., 6.00
cooling,absorption unit
Mailing Address Phone 7) Boiler or comp to 3 HP _ 6.00
Owner absorp.unit to 100,000 BTU _
cdyistate Zip 8) Boiler or comp to 3 HP-15 HP� 11_00
absorp.unit to 500,000 BTU
ree
3Boiler or comp 15-30 HP
.! j �, r &_( �y�-� td- 9) absorp.unit Y2•1 million 15.00
Y0 u
Mailing Address l Phone 1 0) Boiler or comp to 30-50 HP 22.50
l ? , J(- 1 7 f absorp unit 1 -1.75 million
Contractor CI iState u ZIP 11 Boiler or comp to 50 HP _ / 31.50 -
0 ll,\ Q 1Voo� -. ) absorp.unit 1,750,000 BTU
State Registration No. City Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM J
I hereby acknowledge that I have read this application that the information given is 13) Air handling unit 10,000 CFM i 7.50
correct,that I am the owner or authorized agent of the owner,that plans submitted a-e In --
compliance with State laws,that I am registered with the State Builders'Board,that the 14) Non portable 4.50
number given is correct.(If exempt from Stale registration please give reason below). evaporate cooler
15) Vent fan connected 3.00
to a single duct
16) Ventilation system not 4.50
_included in appliance permit
-T- - 17) Hood served by � 4.50 --
0 s L,4 I" j mechanical exhaust _
Sig tura ner or agent) Dae 18) Domestic type 7.50
Describe work El addition S1 alteration Elrepair Elincinerator
to be done residential ❑ non-residential 19) Commercial or Industrial 30.00
Existing use of type incinerator
building or properly, 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc. —
_1 building or property C' c�r F�_ ___ __ 21) Gas piping one to four outlets 2.00
Z.
Type of fuel- oil ❑ natural ges-4 LPG LI electric I 1
----------------
22) More than 4-per outlet
l:
NOTICE SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SaIO 416 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR N REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER — ,s
WORK IS COMMENCED. L TOTAL S
Special Conditions
Date issued by_
FRITI 1)I: . PF"PI'll"E'T
1�4\ I:*1I*-:'VM1'1* NO . BLA30W?"70
CITY OF �I��
RD CITYOF'71GARD
COMMUNITY DEVELOPMENT DEPARTMENT 021GON
13125 SW Hall Blvd..P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 1.)1-41 M P 1011, N0 (:11302
J(113 AI*.)I*)F2k:*St*3 : A.6,390 SW 72ND -0 V I*----
'T AX MAF'/I"C)'I' SUB. l:)A(',*T*P(.J!;;T LA, El I<
I-AND LHIE'. .'
I OT V61 ON:
F*R 0 N 1* RE'A R
WORK CI ASS : UN]"I'S 1:4 1.
(.)!--sE: 'I'Yl:)F- : COMI'll":"RC1:()I-- NO REA)HOOMS E:X Y' W01-1 .,0NS*T'
CMNS'r . 'rym: VN N(") LIA1+143 N W
OCCUP .GIRP. : F-42 1"P01
UP.I OAD zjzi N W
F'IRE RE-J"?
:1.9
BASENE:W"? NO 31111) PATED:
MEWANTINIF"? NO HASEM T
FA 001-1 1 (:)AD: :1.00 A I-.4 A I',I SPI:WIL.1-17 ALArim'?
F LOW I('.,PM) DE1*k:J""'T*'7
HEWT 'I*yP;:r.: (11 AS VIDGII) .
MAN 1<',FII-.CK DY ihi
AC10 J.rlt W80.1% I-IFEESSUL C)I;:' NO.
!Ntclr' . etc' . L.AS*T* P1';-JSSUk.'
VIES MIJ, !111.155 . aO
r-:'I-AN PF.-.:V:rE:W 4111)9 . 13
rl
F-XPE DEP'1* $61. . 00
STAI'E'. I*AX !I+'1 . 63
I' EVELOPMEN'T CHAM'.-Ai.
