12165 SW MARION STREET IS NOIUVW MS 99 L 1
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12165 SW MARION ST
CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2004-00809
13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 12/9/2004
PARCEL: 2S 103CB-02600
SITE ADDRESS: 121Fi SW MARION ST
SUBDIVISION: WIC LAMETTE NO.2 ZONING: R-4.5
BLOCK: LOT:029 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE 01' UFAE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO APDL: 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 DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace.
Owner: _ _ FEES
BERGSTROM, EDWARD A Description Date Amount
12165 SW MARION (MECII] Permit Fee 12/9/2002 $72.50
TIGARD, OR 97223
[TAX] 8%State Surchart 12/9/200 $5.80
Phone:
Total $78.30
-
Contractor:
OREGON HEATING 4 A/C INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Phone: 538-2953 Heating Unt Insp
Final Inspection
Reg#: LIC 125815
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, Plate of Ore. Specialty Codes
-J 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
952-001-001Qthrot�gh OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699.
Iss Af Permittee Signature:
Call (503)'539-0175 by 7:00 P.M.for Inspections needed the next business day
Mechanical Permit Application M1 11,11blam
J lRecc;ved
City of Tigard Da'.'By 1A1, 11cmut No
Date/hy (fix q, 2:
1312.5 SW Ilail Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.548.1960 Date/By: Other Pennit
Inspection Line: 503 639.4175 Date Ready/By. Page 2 for
Imcmet: www.ci.tigard.or.us NotifiedfIvieditA mental Information
TNTE OF WORK COMMERCIAL FEE* SCHEDULE — USECHECKLIST
F]New construction Add it ion/al teration/rcpl acement Mechanical permit i".s*are based on the value of the work
performed. Indicate the value(rounded to the nearest dollar)ofull
F� Demolition F1 Other: mechanical materials,equipment,labor,overhead,and prolit
CATEGORY OF CONSTRUCT, )N Value:S
RESIDENTIAL EQUIPMENT/sysTFMS FEES-
01-and 2-family dwelling ElCommcrcial/industrial CAcccssorybuildirig For special information use cherklisi
n Multi-family [I Master builder 0 Other: Description Qty
JOB SITE INFOPMATION AND LOCATION Heating/cooling
Job site address: C-- Aif conditioning or heat PUMP
(requires site p!an showing placement) 14.00
Furnace 100,000 BTU(durtslveno) 14.00
city/stalefzlp:
Furnace 100,000+BTU(durvvents) 17.90
Suite/bldg./apt.no.: Project name: _gas hqLpump 14.00
Cross street/directions to job site: Duct work 14.00
----T— Hydronic hot water system 14.001
LE F I D I e. Residential boiler(radiator or
hydronic) 14.00
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
to 0()
Flue/vent for any of above to—
Subdivision: 10 00
Other: to..
Tax map/patcel no.: Other fuel applin ces
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
fir,-place 10.00
_1��Shter(ps) 10.00
_�y�od/ cl�et stove .00
Wood fireplacehiihL.-, 10.00
0'PROPFRTY OWNER El TENANT Cininincyliner/flue/vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 10.00
City/Statc/Z[P: Clothes dryer exhaust 10.00
Single-duct exhaust(bathrooms,
Fax: toilet compE Iments,utility rooms) 6.80
Phone: �53161 1 -
BICONTACT PERSON Attic/crawlspace fans 1000
APPLICANT Other: 1 0
Bus:ness name: Fuel piping
Contact name: $5.40 for flrst four;$1.00 for each additional
Address: Furnace,etc.
-Gas heat pump
U) City/State/ZIP: Wall/suspended/un it heater
Phone:(1z,,3) 1Wcfe(0-5-6 ----FFax Water heater
-J — Fireplace
E-mail: --NTRACTOR -Range
EO Barbec-;c
W Clothes dryer(gas)
Business name-(,),e1
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal I
Phone:(,,k,'3) Fax: Minimum permit fee($72.50)
Plan review(25%of permit fee)__
CC9 lic.: t'3 "i State surcharge(8%of permit fee)
TOTAL PERMIT FEE
This permit application expires If a permit Is not obtain withinlilo
Authorized signature: days after It has been accepted as completeed
H-AA1 Date: Fee medirdology set by Tri-County 13ttilding IndLotly Service Board
i%Ruilding\Pemits\MECP�.itAppdoc 12/0 440-4617T(I 1/02/COMIWER)
Mechanical Permit Application - City of Tigard
Page 2 -Supplemental Information
Commercial Fee Schedule:
Total Val lnt oAt Permit Fee:
$1.00 to$2,000.00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30
for each additional$100.00 or fraction
_ th:reof,to and including$5,000.00.
$5,001.00 t_o$10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and including
_ $10,000.00.
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$100.00 or
fraction thereof,to and including
$50,0.00.00.
