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11533 SW ELTON COURT 1 cn w w m 0 �1 r. 0 c 11533 SIN Elton Court CITY OF TIGARD 24-Hour BUILDING inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received Date Requested_fid . AM—__--- PM_ BUP _— Location _ < < 5� 3-3_ � Suite — MEr: contact Person — _ —_ Ph( ) �' L 1 PLM Contractor __ _. Ph SWR BUILDING Tenant/Owner .__._ - - _- ELC Footing ELC _ Foundation Access Fig Draino ELR Crawl Drain Slab Inspection Notes: SIT Post& Beam --------- - - -------- -- ------ Shear Anchors !- - Ext Sheath/Shear Int Sheath/Shear - --T Framing - ----- -- - --- -- --- Insulation Drywall Nailing —— -...------ -- --- -- -- ------ -- Firewall Fire Sprinkler -- -- Sue Alarm s FirCeiling Roof Other: -- -- -- -- Final PASS PART FAIL PLUMBING Post&Beam _ Under Slab - -- -- - Rough-In Water Service - -- - -- Sanitary Sewer Rain Drains -- - -- - -- -- -- --- - — — Catch Basin I Manhnle Storm Drain ----- - -- Shower Pan Other: Final -- _ PASS PART FAIL MECHANICAL Post&Beam Rough-In ----.-- - Gar,Line Smoke Dampers -- --- - Final _PASS PART FAIL --- ELECTRICAL Service - - Hough-In UG/Slab Low Voltage Fire Alarm P.1RT FAIL El Reinspection fee of$_—_— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please ca';`or reinspection RE: —.._ __—_ Unable to inspect-no access Fire Supply Line ADA r Approach/Sidewalk Dot* ¢_��-. Insp�ato� __._.�`�_��. __ C Ext Other: _ Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL 24Haur MST Inspection Line: (503)639-4175 CTY OF TIGARD 503 639-a�71 SUP I ------ BUILDING Business Line: ( ) INSPECTION DIV - ISION PN' I l I __ AM_---- MEC _----------_- p,it Requested -- Suite 1 - PLM ---------- - Received _� Ph ) _ SWR Location - __-_- ---- - Contact Person - -- -_ Ph 1-----) "¢--=�-! ELC -----�-- Contractor -- ELC -' TenantlOwner ---- - !- ---�-- BUILDING ��j ELR ------` - F�oting Access: , / ' SIT Foundation 6 If-v YYI�2 I Fig Drain I ( S Crawl Drain Inspection -_____----- Slab --~ Post&Beam O�/ / ----- - Shear Anchors Ext Sheath/Shear - ___---- --------- Int --Int Sheath/Shear - _- - - Framing _ ---- --�- Insulation -- Drywall Nailing - -�` Firewall Fire Sprinkler -- -_- Fi.;Alarm - 5usp-d Ceiling - Root ----' - other: _--------- - - --- -- - PASS P _FAIL- _ -- ---- _ - - — Under Slab _-------- Rough-In Water Seryice -- Sanitary Sewer _-------- Rain Rain Drains —,--- -- ------- Catch Basin I Manhold - Storm Drain Shower Pan - -- - other: PART_FAIL --- ___ �_--- ---- -C AL --_-_-' ' - --_--- r---- - POst&Beam - - --` Rough-In -- - ------- Gas Line --- --- -- ----- ----�— Smoke Dampers - _- ----- - ----- Final FAIL - -- PASS PART FAIL - ELECTRICAL -_-- - -__--- -- -- _ _..__-_------ ServIce _--_- -- ---- Roug __ ---- --- _-- UGISIab --- _-- NaP, 13125 SW Hall Blvd. _- ------.`._ ection. Pay 3t City Low Voltage required before next inst+ Fire Alarm ion See of Unable to inspect-no 80ess Final [� Reinspect PASS_PART FAILplease call for reinspection RE. SITE � ------yV—_ - ----------- or Fire Supply Line Dom• L �j' Insped _ job alto. ADA - actio other: record from the Approach/Sidewalk -___--.------ QO Noy REM011E this nsP Final FAIL PASS PART AAAAAAAAAAAAAAAAAAAAAAAAAAA I ► o.. d 4 ► rcn I � ► a d ► ;\ �J b Not, t 1 I® a M l► i C�! ► t a °� ► 4 4 a ro d o n `� ► O ° e a z ►-� 4 , ► a �� a s r _ ) a ► 04 > > n o 4 4 p ► 4 � o ► a 10. 