C 1-1(:IWAPI) GPEKEN SIX(S1131'.4m)
0
N SIX(5*T 14'.::F-T)
T
R .1.:1.1. SW I"-'1F-*ri-i PUC(.6
A P ci I,t:l,a ri cl 0P < 1111111.60 . 1.'3)
C
T , 'T04 AL. : $1.60 . 1.3
r
NO. Gr,eimn
RECE'IP'T NO. F..'.F.9 IS
This permit is issued subject to the regulations contained In Title 14
of the TMC, State of Oregon Specialty Codes,zor Ing regulations PEQUIPIED INSPEC,'I"IMIS114
and all other applicable codes and ordinances. and It Is hereby F001"ENO
V) agreed that the work will be done In accordance with the plans and SLAF"
specifications and In compliance with all applicable codes and PLS .UNDEASI AS
ordinances. The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city FW4101ING
W business tax permits. This permit will expire and hecome null and V14SUI A*T T ON
void if work Is not started within 1R0 days,or it work is suspended or
U; G,yr." . BOARD
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee"I assure S L I S P I-*.N 1) .CF.".I L.X N G
rill required Inspections are requested and dl-proved. MEIIHAN(:A- . sys'rEM
r1ormittee Signature �LI_. E-01:1 INSPECITLIN A:X9,-m—ell- /.,j
Issued By, ---e--
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
All
CITYOFTIGrARD ® PLAN CHECK APPLICATION
COMMUNITY' DEVELOPMENT DEPARTMENT
C
EooTWA AN) PLAN CHECK 1 ' Z L
u,2s sw wn Mid P.O.8=23397.T1gaM,orww 9722J(SW)03D-4176 PERMIT I_
DATE ISSUED
JOB ADDRESS: TAX MAP/LOT_
SUB: LOT: LAND USE:
VALUATION: SETBACKS: FRONT: REAR: LEFT: _ RIGHT:
WORK CLASS: HEIGHT: TOTAL. AREA:
USE TYPE: FLOOR LOAD: 1ST:
CONSTR TYPE: `•Jr C HEAT TYPE: 2ND:
OCCUP GROUP: ;[. DWELL/UNITS: 3RD:
OCCUP LOAD: NO BEDROOMS: _ BASEMENT:
NO STORIES: NO BATHE: GARAGE:
IMP SURFACE:
APPROVALS REQ'D SPECIbL NOTES ITEMS REQUIRED
PLANNING: REISSUE OF: LIST/SUBCONTRACTORS:
ENGINEERING: LAST REISSUE,: BUS TAX:
FIRE DEPT. : FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND.: TRUSS DETAILS:
PARKING PLAN. _
LANIISCAPE PLAN.
PLAN CHECK BY: OTHr-.
COMMENTS:
ACCT f DESCRIPTION AMOUNT
OWNER 10-432 Building Permit Fees s 1 5 2 5 D
NAME: T 10-431-600 Plumbing Permit Fees f
ADDRESS: + 10-431-601 Mechanical Permit Fees
10-230-501 State Building Tax (5x) s (,.3
10-433 Plans Check Fee `]`1. 13
PHONE:_ 30-443 Sewer Connection (20X) s�
30-202 Sewer Connection (80x)
CONTRACTOR 30-444 Sewer Inspection t
NAME: � ., _ .51-448 Street System Dev. Charge (SDC) �
ADDRESS: 52-449-610 Parks I System Dev. Charge (PDC) s
52-449-620 Parks II System Dev. Charge (PDC)
31-450 Storm Drainage Syst Dev Chrg(SSDC) t
PHONE: 10-230-505 TRFD (95x) 00 -5 ;1 C 5
10-435 TRFD (5z)
ARCH/ENGINEER 10-230-506 Washington County Fire /1 (95x)
NAME: -1 ,�e�- _.10-435 Washirgton County Fire !1 (5%)
ADDRESS: 10-•220 Amart/Wedgewood s
r7 TOTAL
PHONE:
PRT�PAID
RFC
% BALANCE DUE $
X
ASIGNA'rURF.eived By: e Date Received: o�
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INSPECTION NOTICE
City of Tigard 91jilding Department
P.O. Box 23397
Tigard, Oregon 97223
Phone. 639-4175
Type of Inspection ------ _Z _ c.L�C� `} m D
Date Requested �' _ Time- A.M.-P.M.
