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13205 SW CHELSEA LOOP
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CITY (7F "I,IGARD PLUMBING IMu M Hall Wwl.
�ITR M 11' 1� 97223
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conduct muss ..old Oregon Registration to conda plumbing ) 633.4175
business or must be property owner/operator not hiring outside help.
Nair of Development /
C_ Plumbing Permit No,
Address DeKwipyo
S1�^ C�P/ P r ORS 814.21-610 DUAN, PRICE AMT
Job Tax Lot Map.W.
Address
FIXTURES
Lot Block Subdivision
G I P Sink --- _ 7.50 -
acs rOf nameR bU$MSSI Lavatory __ 7,50
Tub or Tub/Shower Comb. ! - 7.50
M411111C, see Oew Shower Only -----I -- ^7;50
Ownertale - p Water Closet _ 7.50
IJ / 2 -- Dishwasher - ---- - 750
Phone Ga`)age Disposal _ - 7.50 -
------- Name - _Washing Machine 7.50
Floor Dram - - 7.50
Mailing Wass Phone----- Waler Healer -- -`�_ 750.
Occupant -- - Laundry Room Tray 7.50
P City/State Zip -- -
Urinal 7.50
armPhone Other Fixtures(Specify) - 750 --
� i�(,�// (Vw Z L 7.50 ----
�s fe C ?ane 7.50 -
00 _' 1WA,,z f 6g f�«?C - - -- --- - 7—_
C - -
ontractor /State Zip So
72 MISCELLANEOUS _
City Bus.Tfx No Sewer 191100' 90.00
- s s o r
tat* s.Board a Sewer-so.Addis 100 - ,-- -_ 15.00
Wo al
(Resdenlial) r-D K7 F 31 _/�Y CZ. Water Service 1 st 100 20.00 -
I twOby ar*now1edgv that I have read OMs application.OW the k*xTnation Water Service ea.Addit.W - - 15.00
W"en Is 001'r0011,that 1 wm regialwed with the State Builders Bowd.and also Storm 6 Rain Drain 1 st.1100' 30.00
have a Stn*PkwnbirV►0snse that the ncwnbw*given ars correct,that all -- - - -
pkjrnbwV worts will be done in socordance with appacablo Provisions Of 01 e- -Storm 6 P:jn Dra,n Addil.100' 15.00
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gon Revises!Statutes Chapters"7 and 843 and applicable codes and thal Mobile Horne Space - - -- -2500
no hall)will be enpicyed unbss Moervood undo.ORS 8a3 (n eKe"t hom
Slat*r*gitVafion.please give reason below) Back Flow Preventpn
HOMEOWNERS-I hereby c wxyfy that I am the owner of Ore fwnpwty de- Device or Anti-Pollution Device _^ -- 750
scrbad above,M which hGtlan I propo"to make a plun>bing k►slallatbn kw Any T rap or WaeM Not
my own u**and OMs property is not bekq ocrtatrvlMd for Gain,base or rw)t CololeclsQ to a fixture 7.50
- Crich Bask► 7.50-1
k".of Exist.Pkxtttkq 40 00 Per Nr
Specialty Re"ls0 kupecllorta 40.00 Per Ht
_-- - ------- --_ -__ -
Allier.of Pkaft 0 ^-
- an Exlstlnp Bldg 15.00 min
AI!T1K?RIIF()SIGNATURE Dade New Bldg.of Build AddUon 26.00 nun
- rBjjD Ltain,agigle fa11n.1
t?ss<xibs wrxit new(addition C1 afhersdon❑ repair n dwell' 15.00
52_be dare r"idential(A ran-redd�l�lNallj
Ext"use of ----- - --
fa,tldk>Q or prc>t)erty MJFTOTALbi.o* at
Ptliciposied use of
a�a.�ty -- -- - - - rows .