4 p ► 7 ► 4 pop. 4 ® ► t ► j 'Ar�ccciccciec�i �►ccccieiia�icii . itccccccccc��' r. Ei �n N � 7 n � J Q o � o � aQ 5 R• (� roll con z �C o O x �o a CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 1-2 INSPECTION DIVISION Business Line: (503)639-4171 MST __— 2 BUP —_— Received _____— Date Requested_—__�3— 1� AM_—____ PM—_-- BUP Location �' ' f Suite t — __ MEC Contact Person — —_ _____ Ph1-7 PLM Contractor -- ----- -- - --- Ph(-- ) g F77 3l g _ SWR -- --- -- BUILDING Tenant/Owner _ — ELC Footing i ELC Foundation Access: — Ftg Drain L_ - 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 Alarm Susp'd Ceiling --- - - - ._. _.-. - -- - - ---- ----- ------ - _ --- -------- Roof Or:- PASS _PART FAIL PLUMBING -_-_ Post& Beam Under Slab Hough-In WaterService ------- ---_ ---- ------------__....___.________.__-__�_-_------------------- _. Sani!ary Sewer Rain Drains --- -- --- ----- ----`------------ Catco Basin/Manhole Storm Drain _.__.- __-- _ -- ---------------_-_.__ Shower Pon Other: --�-- - Final ---- ----- PASS PART FAIL ----- MECHANICAL Post&Bearr, Rough-In ----_--_-- Gas line Smoke Dampers Final PASS PART ELECTRICAL Service- _- Rough-In UG/Slab Low Voltage - Fire Alarm Final Reinspection fee of$_-- -required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FALL SITE Please call for reinspection RE: —_--- Unable to inspect-no access Firb Supply Line _ ADA Approach/Sidewalk Date. Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the fob site. PASS PART FAIL OF ������ MASTER PERMIT CITY � PERMIT#: MST2002-00016 L'E ELOPMENT SERVICES LiATE ISSUED: 2/22/02 13125 S N Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11:533 SW ELTON CT AS SHOWN ON PLAT PARCEL: 2S103BD-10200 SUBDIVISION: HUNTER'S WOODLAND ZONING: R-4.5 BLOCK: LOT: 014 JURISDICTION TIG REMARKS: Construction of new single family detached residence. Path 1 BUILDING REISSUE: STORIES: 2 FLOOR AREAS __ REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 7Eu of BA;IEMENT at LEFT: 5 SMOKE DET:CTORS: Y TYPE OF USE: sr FLOOR LOAD: 40 SECOND: 1,129 sf GARAGE: 448 sl FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N UWELLING UNITS: I FINBSMENT: sl RIGHT: -.7 VALUE: E 186,007 10 OCCUPANCY GRP: R3 BORM: 4 BATH: 3 TOTAL: 191900 N REAR: 38 PLUMhING SINKS: 1 WATER CLOSETS: 3 WASHrNG MACH: 1 LAUNDR1f TRAYS: I RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWL:R LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB/SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATI:4 LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER F. TURES: MECHANICAL FUEL TYPES FURN<100K: 1 BOILICMP<OHP: VENT FANS: 4 CLOTHES DRYER: 1 GAS FURN>-100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS 1 WOODSTOVES: OAS OUTLETS! I ELECTRICAL RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADO'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMPARRIGATION: PER INSPECTION: EA ADD'L 500SF: 3 201 400 amp: 201 - 400 amp: 1st WIO SVC/FDR: 00 SIGNIOUT LIN LT. PER HOUR: LIMITED ENERGY: 401 800 amp: 401 600 amp: EA ADDL OR CIR. SIGNALIPANEL: IN PLANT MANU HWSVCIFDR: 801 • 1000 amp: 801+4mps•1000V: MINOR LABEL: 10004 8InplV0ll: PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR»225 A.: >800 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO 8.STEREO: FIRE ALARM: INTERCUMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTI4: BOILER: HVAC: LANDS(.',PEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION MEDICAL- OTHR: HVAC: DATAITELE COMM: NURSE CALLS TOTAL.N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,719.80 This permit is srbJect to the regulations contained in the DAVE AMATO&ASSOCIATES LTD DAVE AMATO AND ASSOC LTD Tigard Municipal Code,State of OR. Specialty Codes and PO BOX 19576 4351 SW CULLION BLVD all other applicable laws. All work will