$50,001.00 to$100,000.00 $771.50 for&.c first$50,000.00 and
$1.25 for each additional$100.00 or
fraction thereof,to and including
$1 OC,000.00. _
$100,000.01 and up $1,396.50 for the first$100,000.00 and
$1.10 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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i:\Building\Permits\MF..C-PermitApp.doc 12/03 2
• f�D• 1 ELECTRICAL PERMIT
CITY OF TIGA
PERMIT#: ELC2005-0000.4
DEVELOPMENT SERVICES DATE ISSUED: 114/2005
13125 SW Hall Blvd..Tigard, OR 97223 (503)6394171 PARCEL: 2S103CB-02600
SITE ADDRESS: 12165 SW MARION ST
ZONING: R-4.5
SUBDIVISION: WILLAMETTE NO.2
BLOCK: LOT: 029 JURISDICTION: TIG
Project Description: 200amp service.
_ RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amplvolt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR—225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WATSON, MIKE HILLSBORO ELECTRIC
12165 SW MARION 21185 NW EVERGREEN PARKWAY
TIGARD,OR 97223 HILLSBORO, OR 97124
Phone: 503-439-9666 Phone: 503-439-9666
Reg#: ELE 34-4399C
—— LIC 134481
FEES Slip 49415
Description Date Amount
- Required Inspections
[ELI'RMT] El-C Pcnnil 1/4/2005 $80.30 `— -
(TAX]8%State Surchai;ge 1/4/2005 $8.42 Elect'I Service
Elecfl Final
Total $86.72
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 1 PO days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the O,egon 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- 2-2344.
CIssued By: LCL.µ_ Permit Signature:— '�-n C1 C
0 OWNF!!• MSTALLATION ONLY
The installation is being made on property I own ,.-;huh is not intended for sale, lease, or rant.
3
0 OWNER'S SIGNATURE: DATE:__
7
a CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ i DATE:
LICENSE NO:
Call 639-4175 by 7:OOpm for an inspection the next business day
From:HILLSM ELECTRIC LLC. 5036013680 01/04/2005 0:56 #626 P.002/002
RECEIVE)
_Electrical Permit Application
Lv. Rrcrived
I Permit NO �LC.a uo
City of']igard -po ov
13115 SW Hnll Blvd,Tigard,OR 97227 Plan •view
Phone .50J 6.19 4171 Fax' so1•sjuv*F TIGARD DOWBY ^!_ Other Permit:
hispcction Linc 503.639,4173 I WILING DIVISION Dote Ready/By �+ Pop 7 far
Internet: ww\u ci tiyard or.us "ir'tdrMtdrod —� I L� !a lemeoral Informstiaa
TYPE OF WORK _ !�^ PLAN REVIEW
U New construction Addition/alteration/replacement - Plaue check all that apply,
Dcmolilion ❑Other. ❑Service over?35 amps,camm'I 'LOHaralydous location
[]
[]Service over 120 amps-rating []Dulldny over 10,000 sq.ft.,
CATEGORY OF CONSTRUMON - - of I-and 2-family dwellinyls 4 or more new residential
II [� 1-end 2-family dHcllmg ❑Commercial/industrinl�]Acoassory bu1101118 L]Syatenl over 600 volt!nominal units in one structure
El Master builder Other: I ❑Building over thea norl•r QFoeden,400 amps or poops
Multi-famil
yQ ❑Occupant!^zd aver 99;wrsons ❑Nlanufact ured structures or
JOB SITE INFORMATION IND LOCATION LICIFirsstliphting plan RV park
i+ (]Health-care facility []other:
Job no.. , lob silt address: � Submit 2 Bete of plana with any of the above.
City/S1ate21P: The above are not applicable to temporary construction aervioe.
$uitehrldg./epi, no,: Prc;itsct name 1t FEE*',SCHEDULL
1L r� -- usoer+noe.) �OrrT ►a rM.l
Crosse street/directions t0 job Site' New residential single-or multi-family dwelling unit.
— -— Includes sttarhed garage.
1,000 sq,ft.or less 143.13 4
Subdivision: ---- _ - Lot no.' _ Pa.add'I 500 sq R or ponlon - 13.40 1
-- — - Limlistt energy,midcntial _Tax map/parcel no. Limited energy,non-residential 4-75()o?5.00 2
DESCRIPTION OF WORK Each menuflictured or mndulat
dwellinu service an feeder
Servirp or feedersimtetla!;,�n,■If ration,and/ar rdtaatMn
200 amps or leas 80.30 ?
................... PROPERTY OWNER 201 zmLn to 100 amps 106.85 Z
— -- 401 amps to 600 amps _ 160.60 ?
