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11605 SW 95"" AVENUE
/0 �� _—.—MECHANICAL PERMIT"
CITY
OF
T'G
n DEVELOPMENT SERVICES PERMIT#: ME 151333
/0 "300526
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED:
PARCEL: 1 S135CD-03700
SITE ADDRESS: 11605 SW 95TH AVE
SUBDIVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT: W5 JURISDICTION: TIG
CLASS OF WORK: ALT sFLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS.
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES _ 0 3 HP: DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAIAPERS?: 30 - 50 HP. WOODSTOVES:
GAS PF:ESSURE 50 + HP: CLO DRYERS:
FURN < -100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install oil furnace&exterior A/C unit. Do not place A ithin the required setbacks
Owner: FEES W --_---
DAW, LAWRENCE D Description Date _ Amount
DAISY L [TA X 18%)State lax 8/28/03 $5.80
11605 SW 95TH AVE [Ml t I I I Permit Fce 8/28/03 $72.50
TIGARD, OR 97223
Phone: 503-u39-4227 Total $78.30
Contractor:
FIRST CALL HEA'i ING & COOLING
1650 NE LOMBARD
PORTLAND, OR 97211-4798 REQUIRED INSPECTIONS
Phone: 503-2.47-2054 Final Inspection
Reg a: LIC 102030
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and ail 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
(500246-6699. _
Issued By: )�!. ,J1t Permittee Signature: 14-
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next busi77ess day
AUG-27-200:3 k� 09: 13 AN FIRST CALL HEATING FAX N0, 503 286 5194 P, 02/03
Mechanical Permit A��►licatio>n Received MechierIl"t
Permit ..Pate/Ry:Q; 03' Permit Nu.;���, 3,7vSaCo
C illy of Tigard 1'Ianiti�igAppruvatl.r-- fluildin6
1)atc/Ii : Pl:rlrtit No.:
13195 SIN 11111 Illvd. Plan Review Otho
'ficard,nregre l 972'13 Datea . Permit No,: .
11houe: $03-640-4171 lax: 503-5')8.1960 Pu t-k_vicw (doll t n
:nA Uate/Uy:� Case Nn.,;;
Inictiko: wwwxMigard.or,us Contucl !uric.; Sec Pagc 2 for
l 1 n+r Itt:gtea•tintt Reglt�yL
5-03-039-41 75 LName/INcthod: supplanrulllal Glfill-m,tion.Y
—.._
FF;M" E�F,DULE""_'ISF
ll
, TM
eniolition Mechanical pclnut fees"are based on the total value of the work
_. ..... ,.. _ performed. Indicate the v;iluc(rounded to die neurest dollar)of oil
/titllliiit�n/::licl'atign%rr tlalacrnt Other:
(:.A'1'r;Ca) �U111S'I'Ri1f'TIUN ntechnniwl materials,equipment,labor,overhead wiQ profit.
1 lti .<-1 an till/liwt�ll'11� C olnntcl•cial/induslrial see Page 2 for Fee Schedule
Acct �r�►ryltuildin}, _ _�;�Mhlti-T�aniily .RUSIDEN37ALE R1MFIVT/WN[EMs>•',EE-8 !j:r:,
+a 11T�RIt'1'ltllildrp_"_ ()1.hrr: - — 1)eaetJWon.., ._Qtr. !'ec(ea.)�—'rod+►(.._.