Address /�.� ! /� L ��7 Permit # X0 7 7 U
Owner G `I 1'l�� Lot #
Builder e C- �4.` )(; .' ? ) 1 1 )
The following Building Code deficiencies are required to be corrected:
Ci
N
cc
(.7
LLl
Presented to .4.Approved
Inspector _�_ ___ _ f_i Disapproved
Date G
CALL FOR REINSPECTION
L I YES 1-1 NO
FIRE PREVENTION BUREAU Q
OFFICE OF FIRE MARSHAL 37802
INSPECTION NOTICE
OWNER DATE
OCCUPANT V#eC'fPCM OCCUPANCY
/� -
LOCATION
•OUP ATTENTION 15 CALLED TO THE FOLLOWWG FIRE SAFETY 0t FICIENCIES!
fa .ice/i /�- XL
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rt -
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FAILURE 10 CORPECT THE APOVE CONDITIONS 00IT41IN MAYS WILL MAkt YOU LIAPLE TO FPOSECU ON SHCULC VIRE
RESULT FPOM SUCH CONDITIONS YOU MAY DIE LIABLE FOR DAMAGES TO PERSON! Op•TTRO,l'�RTY' R PROVISIONS OF
ORS ATS loo BY `0
1;1
WASHINGTON COUNTY FIRE DISTRICT a1 FIRE MARSHAL
20665 S.W. BLANTON STREET
ALOHA, OREGON 9706 649.8577 PRESENTED TO
FORM 900 40
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:3 H-
Cleaver-Brooks packaged commercial watertube boiler
Specify and buy ., .
Cleaver-Brooks -
Model M4
IIR
boiler compactness
Savings of up to 50% i
it floor space
Size for size, the Model M4 requires as little as half
the floor space needed by other boilers of its type.
This can result in new construction savings —
especially important with today's ever-increasing
cost of construction. Every square foot of floor
space that can be saved means a direct dollar
saving. And it can also open up additional income-
producing area.
Sized for quick replacement
of old boilers
Model M4's trim 33" width eliminates costs of
knocking out walls and facilitates easy
replacement of old, inefficient boilers. This 143 HP goes through standard size door!
simplified replacement advantage is especially
important in emergency breakdown situations.
Weight savings up to 40% Packaged for quick hook-up
This concept originated with Cleaver-Brooks, and
The Model M4 weighs far less than comparable for 50 years CB owners saved time and money in
boilers. This results in lower freight and rigging reduced installation costs. Each unit is fully assembled,
costs. And supporting structural requirements also tested, UL approved and shipped ready for fuel,
can be reduced. water, electrical and breeching hook-up.
a
LA(t:
F"
Specify and buy Model M4 engineered advantag(
J
C]
u CB70 COMPUTERIZEDI ;. A NEW LOW IN
BURNER CONTROL SOUND LEVEL
The CB70 provides such exclusive Model M4's combustion air source Is the
features as status and timing display. Cleaver-Brooks exclusive,direct-driven,
automatic burner programming and vibration-free centrifugal impeller. This is
flame supervision,and reaches the secret behind Model M4's extremely
beyond the limitations of i"�`� quiet operation. With the burner at high fire,
conventional controls to provide first-out- the Model M4 produces a maximum of only 80 dBa, making
annunciation,self-diagnostics,energy conservation It ideal for use in noise-critical areas such as hospitals,
and safety functions —all in a small single package. nursing homes, schools,churches,apartments,etc
R'
-Brooks
Cleaver)11491 ,,ki-
C,l
MODEL M4 PACKAGED
COMMERCIAL WATERTUBE BOILER
i
1
`'IcaveN;Brookti '''
• r
I« r --
I � �
owe ;+
1
Lzi 44 1
1
�M
7 iF�
Cleav�Al"' 1'"OOkS Thetotal concept name in boiler room systems
Specify and buy POSII IVE FLAME-OUT UPPER DRUM
Mode! M4 PROTECTION INSPECTION
SOOT WASHER
high efficiency
forced draft firing Clvas
°°w1
LOW SOUND
Cleaver-Brooks' Reverse Firing is the key LEVEL
reason for Model Mil's compact design. The
hot gases travel the length of the furnace,
then reverse back, providing greater heat 4 i
release per cubic foot of furnace volume and
greater heat absorption per square foot
of furnace waterwall area than other boilers I rrx t
of its type,
The third and final pass is down the a
convection zone, where the hot turbulent
gases scrub a maximum amount of water-
backed surface.