be done in PORTLAND,OR 97280 PORTLAND,OR 97221 accordance with approved plans. This permit will expire H work is not started within 180 days of issuance,or if the work is suspended for more than 180 days ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set Rag N: LIC 00208092 forth In OAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final Grading Inspection Pnst/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Sewer Inspection Un(t.,caor insulation Plumb Top Out Exterior Sheathing Insf Rain drain Insp Plumb Final Footing Insp CraA,'OralnlBackwater Electrical Service Low Voltage Water Lina Insp Final inspection Foundatlon Insp Footing'Foundalion Dr; Electrical Rough In Gas Line Insp Appr/Sdwlk Insp AIssued BY : �Lx_ tit- Ki �'--- _ Permittee Signtature : _ Call (503)639-4175 by 7:00 p.m for an inspection needed the next business day CITYOF TIGARD _ SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2002-00009 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/22/02 SITE ADDRESS; 11 533S'.r ELTON Cf AS SHOWN ON PARCEL: 2S103BD-10200 SUBDIVISION: RIUNnER'S WOODLAND ZONING: R-4.5 BLOCK: LOT: 014 Y! JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 i YPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new single family residence. Owner: _ FEES DAVE AMATO& ASSOCIATES LTD Type By Date Amount. Receipt PO BOX 19576 --- PORTLAND, OR 97280 PRMT CTR 2/22/02 $2,300.00 27200200000 INSP CTR 2/22/02 $35.00 27200200000 Phone: 503-245-2117 Total $2,335.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side: ver' Perm /7 Issued b 1 s�, Permittee Signature: y: � _►�= - Call (403) 639-4175 by 7:00 P.M.for an Inspection needed the next business,day i .wilding Perin:tl: Application ` -- Date received: '/ ?�a 1. Pernut ar "��.• City of Tigard 1'rojecUappl.no.: � f:xpire date: o Tigard Address: 13125 SW Hall Blvd,Tigard.OR 9 2 3 Cir v .! R Phone: (503) 639-4171 h , I)ateissued: By: Receipt no.: Fax: (503) 598-1960 `I O Case file nn.: Payment type: Land use approval' __� __ � 1&2 family:Simple Complex: U i &2 fancily dwelling or accessory U Commercial/industrial J Multi family U New construction U Demolition U Addition/alteration/replacement LI Tenant improvcntrnt U rine sprinkler/alarm U Other: J'gB SM,INFORMATION Jab address: a S LL), Loc BhKk; Subdivision: ,� 1 ax ma c/tax IoUaccount no.: l�r-�c t�Kt c���c�,ra — Projeat name: 1'' � -- ' Description and location of work on premiscs/special conditions:,----- 0%% onditions: _ — --- — -- J Name: lEf f Jct. plai n,tic pt ic en pacify, t { MaI & 2 familt d»clling: n/ k/ StateFt .-_7.IP•u a c Valuation ofwork $ Ucity: � �� •� � ,�`�. ........................................Phonc: -Z rax: Z S No.of bedr(wmis/baths................................. Owner's representative: c�� _ 'Total number of floors................................. Photic: jrax: Z,. -. 7 yc L mail New dwelling arca(sq. ft.) .......................... Garage/carport area(sq.ft.) ` --- Covered porch arca(sq. ft.) ......................... Name: Mailing address: w 3. 1 � --- Deck arca(sq, ft.) ........................................ 3 5 City: t _ Stale 7IRet�Z$j, Other structure area(sq. ft.).......................-— -- Phone: 4Z t I'stx:2 Zg3 [:mail CommerciaUindu.4triaUmulli-family: Valuation of work.............. ............. .. ..;�4 l?xistoig hidg.arca(sq. ft.) ....... ............. ... ---- Business name J(f Ag, ( la:t--x�_. L l%� New bldg.area(sq. ft.) .............. . Address: ' I�=�'�(o . Number of stories....................... ...