11925 SW BURLHEIGHTS STREET W r l RI AIPI
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11925 SW BURLHEIGHTS STREET
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INSPECTION NOTICE
City of Tigard Build ng Department
12420 S.W. N ain St.
Tioard, Oregon 972233
Phone 639-41.'1
Address_._ –-- •r4`..' _.. �. – — Permit 4k_
Type of InspectionThe following Building Code deficiencies are required to be corrected: ---
Presented
Date
G411 FOR RENT(SPEC17ON
[] YES C] NO
Y
City of Tigard Mechanical permit Permit___ $3,09-
Fee-
New
3.00FeeNew Installation I .1 Replace I-A Relocation F1 Addition L_1 Aitera-ion U 3%State
TOTAL—_ -.��
CONTRACTOR OWNER
ADDRESSr WORK ADDRESS
PHONE APPLICANT
Heat input Rating (BTU Per Hour)_ —� Venn Size --_ Flue Size__--_
FUEL OIL ❑ GAS ❑ ELECT ❑ OTHER
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit y 3.00 Air Condition Compressor 15 to 30 HP 10.00
New-Under 100,000 BTU 4.00 -Air Handling 10,000 CFM_ 3.00_
New- 100,000 BTU&over 5.00 Air Handling Over 10,000 CFM 5.00
Floor Furnace _ 4.00 Evaporative Cooler _ 3.00_
Wall -Floor-Suspended_ _ _ 4.00 Range Vent Fan -� — - 2.00
Install Vents Only 2.00 Vent System E1�00
-
Repair• Hest&Cooling 4.00 Hood Commercial _Air Condition Compressor Under 3 HP4.00 Commercial Duct System
Air Condition Comp-essor 3 to 15 HP �— 7.50
INSPECTOR'S COMMENTS
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS
APPROVED BY DATE ISSUED BY DATE
RECEIPT NO.
774 Signature of Applicant —
Address���?.S" ��iR L t/
11_ Permit No._rI7 51
Name of Occupant Permit charge—
Connection fee
Paid bq _
--- -- ----------------__-_ Date connected��
Tyne of Building_ _ �+ Inspection fee
Service Rate Paid by --- ____Date
Contractor Assessment---Paid---
Size
ssessmentPaidSize of connection 4
City of Tigard
Permit NV 3 7 9
DATE
PERPAIT IS GIVEN TO _ `b'� +f ( ♦ ��� l�r«� � ,;� 41
OF
TO CONNECT A
TO THE SYSTEM OF CITY OF TIGARD
THIS PFRMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON.
NFCTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COMPLETED.
PERMIT FEE PA;D $ CITY OF TIGARD
• �.�tir�.ro��r.��wr.�.���.we�r��.rte„�.�.��wn�n��.,�nw�
CONNECTION INSPECTED AND APPROVED
Date Suparinf�nd�nf -
7 � I
City of Tigard (;�-
INSPECTION REQUEST
f r
'NSPECTION TIME: P�? PERMIT NO. ' _
DATE: ��_�_ � DATE ISSUFD
1
OWNERS NAME : ---
ADDRESS:
AME :ADDRESS: -jLTiPS
rONT9ACTOR : — a
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