()it 81,TC',INVOI%_M!}'I;IUN•}md l,t)(�A�fYON F'urnice-aid•on air conditiunin +�
Jab t il+r.ttrlllr�'�;S• ._. _ �_. _ c;,,s I+cut�t,n�-----.__ _14.00 ____._
Quik'11: •• _ .__� lild�./A}fit/F:�..__ __ -Duct work
eject Mime' _ ^� ��- _- llydronic hot water system 14,00
-_ Rosidanlial boiler
Cros;l steer-UCNfCctions it)jolr site: (furr�diatororhydroniLsy�lctn), _ —14.00_
Unit heaters(fuel,not cleclric)
In all,in tltlol,set �ntic d,etc. _ _ 14.00_ _ w�-
F lue/venl Cor eny of above- ___ I0 00 -
hlihrliVi _._..- -_._,; �, 1tc �ir units _ t2.IS
%[Ilea,('Fleet Ilialleas _ —
'7'ax ina�/�laruel ll: _ _ Water heater
F�'1tTiF'1 )IY,f,t V1'(lf<K y_ Ci>,y,frcpinca _10.00
1I`ltleyCllt(walyLhe:nrr/y_aK fire I:+crL 100
I,fi t 1+X111 -f(�y't16) 10.00
Wnad/na net save' 10.00 _
.,.»,.... . ........._. �.»__. ,. .... ..,...._.._ Wotxl fir�lacclin8S0 _. - 10.00
Chirnno /liner/llotlycni`� r-10.00 _—
i�l'!`It1'Y+�IVC!Nlrlt r1iIf.�lA1Y7"_" rrlhe1::___.._.. . _ �_ „ 10'00
ilglt` (d,cl C!rI t t!! �f(�jStl - rnvit•onulenlal Eflion. Vendiallau_
Ia
+Ac�dr�q,,, ngehood/odierkitchenequilinicret
._._..... .. . ._......__ Clothe dryer exhaust 10.00
��I 0-101::'+'�*!'_�:_�� �� � _
�y Sing�c duct exhaust
,•r 11411U; + _ r1..7-;'y )'ax: (buthroonis,toilet compartments,
roams; 6,so w._.
hlHll'IC' Altic/crawl space fans 10A0�
A.ddt4:i�.. �Citlicr:•..._.,...__.. - . � _ ._. .._._111.00 _..._....
l!iFrtnji �....... .
cite _
,...._I. -ax:..-� l'a+'nncu,etc,._�._. .__- _ -►• �._._
Gas lieI pyt l
L r11;lli: Wall/xuapmtd qd tinct heater Tf- _
Walel heater---___.
Blisilios-, Naulo: FW#&'-.AetA11 �f44N17 ><_r
_.. .. .
'kit :Jr.3 ra +tlf"..L•P, •+�a�..-�- ka�t�� —.____.._.. ..
=- -
qty/snit'i7,iI tt'. Y
.A_.
....
.__pitolle
ralnL, _
Airitf►iii licit' _ .. _�.'-,��. ... --------�_ . _ ____Mrcheuirrl prrdrlt�'en1`
Subtotal:
Mt
Sielu+l lir: .�► •. '�►* - I)arc.'�M 1.- __.:... �.. . _..-.__ -_
nirum ltPcrnill Fee ,72.50
�►�r 1'Imiltev_tcw frc('S%of I'erwi roc) .S ~�
(1'Irnxe brio!name) ~rate Surchar�c(8°'e of I`ermrl(ccs 1 _ �—�
_ 0TAI,PI
1; 92MI'l,eft
Nolirr: 'l'lalz prrmli application a:parer If pwulU h nut ubtrined wldd„ `Ret lntllaodolopy.rl by't'e(County tiulldinp,(wtuMly ervlce IlourJ.
1119 days after.It hai her"arCaPlrd as Complete. "Slit plan requh-ad ror rilerinr A/ConlM
1;11b1vV'randf 1'uuh:,\McrParinilAPp.dnC 01103
AUG-27-2003 WED 09; 14 AM FIRST 'BALL HEATING FAX N0, 503 286 5194 P. 03/03
_ .... _
ISI
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CITY OF TIGA RD 24-Hour
BUILDING Inspection Line: (503) 639--175 MST -.-
INSPECTION DIVISION Business Line: (503) 639-4171 RUP
�— AM PM - BLIP
Received -----Date Requested -
D Suite_- - -- NIIEC
Location -
PLM
Contact Person __ - _
Ph(_ ) SWR
Contractor_ - _ fEL3C
BUILDING Tenant/Owner
-n, e
ELC
Footing
Foundation Access: ELR - --
Ftg Drain
Crawl Drain SIT
Slab Inspection Notes:
- - --
Post&Beam --
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof
Other:
Final _
_PLPASS PART FAIL
UMBING _ -
--
Post&Beam
Under Slab
Rough-In
Water Service -
Sanitary Sewer
Rain Drains -
Catch Basin/Me ole
Storm Drain
Shower Pan
Other:-__.---------- _
Final
PA _ T FAIL -
ECHANIC L — -
Po mI"Ir�
G s Lit
In (/
Gas Line --------
Smoko Dampers
T FAIL — —
Service \
Rough-In
UG/Slab ID
L ow Voltage --G--- -'--~
Fire Alarm
❑ Reinspection fie of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASPART FAIL ❑ Unable to Inspect-no access;
SITE ----�--�___ ❑ Please call for einspe Ion RE: __.-__-__.---
Fire Supply Line r n--�-
ADA Date 0._3 Inspector --
ApproachlSide
walk
Other: - - DO NOT REMOVE this Inspection record from the lop site.