This pair, bsoomes nail end avid 0 wcsil or oorlseuoron a i0horlxsd is not oorn
rrtartoad wWdm%W days,sr N M I*txgm awn*4s Mlapo ids a ebwndonsd br
a Pooiod of 180 6"M any&M 0110'wok is o0mrrtsrtasd
W*CIAL 0000"W"
[)ate Msussl .1�. _-�, -•1- by
�.o r r ur IVIHIIU IVICV,frf\IVI�.HL t'C�iVll 1
Permit
Description
Table 3A Mechanical Code OTY PRICE AMT
City of Tigard 1) Permit Fee 0 •0- 10.00
13125 S.W. Hall Blvd,
P.O. Box 23397 2) Supplemental Permit 3.00
Tigard, OR 97223 -----
639-4175 1) Furnace to 100,000 BTU 600
incl.ducts&vents
2) Furnace 100,000 BTU l 750
Incl.ducts&vents
Name of Development 3) Floor Furnace 6.00
incl.vent 1
------- -- 4) Suspended heater,wall heater
Job Address 600
Address ,,3 9•? S K � or floor mounted heater
Tax Lot Map No 5) Vent not incl.in 300
Lot Block Subdivision appliance permit
Name(or name of business) 6) Repair of heating,refr ig., 600
cooling,absorption unit
Mailing Add(ii ) Boiler or romp to 3 HP ss Phone � 600
Owner absorp.unit to 100,000 BTU
Chyfstate Zip 8) Boiler or comp to�HP-15 HP 1 1 00
absorp.unit to 500,000 BTU
Name 9) Boller or comp 15-30 HP 1500
absorp.unit 1/2-1 million
Mailing Address Phorw 10) Boiler or comp to 30-50 HP 2250
absorp.unit 1 -1.75 million
Contractor Cttyrslate Zip 11) Boiler or comp to 50 HP 31 50
absorp.unit 1,750,000 BTU
State Registration No City Bus Tax No 12) Air handling unit to 450
10,000 CFM
Air handling unit 50
I hereby acknowle'•ae that I have read this application that the information given is 13) 10,000 CFM
correct,that I am the owner or authorized agent of the owner,that pians submitted are m — -- ---- --
con+pllance whn State laws that I am registered with the State BuildersBoard,that the 14) Non portable _�– - - 4 50
number given is correct (It exempt from State registration please give reason below) evaporate cooler
-- -
15) Vent fan connected T 300
to a single duct
--- -- - Ventilation system not
18) 4501
included in appliance permit
- - - Hood served by 4.50 y n
/ 17) mechanical exhaust
tura
4�t).. _ Dau 19 Domestic type 7.50
Describe w•)rk � addition ❑ aHeretion U1 repair repair
Incinerator
to be done residentialZ - non-residential O _ 19) Commercial or industrial30-00
Existing use of _type incinerator - -
building or property 20) Other i.e ,woodstove,water 450
– — -- ---
Proposed use o1 - heater,solar,clothes dryers,etc
--------- "
building or Property 21) Gas piping one to four outle!s /_ 200
Type of fuel- oil 17 natural gas
,V LPG ( I electric f I {
22) More than 4-per outlet
NOTIC -- _- ---_ _- SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON• - -
4%SURCHARGE �
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 261E OF SUB-TOTAL a l�
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - "�"
WORK IS COMMENCED � TOTAL y/ :3
Oil!
Special Conditions
/ -Aft �
DAfo Issued by
BUILDING PERMIT APPLICATION DATE_ 'Fu's's" ,19 81 t
684--7543
THE UNDERSIGNED HEREBY APPLIES FOR A PERM i FORTH G.WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWN�ER_P_H�O_NE
OWNER Jay Miller JOB ADDRESS 13205 SW C110130a 1-P- �TORJK �7?—.�:�1���1
ARCHITECT
ENGINEER
BUILDER r411mw ADDRESS _ DESIGNER
STRUCTURE (ff NEW ❑ REMODEL O ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
EARESIDENCE P, COMM ❑ EDUCATIONAL ❑ GOV'T Cl RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
PCIR
OCCUPANCY --13—LAND USE LONE 112PRDG.TYPE SN FIRE ZONE—_PLAN CHECK BY HEAT
Construct single family dwelling w/attached garage, all par approved pans.
Subject to 85 aode.REtSSUE of 6767 —
SEWSR PERMIT# 33454(ldu) 3 bath, 11 traps garage 4i'14
OCC.LOAD FLOOR LOAD 40 HEIGHT 02 0 NO.STORIES 2 ARCA 1490 NO.BEDROOMS VALUE 66000
— BUILDING DEPARTMEhtT —
SETBACKS FRONT S REAR 3 LEFT SIDE 6 RICHT SIDE _
Permit 331 .00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULA'rIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALI. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT T HE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE. PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CURES AND ORDINANCES,. THE ::,ouANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CiNTNACTORS TO HAVE CURRENT CITY BUSINESS
— LICENSE.SEPARATE.PERMITS REQUIRED FOR SFMfER,PLUMBING AND HEATING.
State Tax 13.2t SSDC 250.00
— SDC— 600.00
Total 3Rd.2—-- PDC# P LI NT EMT , L__, L/ / J
BY ^—
�0.00 /
Receipt N 50.C
No. O v4/ 1
74
1
1D�lEssL.2.—'_ ��/�— -- --------
Approved v_ / PHONE
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DATE P. TYPE ["PECTION EMARKS PLUMSING DATE
Contractor
737,
Permit No. q4(A4,
Fixture
HEATING
Contractor
7ex Oil
SEWER
FinalFinal
DnIVEWAY
Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLOM DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY
7oning Final
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