Name 601 smpa to 1,000 amps 240.60 2
Address, Over 1,000 amps or volts 454.63 2
- - -
- — Reconnect only 66.65 2
City/State/ZIP' Ttmpnrory services or fexlers installation,siteration,and/or
_ _✓ - —J�v''( ) �� 200 amps 0l less _ 66,83 1
Owner Installation(TTiis ins allohon to being made on property that I own which is not 201 amps to 400 at 10 _ 2
intended for sale,leasee,rent-or exchange,aecnrding to ORS 447,449,670,and 701. 401 am to 6(10 am 133,75 _ 2
O Anrr signature: Date: Branch circulta-new,alteration,or riteealon,per panel
-- ❑ APPLICANT ' z`. CONTACT PERSON rA.1 Feeor branch circuits wish
!etvicc or(boder fee,each 6.65 2
Business name: n h r it
B.Fee for brant eh irci.:tc
Contact name, wllhuw service or feeder fee, 46,15 2
-- ir>: it
Address: Each sdd'I branch circuit 6.63 2
City/State✓ZIP: Miscellaneous(service or feeder not Included)
Fump or irrigation circle 53.40 2
Phone ( ) Fex: ( ) Sign or outline lighting 53.40 2
E-mail: - Slgrr circuits)or limited-
CONTRACTOR energy panel,alteration,or
N — artansion.Describe- Page?
Susindsname:gilleboro Electric L.L.C.
Address: Each additional Inspection ction over allowable in■n of the above
�_ 21 18 5 NW Evercirreen PKWY- Ste #1 1 0 i'er fns)xcilon 6250
m Ciry/Siate/ZlP. HiI Ishorof OR. 97124 hrvesNgationperhour(Ihrmlr� 62.30
�nslusUial PIAM pet hour _ 73.73
W Phone(503) 439-9666 �Fsx:(503 )601-3680
RUCTRICAL PERMIT' FEES
CCB Lic.:134481_J Electrical Lic.:34-499C Suprv. Lica: 4941 S
Subtotal
Suprv.Electrician signature,required jl-
Y Plan review(25%of pemllt fte)
Printname:Joey Vitacco Oalr. 1 �9uteatrcharge(l�ofprnnitlise)
— --�- - -- TOTAL PERMIT PER
Authorized Signature: J This permll appllcatlon•spires i r permlt Is note to std It In ItA
days after it ass been aceepaed as roetplst•
Print name: Date J see mathodolM sear by Tri-County Building Industry Service Board
-- - ••k,m lx �f mspaetiav par permit alio'vtd
I\BulWinp\Pcmws\aLC-PmmilApp.dnc t+nn 4411-461 ITIIIVoWOMMEB
CITY OF TIGARD 24-Hour
BUILDING - Inspection'Llne: (503)63A-417a0 MF,T
INSPECTION DIVISION Business Line: (503)639-4171
SUP
Recsived _. Date Requested-! Z AM PM BUP
Location Suite— MEC
Contact Person Y1-i% — Ph(—) 5 �� �� PLM
Contractor__ _- _ Ph( ) ---__- _ SWR
_BUILDING - Tenant/Owner ELC —
Footing
ELC
Foundation
ACCRSS:
Ftg Drain ELR -
Crawl Drain
Slab Inspection Notes: SIT _-----
Post& Beam
Shear Anchors - -
Ext Sheath/Shear
Int Sheath/Shear
Framing --- - -- - - -
Insulation
Drywall Nailing - -
Firewall
Fire Sprinkler —
Fire Alai
Susp'd Ceiling - --- —
Roof
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 — -
MECHANICAL
Post 8 Beam--- --- -- -- - --- --
Rough-In
Gas Line i
Smoke Dampers - ----- ---- ----- -- --—
Fin
1 _ PART_ FAIL --- - - --- -- - ------ -
ELECTRICAL
----- ---------
Service - ---- - -
Rough-In
j UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$— required befora next I ection, Pay at City Hall, 13175 SW Hall Blvd.
PASS PART FAIL
SITE _ F] Please call for reinspection RE: -- _ _ r Unablo to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date�_.Z� -Q�--_ Inspector
Other:
Final DO NOT REMOVE this Ins>speeVen record from the job *He.
PASS PART FAIL
CITY OF TIG,ARD -
BUILDING DIVISION PERMIT
13125 SW Hall Blvd., Tigard, OR 97222 DATE ISSUED. )/R/ '1006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/14/7006 TIME: ).))I'M PAGE: �t)
n
SITE ADDRESS: I))V)c'W MARION I CLASS OF WORK:
SUBDIVISION: WII_I AM' l_n,E N0.I LOT 0: n y TYPE OF USE:
PROJECT NAME: SI lij-,HE_RD
DESCRIPTION: New sewer connection
OWNER: SI W 11HFRD, NICHOLAS PHONE #: ',(l t h 14
CONTRACTOR: (-�VMEp PHONE #:
Inspection Request Scheduled For: Date: 2114rM Nuur Time:
Code # Inspection Description Confirm # Contact # Message
1'lurnbing final 503351.8715 N
Corrections/Comnlents/Instructions:
All
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECT;ON ❑ ADDITIONAL FEES ASSESSED
Inspector: " �-'� V __ Date:Z/1I.h W1 Phone #: (503) 718-_Z-!Y2