�....... _— City: yyti�-�, Stole ZI �zit Type of construction.............. .. ................ — Phonc:Zc�:.Zl rax: Email: Occupancy group(s): I:xtstinF: __ -- CCB no.: 2C� ")• New: CitylnetFlie.no.: Notice:All contractors and subcontractors arc required to be IWIM licensed with the Oregon Cc Aruction Contractors Board under 7Nwne: v f'll�`�('d�-7 — provisions of OItS 7(11 and may he required to be licensed in clic s: I eL)w ��b� jurisdiction where.work is being performed. If the applicant is exempt from licensing,the following reason applies: nay ` Slate:CNL ZIP: — Contact person: N Plan no.: - Phone:ZZ - rax:LZ.S�i33 E-mail: — Name: t 2 t_ Contact person: ,� Pecs due upon application ........................... Date received: AddAddrcss: -- _— -- : itateOrL. 7,I P: Amount received ..... .................. . ..............CityS Phone: '2 `�Y Pax:Z �(, IF-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all Juridre0ons srcept credit cards,please cat Jurisdiction fix more Information attached checklist. All pro tons of laws and ordinances governing this U Vigo U INagter(and work will he complied w' ,heti t ifi herein or not. c fedi'c"`t"0tl1�' --- — ---- — Expires signature: Date: I ( O L— - None or c der as shown on c It card — S -}- Print name: /ec+'tk T -- cardholder�ijnoure Amount Notice:This perimit application expires if a permit is not obtained within IAO Jays after it has been accepted as complete. 440.4611(M ICOM) Plumbing Permit Application Date received: Permit no.:; City of Tigard Sewer permit no.: Building permit no.. Address: 13125 SW Hall Blvd,Tigard,OR 97223 City ofTigard Phone: (503) 639-4171 Projecl/appl.no.: Expire date: Fax: (503)598-1960 Date issued: By: Receipt no.: Land use approval; Case file no.: Payment type: ❑ I &2 family dwelling or accessory U Cnmmercial/industrial U Multi-family U Tenant improvement U New constnr:tion LI Ad,litiun/allerali�m/rchlacentrnt U Food service U Other: 1111#011111111101111111 illyt , 1 AE(for use cliculdist) Job addr ss: •-�.�' �, C-l.�[ .` L c 1)cscri�;±an Qt Y. Fee(ca.) Total Bldg.no.: Suite no.: New I-and 2damily dwellings only: Tax map/lax lot/account no.: (includes 100 ft.for each utility connection) SFR(1)bath Lot: Block: I Subdivision: SFR(2)bath ---�- — - -- Project name: SFR(3)bath City/county: ZIP: Each additional bath/kitchen Description and location of work on premises: _ siteutilitles: _ Catch basin/area drain Est.date of completion/inspvclion. - — — Drywells/leach line/Imnch drain Footing drain(no.lin.ft.) t Manufactured home utilities Business name: 7 �s _C� Manholes Address: Rain drain connector City: Ys,pt,, State, ZIP: SizAtary sewer(no.tin.ft.) Phone: Fax: - •(onb 1 E-mail: Storm sewer(no.tin.ft.) CCB no.: 10-44;- Plum bus,ceg.no: Water service(no.lin.ft. _-- City/metro lie.no.: Fixture or item: Contractor's representative signature: Abso tion valve --- Bac flow preventer Print name: Ss Dale: Backwater valve Basins lavatory Name: C othes washer Address: -- - - ishwas er ZIP ` City: State: . - _ Drinkingfounlain(s) 1 __ E ectors/sum Phone: Fax: I �na�I. .xpansion tank Fixture/sewer ca Name(print): oor drains/Aoor sinks/hub _ Garb a isposal Mailing address: arbbi b City: State: ZIP: ice Hosa Phone: Fax: E-mail: ce mier for/grease trap O-vner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular oof drain(commercial) employee on the property I own as per ORS Chapter 447. Sin (s),basin(s), ays(s) Owner's si nature: Date: Sum Tu s/s ower/shower pan Urinal Name: - - Water closet Address: Water fieatet City: State: ZIP: Other: -61 Phone: Fax: E-mail: o Not VI puisaicdam wcW credit cant,please call Wadlction for more inromution. Notice:This permit application Minimum fee................