Add Model M4's rapid circulation to this
high heat transfer capability and you end up
with quicker heat-up characteristics and
faster response to load changes than you
can expect from other designs. -7 ISOLATED
DOWNCOMERS
EFFICIENT BURNER
DESIGN 3-PASS GAS TRAVEL
LOWER DRUM
INSPECTION
•OIINtI
rno
PROVEN BURNER DESIGN � • � CLEANING WITHOUT
The Model M4 burner design has been ` SHUTDOWN
erNn
used on thousands of installations. Soot build-up in a boiler reduces •^ •
This high-pri ssure-drop burner has
heat transfer efficiencyand wastes Mes
been designed to use No. 2 oil, natural •'�
and LP gas,or combination. Thus, s precious fuel.That's why Cleaver-
when it comes to converting fuel into usable energy, Brooks has made this simple,
you can take advantage of any fuel availability or fuel effective soot cleaning method standard on the
Model M4. Because there is no mess, no shutdown
cost changes, since M4 controls are arranged required,you can clean as often as necessary to
for speedy changeoverr from one fuel to another. maintain peak boiler performance.
Cleaver-Brooks
Model Mt4
Packaged Commercial Watertube Boiler
OFFICE COMPLEX
EXPECTS TO CLT ENERGY
COSTS BY MORE THAN
50 PERCENT
t�1� 'iiii�o�■ �is1.
A large insurance company owns this half-
million square foot office complex near a
Now 00 ,11����s//■• mid-westrn city. Recently completed was a
�r���R.10518N/ON■, large HVAC retrofit project, which was done as
� - .� 7//�� ��•rf a result of re-evaluating energy costs.
Initial plans called for eventual expansion, so
C two 500 horsepower Cleaver-Brooks firetube
boilers were specified and installed. However,
> expansion was delayed, so two small 71
horsepower Cleaver-Brooks Model-M4
! -- Watertube boilers were instal;ed because of
z
reduced boiler needs.
With this variable power supply of steam
r and hot water, any type of demand can be
L. I met, no matter how small or large.
� i
4
Authorized Sales, Service and Parfs, Worldwide Cleaver*4srooks
DIVISION OF AQUA CHEM INC
PC,So.421 MlIwnukm,Wiecomm 53201
$71`r 5 A 1 P 0 90k 1338 98040 141A)982 0100
TELEX 02e714
Sak< I cotL_«� 6994 Mid at 5 w
sz005 ,o,.1,,.,1 Ly1111*400,WA *1 Ie
��s�a►�,, i�hen� ea:fi�erne
CBW-400-R7 Printed in U.S.A. 6M•5/87
Specify and buy MINIMUM
INIMUREFRATI'ORY.