Final
PASS PART FAIL
CITY OF T! WARD ELECTRICAL PERMIT
TIGARD #. ELC2003-00556
DEVELOPMENT SERVICES DATE ISSUED: 9/5/03
13125 SW Hall Blvd., Tigard, OR 87223 (503) 639-4171 PARCEL: 1S135CD-03700
SITE ADDRESS: 11605 SW 95TH AVE ZONING: R-4.5
SUBDIVISION: BOETCHERS ADDITION
BLOCK: LOT - 005 JURISDICTION: TIG
Project Description: (3)branch circuits,new furnace and AC unit.
RESIDENTIAL UNIT 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/PAN'EL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_ SERVICE/FEEDER BRANCH CIRCUITS _ _ ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR .-EEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRV'; OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 7 IN PLANT:
601 - 1000 amp: _PLAN REVIEW SECTION
1000+ amp/volt: -4 RES UNITS: >600 VOLT�'OMINAL:
Reconnect only: _ SVC/FDR—225 AMPS:_ CLASS AREA/SPEC OCC:
Owner: Contractor:
DAW,LAWRENCE D WINNER ELECTRIC INC
DAISY L 5950 SW PROSPERITY PK
11605 SW 95TH AVE TUALATIN,OR 97062
TIGARD,OR 97223
Phone: 503-639-4227 Phone: 638-5028
Reg #: I.IC 14794
SIT 28255
FEES
Description Date Amount Required Inspections
JI.I.PRM"I'J FL( Penna $60.15 — —
� I'NX1 8"s,Slim f v ; u) $4.81 Rough-in
Elect'I Final
Total $64.96
This Permit is Issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialt;f 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 a ys 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 Notifimflon Center. ThoA.e 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)246f699 or
1-800-332-2344.
Issued By:
Permit Signature:
�� -----��._. _ = �---_ _ — -
OWNER INSIALLATION ONLY
The installation 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: — �—� DATE:
LICENSE NO: _---- ----._-____�_----.---- __ --
Call 639-4175 by 7:00pm for an inspection the next business .,ay
+
Electrical Permit Application
Date received: r ��,� Permit no.
City of TigarPECEIVE
C'uy njTibard
Address: 13125 SW Hall Blvd,Tigard,OR 9722; ProjecUappl.no.; Expire date:
Phone: (503) 639-4171 (+ ' Date issued: Bya' V Receipt no.:
Fax: (503) 598-1960 `1P 0 `1 f00-,
Case file no.: Payrnent type:
Land use approval: etre n�r,r�d,
1 &2 family dwelling or accessory U Commercial/industnal
U New construction U Multi:family U Tenant improvement
.E�Additiot>/altcration/rcplaccment U r.
Othe
❑Partial
Job address: .Sw S Aye �,hp� J Bldg.no•: Suite no.: Tux map/tax lot/account no.:
�'O1' Dlock: Subdivision:
Project name: l (.Qt w Description and location of work on premises A:C ,;
Estimated date of completion/inspection: _ 0 3 _ (' AC
— -- --- -
Job no: i
Business name:
_i0 k 1 N roUl� /cscriplion
per•
Matt
Address: c' New ). (e .I lural no.im
p
Elly: n q�, 7.7- dwellinguni.incide- or multilamilctir
Stale:(Y2 'IP: C/70=2 Servlceincluded: .altaclK_dgarage.
Phone: p 5oZ Fax: jg yz t E-mail: ((x10.%ft,or less
Bach additional 50 m rtion thereof 4 o
CCB no.: /N7��/ Elec.bus. lie.no: �/_/,SUE 0s .ft.
