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16740 SW Matador Lane
\ CITY OF TIGARD -
�_MECHANICALPFRMIT
CITY 1�..
DEVELOPMENT SERVICES IT M.SUED:PERM . MEC2002-x.10460
13125 SW Hall BGATE PERMIT
1lvd., Tigard, OR 97223 (503) 639 4171 10/16/02
PARCEL: 2S116AD-08600
SITE ADDRESS: 16740 SW MATADOR LN
SUBDIVISION: KING CITY NO 12 ZONING:
BLOCK: 18 LOT: 018 JURISDICTION: KIN
CLASS OF WORK: OTR FLOOR FURR: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS VV,'O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS H, -10S:
FUEL TYPES _ 0 3 HP: 1 DOMES, INL—
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:
FURN < 100K BTU: 1 AIR HANDLINC_UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of furnace and a/c unit.
Owner: FEES
NILSSON, KENNETH A + Description Date Amount
ALICE L [MECI1[ Permit Fee 10/16/02 $72.50
16740 SW MATADOR LN
KING CITY, OR 97224 [MF('1IJ Permit tee 10118102 $0.00
[TAXI 8%,State'Tex 10/16/02 $5.80
Phone: [TAX[ 8%,StateTax 10/16/02 $0.00
Contractor: _ _ Total $78.30
MILWAUKIE HEATING + COOLING
9961 A HIGI--IWAY 212
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 557-5562 Cooling Unt Insp
Reg #: 104102 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. Ali 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.
A Permittee Signature: L,-A- _t
Call (50 ) 639-4175 by 7:00 P.M. for inspections needed the next business day
10/14/2002 08:34 5035393771 CITY OF KING CITY PAGE 02/02
TRI-COUNTY
SERVICE CENTtP Mechanical Pe mit Application 1 /
Dace receival: i-i/`/ ''i Permit no.:��fC��'��(�
' Cit�r of King Cit •� '� --
Pmject/appl.nu.. Expire date:
I'll 25 SW Hall Blvd. _
Tigard,OR 47273 __��--111I--{{� '�l Date issued: By: )( Rearipr nn
Clackamas Phone: (.543)639-4171,FA*:(503)t�M-r7Z97 1
Multnomah Case file trn.c payment type:
Washington
Land use approval:
V
1 '
I & 2 family dwrlling or accrssrtry U Commerciallindustnal C:] Multi-farruly U Tenaw improvement
I.l Ncw coosmtctior C1 Additiont/ulreration/rcplar-ement LJ Other:
It SITE INFORMATIONVALUATION
Jet)address: t- I.idicate equipment quantities in boxes below. Indicaw the dol lar
Hldg, no.: _ `- Suite_o.: A- t value of all mechanical materials,equipment,labor,overltrad.
('ax ma tax IoVacc_ount rto.: Profit.Valut.S
Lnr. Bl�k Subdivision -- -_~�- «S¢c cherklist,r,ir 'mporram appliauton Inform wion and
Project name: _ _ jurtuiicriun's frc •:hrrlm'e fcfr rpsiricntivl prrmit fcc.
City/county: .. t h �fw®rk
` ZIP Z -- tDescription and Itx�ttion on prertttses: t 1 ilv
rrM(es.) Total
Fist.date of curnpletion/-tna tion. Ditsixi tion Qty. flee.otd Ke%only
Tenant improvement or change-;15e-C^1 Air handling unit-1-An CFM
1s exLtting space heated or c�ond�' 'vned�-11 d No Air cnn�uon n`(A rte lao of _
Is ex53ting space insulnttxl7[3Yec U No te'rauan
CONTRACTORnt eikumprexzors
State boiler permit no.:
S tisirtess t1>itnt l•�L 9.1t t�l -.�I�>F4 L�Z HP __ Tons 13TUM,
�ddrds: �:t��( Z •v Irve/s_make dutrpers%rluct smoke deeermr
��i `.� _ Start. Q LIP: Fesf um (site plot rcquue� -_.
�•S•7-.� ML Fax:S^Jr-!2m F rte: dntita rep ace7iitn 7fiu�mec BTCi
""4----~--- w: Including ductwork/vent tin" 0 Yes 13 No
�CEI nu.. 0"/v L _,�..___ _, _ Inanll/repiace/ee ocett haaoers--suspe —
.ity/mCtTAIIC,rw.: wall.orflourmounted —
vame(please print): npPtRnee omit ill UCurrin«-
/ -�etrlgvtratlea: --�
_ Ah3nrption units _--
.ame: 1 S✓ Chillero ..---- —HI' -- -
1 corn sum lip
%ddress: rt�dr 'r`=�..