$ ❑Visa U MasterCard expires if a permit is not obtained Platt review(at _ %) $ Credlr card comber: -- — wi�hin 180 days after it has been State surcharge(896)....S _ aplrca —'-Aam�or i:rmwte�r u aiowo as s CAW a mepted as complete. TOTAL ................I......$ f ----Cm0older dpem Amami 4104616(60(1 C'OM) Electrical Permit Application, 1 t,o received. 1/174 I I'cnnn City o1 l Bard I'll wlect/appl.no,: Expire date: 011.ofDg(ird Akin:.~: 1312S 5W Ilall Blvd,Tigard,OR 97221 Uatr issuedHY _ krcci 1l no.: Thune: (503) 639.4171 — - -. I --- Pax: (503) 598-1960 c '1W f 11 fill Payment type Land use approval: 1 ' 7U I & 2 family dwelling or accessory U Commercial/indu itrial U Mulil I 111111y J T'e sant improvement U Ncw construction U Addition/allCl_Mil tt/t'Cplaccnit i J r Illi, i J I'al�ull II t ' 1 Joh address: 1, �� . 9 rte, t Com— Bldg. n, .. tit a f;1x n)ap/lax lot/accourll no.: Lul: 131uc4 I Subdivision: --__-.-1._ ------ Project name: Ili^,rllpllnn alit)1r)!•allull oil work on ply inr.rs Estimated date of collipl l n nru •,pcGion: - CONTRACII`Of� APPLICATION FEE r 1 Job no: fee Max Business mune: : l.%t,)L 0.;,, - - Description t1ty. (ea.) Molal Ito.111%11 New residential-single or mulls-family leer Address: dwelNugunh.Includes anorbedgar-age. City:TkAd_,,wtf. ' Sltuc�^K., '7.IP: tiervticinchnled: Rhone: _ .__—__ I-.:olio,I+InnniAl511(1stLnurpuilnnilhcrrnl x�CB nil.: o. Ille .hus. tic.no: %•k- "c. I.ttnilcdelitIgy.Iesidelui;d 2 City/n)cu•o lir. nno.: �-- _ I.unurdcfielgy,non-residentnd -- 2 1.arh numuluctured home fir m0dulia dwelling signature of supervising electrician(required) Sul%Ice and/or feeder Sup,elect.name(prim), 7 -,� ,,,,,,,,,,,,,, 1(,,�., Services or feeders-Installallon, -- alleralion or relocation: PROPERTY OWNER 2(x1 amps of less 2 Name(ptinl): 201 amps to 4(N)amps - 2- Mailing address; -_ — —---- -- 401 amps fit(00 amps 2 _. 601 amps u)1000 amps 2 City: — V Stale: 7.l I': Over I(M amps or volls 2 I'lione: i'ax: E-mail: pc:otutecl(1111' — -_. 1 ()caner installation:The installation is he ing made on property I own I+•mllorary services or feeders- which is not intended for sale,lease,rent,or exchange according to Installalion,alteration,orrelocation: ORS 447,455,479,670,70 L tun amps fir less 2 NII amps l0 4un amps 2 Owner's si nonan:: f r ( 4u l 6t bill)amps s —__----- 2 — I Branch circults_new,alteration, or extension per panel: Name: or fes for branch circuits with purchase of Address service or feeder fee,each branch circuit 2 City: Stair: ZIP: H fes for branch circuits without purchase — -- —'— of service or feeder fee,first branch circuit: 2 Floats: I ax: Li-ttttlll: Loch additional branch cmuit Misc.(Service or feeder not Inclur d): UServiceover 225amps-commercial UHenllhonreplcllils Enchpurnportmgationcircle _ 2 UService ovcr12nnntps-rathipoI,5;2 Ullnzardouslovaii,,,, L•achsignoroutlinelighting — — ---- rnmilydwellillp UHufidingoverHOW m1umefeelhgrtof Signal coutut )or almiocileneigypnnrl. -- — - U System over 61x)volts nominal more residential units fn one stricture Alteration•or extensions U lluflding over three stores U feeders,4f11'amps or more U t h rap;urn lone nvrl v+l lx icon. J Manufactur.•structures of Rv park Each additional Inspection over the allowable In any of the drove: J I pn s/bl hungplmt J Other -_--- Per inspection -- Submit_ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other --- --- Non all(miatictiona accept credit earth,please call jurisdiction fox mine in6nmatirxt Notice:'chis permit applicatiltn peninll 1rc_.... ......... U Visa U MasterCard expires ifa permit is not obtained Plan review(at ____ %) ('redo card number_ _ �—f sl ithin 190 days eller it has been State surcharge(8%,) ....