City/metro Ile,no,: Limitedenergy,residential
it, Limited energy,non-residential 2
l _ 2
Each mnnufac-op-d home or modulardwelhng
Si at re of su rvising electrician(required) Dme a ._y
tlService and/o feeder
5' 2
Sup.c eel.Warne(pont): 4C ., l ; 1 L Cell"no Services or feeder-Installation,
?N�5
t alteration or relocation:
200 amps or less
Name(print); 201 am s lo 400 amps -2
Mailing address: 40l amps to 600 umps 2
City: 60T amps to I O(X)anlps 2
StatC: Z1P; Over 111(x)amps or volts 2
Phone: F'ax: E-mail: -----�. 2
_keconnrct only
Owner installation:Th, installation is being made nn property I own Temporary services or feeder- 1
which is not intended for sale,lease,rent,or exchange according to Invtallorlon,alteration,orrelocation:
ORS 447,455,479,670,701. 219)orop5 or less I�
2
201 amps to 41)0 amps 2
(boner's si+nature: I rut: --- --- I_
-----, __
40110 6(x)ml -1_s
OF]101 R X
Branch circuits-nen,alteration. 2
Name: V or extension per panel.
Address: - A tee for branch circuits wllh purchase..f
City: service or feeder fee,each branch clrunr
Stale: LIP: H. Fee h.r branch circuits without purchase 2
Phone: Fax: C-mail of service or feeder fee,first branch circuit: 6S 2
it W MISF.ach uddiuunnl branch c rcuil
❑Service aver 225 Poch p SerNce nr feeder not included►:
amps-conwlercial J16 'ih,.urfacihtY EochpumporIrrigation circle
U SCtviC",10, :;LOanips-Fall ng of 1&2 U Ilaiartluuslocanon 2
fanlilydwrllings Poch sign or outline Oghting
U Building over 100" square feet four or Signal circuitlsl or a limited rnerRy petrel.
U System over6011 vulls nominal u, n:residential uni s ul one structure aheratiun,or extension'
U Buiiding over three stories U P rders,400 amps or nxxe - 2
U Occupant load over cr) r%ons "A:senptiun
per% U�anufacturedsiructuresot Rvpark
U E.resNli htin Inn :each addNlonal Ins �--
R g R p U(,her _ pecllon overt'. allowable In any of the above:
Submitseta of plane with any of the above. Per ins coon _ �—
The above are not applicable to temporary construct Ion xervice. Othertlgatlon fee
Not all Jurisdlcrinns accept credlt cards,plrar coil Jurisdicti m for more informaourl Notice:'Ibis permit application
i_
visa U MasmeWard Permit lee.....................
credo coni namher __�! expires ii'a permit is not obtained Plan review(at ,) $ _
_ -- `i accepted within 180 days after it has been State surcharge(8%)....$
Name( c n
r a men on c tr c as complete. TOTAL ................... ...
$
Amount
"461.1(60WOMI
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
–-- �— '—_--�� TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee..................................................... $75.00
Number of Inspections per ennit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved.
Residential-per unit 1
1000 sq.ft.or less $145.15 r7 Audio and Stereo Systems'
Each additional 500 sq.ft.or $33.40 1
portion thereof Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $90.90 _---
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.85
El
401 amps to 600 amps $160.60 2 F—] Other_
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts $454,65 2
Reconnect only $66.85
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Fee for each system.......................................................... $75.00
installation,alteration,or relocation $66.85 2 (SEE OAR 918-260-260)
200 amps or less _ r
201 amps to 400 amps $100.30 _
401 amps to 600 amps $133.75 __ 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, Audio and Stereo Systems
see"b"above.
Branch Circuits Boiler Controls
N(,w,alteration or extension per panel
a)The fee for branch circuits Clock Systems
with purchase of L^-.-rue or
feeder fee.
Each branch circuit $6.65 Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.E3 HVAC
Each additional branch circuit $6.65
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or Irrigation circle _ $53.40_ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circult(s)or a limited energy Landscape Irrigation Control'
panel,alteration or extension $75.00 _ _
Minor Labels(10) $125.00 ❑
Medical
Each additional Inspection over
the allowable In any of the above $62.50 Nurse Calls
Per Inspection _
Per hour _ $82.50 _
In Plant $73.75 _ Outdoor Landscape Lighting'
Fees: p Protective Signaling
Enter total of above fees $ ❑ Other ----
8%State Surcharge $ _ Number of Systems
25%Plan Review Fee $ ' No licenses are required Licenses are required for all other Installations
See"Plan Review"section rill
front of application -- Fees:
Total Balance Due $ _—___.
Enter total of above fees $
U Trust Account 0 8%State Sutcharge $
Total Balance Due
All Now Commercial Buildings require 2 sets of plans.
i:kfsts\formaklc-rees.doc 08/30/01