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ADDRESS I36bb 4LA� (�J�O+, ,Q,� Z •_ PERMIT NO.- L
PERMIT CHARGE: none
OWNER '.?�� ��4° > 1,� CONNECTION FEE
_ PAID BY
TYPE OF BUILDING /y��/+ DATE CONNECTED
SERVICE RATE INSPECTION FEE "5-
CONTRACTOR
5CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
JS Y77 U M
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 9723
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
77)
permit
lnspector .�' —
CALL FOR REINSPECTION
f:
BUILUiNU Ul:rAm i ivtcim t,
PLUMBING PERMIT I
holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four _
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and subcontractors.
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te
Owner � u 4_44a) / yy tc)
Address- aDate---41--
NUMBER
ate__ _.
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ^ ITEMS FEE ON EACH AMOUNT (Office Use Only)
R E S I D E N T I A L _�-�- --- +�+
Si Is Farn l - bath-each _ _ 25.00 _ �i
Duplex-Each 1 bath unit _ __ 25.00
__Additional bdorooms•-each -" 10.00 -
Mobile Horne S acs each__`_ 15.00
INDIVIDUAL FIXTURE FEES
_t to 50 Fixtures In 1 building-each 3.00 {
51 to 100 Fixtures In 1 building-each 2.50 - '�
101 to 200 Fixtures ac
Fixtures-in 1 building-eh 2.00 _ I
_201 or more Fixtures In 1 building-each M 1.50 - W
MISCELLANEOUS -'
Building Sewer-Ist 50 ft. _ 10.00 _
Sewer_each additional 100 ft.r 1.0.00 -
Water Service to buildirt�_ __ _ 5.00
- - --- _�
Private Water Systems-each 100 ft. 10.00
Other 5 lfv)'
PERMIT_ �/ For Phimhiny fru;oecthnn Phone 639-4171
_ State V Plumbing Contractor By
TOTAL r < RECEIPT NO. Issued By -
BUILDING PERMIT APPLICATION 11T TIGARD DATE. Y 19`� N
OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHON�� �
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATION`i. OWNERPHONE_— __—
LOT NO.
OWNER -100 ADDRESS HOME.ADDRESS _
ARC4ITECT
BUILDER ADDRESS GNG'NEER
-- DESIGNER
STRUCTURE ❑NEW ❑RIMnDEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
RESIDENCE 1:1 COMM-❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGF❑SLAB ❑FENCE
—❑BOND ❑MOVING _ OCONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
9&-(LUPANCY LAr!O USE ZONE BLDG.1YPE -.FIRE ZONE_" PLAN CHECK BY HEAT----..
!'unatzu:.t »i%ie foxily awaiiiny c.tgdT. sm 04L —
--- Suww.r ';srmlt ;jlt�7• $ �'.�»Ctrl
S?S ,_l.QBQ FLOOR LOAD �} HEFT 7 1 NO.ST�$J�S AR; �7� Iy0.8EDROOfy1$.�5 VALhJ���R 700.
BUILDING DEPARTMENT SET BACKS FRONT 2n REAR SIL! LEFT SIDE RIGHT SIDE
Permit 176�t?L� -- - ---- _ _.
- THIS PERMIT 1S ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN 'THE BUILDING CODE, ZONING
Plan Check a'q.00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- WORK WILL BE DONE IN ACCORDANCi WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub total 267,00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- - RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax.:,. i LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
a4.lo. - p4Ll1j.1:U
Total 27,x, to - FIDE #2 6100.00
By ---
APPLICANT JR AGENT
Appruved Rrcril,+ Nn � �6
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
7P Contractor
Permit No. 74 p 3
Rough-in
��J9 Fixture �-
>y3-7 9 - Final — -
/�079 HEATING
sy�J� Contractor
Permit No.
fj Gas or Oil
—' Rough-in
— ---- Final
SEWER
---�._---
Final
y 9-may
DRIVEWAY
Final
Stonh Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
_ Appro ^h
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
i
City o 'Tigard Mechanical Permit y ?ermit�_�
_..
N,!-ei Installation G1 Replace 0 Relocation 0 Addition [_1 Alteration [� t4� % State
HEATING L.
�J' � TOTAL--
CONTRACTORU_LL. ----��
1-� �_. 5►I-V if y � /�' OWNER '" I ,AL �. ,� ,J p �)
AJ09ESSaL ki L ' WORK ADDRESS SI,J (.
l
FHONE_ LQA- I I ,' 1 _ _ APPLICANT---
_
Heat Input Rating (BTU Per Hour) n C e �� Vent Size Flue Size__
FUEL OIL ❑ GAS E4 ELECT 0THE R_.__ _��_
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit ~� SEE ABOVE Air Condition Compressor 15 to 30 HP _ 10.00
Ne. •Lo & inc.100,000 BTU •�' _4.00 ^Air Handling 10,000 CFM 3.00
New, 100,001 BTU & over _5.00 Air Handling Over 10,000 CFM 5.00
Floor Furnace _4.00_ Evaporative Cooler 3.00
..'ali • Floor •Suspended _ 4.00_ Range Vent Fan
Install Vents Only i 2.00 Vent System _ _ 3.00
Repair - Heat& Cooling _ _ 4.60 Flood Commercial _ v! � 3.0C
Air Condition Compressor Under_3 HP 4.00 Commercial Duct_ System 10.0
air Condition Compressor 3 to 15 HP 7.50 I
I
;NSPECTOR'S COMMENTS
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CON-fRACTORS
APPROVEO BY _ DATE ^ _ ISSUED BY _ DATE
RECEIPT NO.714
q'irinatiorp nF annli,3nt
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