- - -- - n r»nmunr�l tx a>!t aed renl�lalioa:
'lty: State: ZIP
--_ ---- -• A t boner.vent
Nolle.: I'ax: 1=mail: _ ___.—... I ryr,r exhaust
1 i 0tZ,- 1/iZJrrs'Ti+t' liairria►
ts,x)cl Etre suppression
lame: {/�] � {1 Exhaust fat with ainAle duct(bath fans)
_ - -
48iling aridness: ( L✓ xhaust system ulnen from fi Mg it M
_7 _s � T
Furl pipinQind dtctrlbutioe(up to c null rtr)
ily: r — Stare. 7l1': 2
o Faz: E- tail: I Fuel 'pin_g e�a_cih additional evet 4 outlets
' ymaw piping(scttemalic reluirw) - -
ame: Number of outlets _
_ ___.._ oliKer lkiiQ appuiaae or egaiviteeot-
fkcorative fireplace
ity: _ Slate ZJP: Insert-type
lone: ' t Fr,. E f sdl: - -- lyoodstaveT�eIlct stove--
7plltQJll's si/�rr.xnrrT - "Gla�Q 0 L IJthrr -�
1mC(print) -._- - . ' --- -•- -•- - - - -
- -- -- _, Permit Cee............ a��
S _� Q
all jurisdictions weept math conk.,,In.e rarl tunfdiftion for mrd inrorminidw varke. *A;t permit gpplicafiarr
rso 3 MancttJrd Minimum fee ..... ..........$ —�
e.-pardaps tf a p*rmlt it not obtained Pl tit review(et __ 910) s
lit card number, ---- --- tvlthirt lF0 r after it has barn
. By+ites _ State Sntchame
Nato dizMM.as shave 00 cretin Ord arcepeed as rampterr. `t fYr a t it
CITY OF TIGARD _ ELECTRICAL PERMIT
PERMIT#: ELC2002-00548
DEVELOPMENT SERVICES DATE ISSUED: 10/16/02
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S116AD-08600
SITE ADDRESS: 16740 SW MAT-ADOR I N
ZONING:
SUBDIVISION:
BLOCK. LOT: 0.18 JURISDICTION: KIN
Project Doscription: Installation of(3)branch circuits for furna and a/c.
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 HM/SVC/FDR: 601+amps -1000 volts: MINCR LABEL. (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: _FLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=.2.25 AMPS: CLASS AREA/SPEC OCC_ _
Owner: Contractor:
NILSSON, KENNETH A+ GRF ELECTRIC
ALICE L 15460 SE PARADISE LN
16740 SW MATADOR LN MUHNO,OR 97042
KING CITY,OR 97224
Phone: Phone: 503-829-4146
Reg #: FLI? 1-4K Ir
FEES
Description Date Amount Required Inspections —
il I.PRMT1 I I.l'Permil In Ire n' $60.15
I I,AX]K%staleTax 111 I r,n_ $4.81 ROU(Ill III
Fleri'I Final
Total $64.96
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 dont.RaccQr,'',noe with approved plans. This permit will expire if woe, is not started within 180 days of issuance,or'rf work is suspended
for more than,480 days. A3.TENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OA 952-001-0010 t1hpugh OAR 952-001-0100. You may obtain copies of these rales or direct questions to OUNC at(503)246.6699 or
1-800-3 800 33 -2344.
y: Gt g. -
Issued Permit Signature:
- OWNER INSTALLAI ION ONLY
The installation is being made on prnnerty I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: � rCtA` r� _._�_ — DATE:
LICENSE NO: ------ --- ---- _--.`. - _---
Call 639-4175 by 7:00pm for an inspection the next business day
Oct 16 02 07: 42a GRF Electric 503829574V p. l
cleetrical Permit Application
in,
Date received: /r A Permit
City of Tigard Projecl/appl.no.: Expire date:
City ofTigard Address: 13125 SW Mill Blvd,Tigard,Olt 97223 Date issued: liy:_Seiptno.: _
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: Payincnt type:
Land use approval:
&2 family dw••" -v,or accessury U Cuuuncicial/indu:,trial J Multi-family Cl Tenant improvement
U New construction LI Add ition/al tcrat ion/replace ntr.nt J (Mier T_ ❑Partin]
J. OB SITLE INF1RMATION
Job address: I UjvS (.J Bldg. nu.: Swte no.: fax map/tax lut/accuunt no.:
U.t: I Block: Subdivision: K1on
Project name: - Description andlocation of work on premises:
aiirnaicd date.of Lomplctioniinspc:tion: T
It F 1 1 �
Job no: 1cle Max
Business[lattl L� ('C-4 y� (i � ticscri rluu Qty- (ea.) Total no.Insp
New residential-singe or Inuld family tier
Address�C Q d r e. dwelbngtutii.Includmatta(lwdgarq;e.