Model M4 LESS
MAINTENANCE
as With Model M4, membraned
waterwalls seal the com-
bustion chamber, eliminating
L c
stand—by"
♦la n d—b y " the need for approximately `'`
.7 95%of the refractory
normally required by boilers
Running your boiler at low fire means of other design. Thus Model L
running at lowefficiency.And lowefficiency confines the use refractory hthe
burner
means wasted fuel, wasted money. burner throat and furnace floor. This results
in a substantial savings in maintenance
With a compact Cleaver-Brooks Model 4 costs normally required for periodic repair
stand-by unit, you can completely shut down and replacement of refractory.
your primary system during periods of low
steam demand . . . and maintain peak fuel-
to-steam efficiency. HIGH-PERFORMANCE t'
The Model 4 is trim enough (just 33"wide)to
fit through doorways, yet it's available in MEMBRANE
capacities up to 6,000,000 Btu/hr input. WATERWALLS
Design pressure to 600 PSIG, hot water up to I
4100F. It offers multi-fuel versatility,rugged Now you can take advantage
big boiler construction,and quiet operation of the design principles used !�
—just 80 dBa, maximum. What's more,the by hundreds of power
Model 4 ic,a complete packaged system and stations which have proven
is easy to install. the superior efficiency of
membraned waterwalls Only
Cleaver-Brooks Model M4
makes it available to you in a
compact 1.5 to 6 MBTUH
input package, and each
pressure vessel is subjected
to a factory conducted
ASME air test to insure combustion by-products
will not leak into the boiler room
FACTORY START-UP
yu•
AND SERVICE
a
Complete starting service that assures you of trouble-
free performance in the field is Included with the
purchase of every boiler. A factory trained specialist
starts up the unit, re-adjusts controls to suit the
particular fuel you are using,checks over details of
operation, takes CO:readings under your load and
trains your operator in care and maintenance. This
service,full evidence of Cleaver-Brooks'complete
follow-up responsibility, is available to every owner of
CB boilers anywhere in the United States and Canada.
SPECIFICATIONS
MODEL INPUT OUTPUT EDR EDR OUTPUT' EOUIV.
SIZE BTU/HR BTU/HR Water Steam 15 psi LBS/HR HP
Gr.Sq.Ft. Gr.Sq.Ft. Steam
1500 1,500,000 1,200,000 8.000 5,000 1,237 35
2000 2,000,000 1.600,000 10,667 5.667 1,649 47
2500 2,500,000 2.000,000 13,333 7,083 2,062 59
3000 3,000,000 2,400,000 16,000 8,500 2,474 71
3500 3,500,000 2.800,000 18,667 9,917 2,887 83
4000 4,000,000 3,200,000 21,333 11,333 3,299 95
4500 4,500,000 3,600,000 24,000 15,000 3,711 107
5000 5,000,000 4,000,000 26,667 16,667 4,124 119
6^^n 6,000,000 4,800,000 32,000 20,000 4,949 143
Hot Water—to 140 psig std.,temp to 400°F.—Steam to 150 psig std,pressure to 600 psig available.
'Ratings—from and at 212°.
DIMENSIONS ALL DIMENSIONS IN INCHES
HOT WATER STEAM
140 psl 15 psi 6 150 psi
At Btt C D A oft C D Ett
1500 78'H 7 79 54 783/a 13 79 54 7
2000 781% 7 79 54 781/e 13 79 54 7
9500 941A 7 79 691/8 941/8 13 79 6918 7
3000 941/e 7 79 69?'s 941/8 13 79 69'/n 7
3500 1091/4 7 79 85,114 1091/. 13 79 861/;i 7
4000 1091/4 7 79 85/4 1091/4 13 79 85/4 7
4500 1261Ae 7 79 101 1261/8 13 79 101 7
5000 126% 7 79 101 1261/8 13 79 101 7
6000 142 7 79 11611� 142 13 79 116"2 7
1 Includes nipple extension for water inlet
tt Low water cut-off or water column dimension includes union connection for ease of disassembly
Specifications subject to change without notice
SOOT WASHER CONTROL B 33" E
ELECTRICAL
CONNECTION PANELI
SERVICEA—
CABINET _ I�
I °
1C
O —
-- — y 4" RADIUS
TOP VIEW
The Model M4 Boller is fully T approved. LEFT SIDE VIEW FRONT VIEW