$ lixpires accepted as complete TOTAL $ Name of c o nus can on c it c _ S _ (-adhnl3erifanature- --- Amount 4404615(hAM'0MI Mechanical Permit Application "ed:/ Permit'021H T oo pip City of 7 igard ProjecUappl.no.: Expire date: Cirvgffigard Address: 13125 SW Hall Blvd,Tigurd,OR 97223 Bate issued: By: Itecciptno.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Paymcnttypc: Land use approval: Building permit no,: ;IJNcw 2 f anily dwelling or accessory U G"nrmercial/industrial U Multi-family U Tenant improvement .n" 'rurtintr U A I liiitm/alteration/rcplaccment ❑Olhcr: frcss: 1= *, 4,4 ' L�ZpaJ UL Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.c value of all mechanical materials,equipment,labor.overhead, profit.Value$ Tax map/tax IoUaccount no.: _ I.aC Block: Subdivision: *See checklist for important application information and isdiction's fee schedule for residential permit i r Proj-,ct name: jur 271 C:. !,!ounty: ZIP: olts I L' option and location of wort:on picmises: I t oilloill tee(ea.) IWal Do.date of completion/inspection: lk,ct; irrn Qt . Res.onl Res.onl At . Tenant improvement or change of use: Air handling unit --CFM-- 's CFM_— 's existing space heated or conditioned?U Yes U No r conditioning(site plan required) L existing space insulated?U Yes IJ N teras on 70 -e xistin s y stem o er compressors State bolter permit no.: Business name: tut- - HP _ Tons BTIJ/H Add resR: 0 z> Lq I Fite/smokc dampers/duct smoke detectors City: Q,rt%sZa7�� Stat Z1 P: _-1 ZC10 cat um (site plan required) nsta rep ace urnac u eer__ Phone: �- Fax: -1 S-ll4E-mail: Including ductworks vent liner U Yes U No CCB no.: Insoal rep ac rc ocate eaters-suspended, City/metro tic.no.: wall,or floor mounted Name(please print): 01 ens fora ranee other t an urnace e ens on: Absorption units BTU/H Chillers__.. HP -7 Name: -_._— _-_-_-- Com ressors HP Address: n ronmenta exhoan rent ton: City: -- Stetc: ZIP: A) Hance vent Phone: I:rx: E-mail; ryerex haust oods,Type res.kitcherdliazmat hood fire suppression system Name: Exhaust fan with single a duct(bath fans) Mailing address: x aust system art rom heating or AC el piping an sl on tup to 4 outlets) City: Slate: ZIP: Type: _LPO NO Oil Phone: Fax E-mail: Fuel pipingeRF-adat ons over4 outlets Proem piping(sc ematicrequire(]) Number of outlets Name: Other fided app anc-or�Tequ pmint: Address: DrA-orativefireplace _ City: ------ --- Slate: ZIP: nsert-t .-Phone: Fax: E-mail: cx stov pc etch rvt _=17: Applicant's signature: Date: er: - Name(print): 777M -_ - Permit fee.....................$ Not all)uds(licliom @ccep Milt ands,ploaae ca]I furi;Wd_n tar title le/artruuon. Notice:Thinrmit application Pe PP Minimum fee................5 U visa U MasterCard expires if a permit is not obtained Credit can]number — _L Plan review(at _ 96) $ a 1e, within 180 days atter it has been State sun:hatge(896)....S _ Name al cardboldern �n onchi cad— $ accepted as complete. TOTAL .......................$ cardholder At (we Amount 11(1`4617(6011COM) UJ/22/2002 11:31 11AA bU3ZZouN33 ALAIN NAbUUKU ObJIbIN 4wuuc 'Jtn 22 10:31:06 AlLT1LT14HW.dwp MRA DECEIVED iN 89'57'46" f � 5126' Qi it Ok I l(TAIUJ IMMINO DMSIOh 1 , a7 I I iV t I 1 I I t X-X-F-X.X-X-X-X-X-X-X-X•X-*X-X X,;(-A-X-X-X-X-X-X r I ( F- ---._�_.._... 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