City: State: OR-1 ZIP: ll 0�kL Set vice lncWtied:
�v Phone: q Fax: Q E-mail: natio sq.ft.or less 4
CCB no.' J Elec.hns.tic.no:
Fat it additional 500 sq.ft.or portion thereof
C –^
Limitedenergy.residential _ 1
City/metrolic.no.: �G Limited energy,non-residential i 2
/ /(��4 _ Each manufactured horneormndulardwelhog
signature of to tLervising etre 'clan(required) D to F service and/or feeder 2
Sup.elect aurae(print): I,icrnu no: (o 5 Cj s Services orfeeden-Installation,
alteration orrelocation: 3 0
1 I I 200 amps tar less €o. 2
Na111C(print): j j 7201 amps to 400 am + 2
� 401 amps to 600 amps 2
Mallin addt'ess: - M 601 amps to 1000 amps 2
City: L $tale: ZIP: C Over 1000 amps or vola _^ 2
Phone' ax: E-mail: — Rocunuectonly I
Owner installation:The installation is being made on property I own Temporary swvicesorfeeders-
which is not intended for sale,lease,rent,or exchange according to IrWallaturt,alteration,orrelocallon:
20amps or less 2
20
ORS 447,455,479.670,701. 1 _1 amps to 4W amps _ 2
Owns signature: _ _ _ Date: _ 401 to tion am is - 2
Binned circuits-new,alteration,
or extension per panel.-
wile:
anel:wile• A. FCC for branch orcuiu with purchase ofU
Address: service or feeder fee,cacti branch circuit I`, 2
CitY- �~ Stale ` ZIP: B. Fee for branch circuits without purchase — r
-- - -- of service or feafer fee,fire]branch cirrwe I V• t'( .P12
Phone: Fax: H mail: ---
Each:additional branch circuit: �t
Mise.(Service or reeder not included):
2
U Servixove225 ampstnrnatxYciel I;uch urn U Health-corefucility P P or ins Balion circle
G Servier.over 320 amps rating of 1&2 U Huardous location Each sign or outline lighting 2
familydwellings U Building over 10.000 square feet four or Signal c(rcuit(s)or a limited energy panel,
*Systemover60(1voltsnnttunal materesidentiel units inraw structure alteration,or extension" 2_
*Building over throe stories O Feeders,400 amps or more "Description:_.
Ll Occupant load over 99 persons U Manufactured structures or RV park tich additional inspetilon over the al:owable In any of the above:
O F.gretsilightingpiut U:Iter �.._.__-- Pct inspecoun -
5ubmlt._wts of plan,with any of the above. Investigatiun fee �V
The above We not appUcable to tetrpors ry construction service. Odor _
Na all juitd&ijans araep credit cards.please call ju is"on far mac iafdrrnstic Notice:This permit application Permit fee•....................$ n
U Visa U MasttaCasd expires if a permit is not obtained Plan review(at _ %) $
Cmdh eared n,unijer. _(^L-— within ISO days after it has been State surcharge(8%)....$
NPIfG1 accepted as complete.
��------ TOTAL ....................... t
Named u c
sbowa on erexYt aret
S �
( ordhcidri elputtre — - Amount 4444665 bWrWM)
10/16/2002 10:02 5136393771 CITY OF KING CITY P4GE 02/02
I
KANGir CITY
15300 S,W. 16th Avem ,FJng City,Oregon 97224.2693
Phone:(50 1639.4082, 'AX(803)839.9771
Notice To Contractors 'Working In King City
Due to an intergovernme tal agreement with the City of Tigard, many building related permits
for projects in King City a issued and inspected by the City of Tigard.
I
If your permit application DOES NOT REQUIRE PLAY REVIEW, simply complete the
appropriate application le ibly and submit it to the King City staff. The King City staff will
collect all fees and fax die application to the City of Tigard. City of Tigard staff will then create
the permit, issue the petmi , and perform inspections. Please indicate on the permit application
whether you would like th Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returne to King City staff for correction and no processing will occur unt;i a
complete, legible applicati n is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. Kig City staff will simply sign this form indicating land use approval.
Take this signed form to th City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submi applications and plans. Development Services Technicians are
available at 639-4171 Ext. 04 should you have an} questions conc.-ming submittal
requirements. All permit fe s will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard /►
Building Department for the following project. 3 l .(��aP-R-
located at: AAkU"V` I
t
Ain,4
_--�
King City Representative
MrS XCnsr ooc
CITY OF TIGARD 24-Hour
BUILDING inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
BLIP - - -- --
Received _ 'Ate Requested.__ d a 3_- AM- PM- BUP
Location _ l -7=Z"7— /�1� �� � Suite— MECO �' D
Contact Person � Ph(—) 7 _54 PLM
Contractor - — PhS --
_
BUILDING Tenant/Owner _ __ ELC
Footing _I ELC
Foundation Access. Hyl
Ftg Drain f 1 i \ --� ELR
Crawl Drain _ —_
Slab Insprarticrn N es' SIT
Post&Beam kd)a� _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - _ -
Insulatio,i
Drywall NailingFirewall
Fire
Fire Sprinkler
Fire Alarm
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
Final --- - ------ — -
P ABj__FAIL - -- - - - ---
CAL
Pos am`
Rnugh-In - - - ----- -- -- — —
ras Line
Sin2ke Dampers -_ ------ -- - --- — ---
-
ICA- --
Rough-In
UG/Slab
Low Voltage -- -- --- - ----
F Alarm
' Reinspection fee of recuired before next inspection. Pay at City Hall, 13125 SW Hall Blvd
ART FAIL
SITE Please call for reinspection RE: ___ -] Unable to inspect-no access
Fire Supply Line 7
ADA Date_� 1 /Q �� �Mrp�tAt Ext
Approach/Sidewalk _
Other:__ _
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL.