12120 SW KING RICHARD DRIVE 0 millmolsol NO!"glopob a d
ADDRESS:
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CITY OF TIGAXRD
{ COMMUNITY DEVELOPMENT DEPA9TMENT
i 13125 SW Hall Blvd.Tigard,Oregon 97223.6199 (503;R39-4171 GLUMB I NG PERMIT
F'CRM1'1' i+. . . . . . .
-,39-4171 DATE ISSUED: 08/02/95
PARCEL: =:S r. 15BC--1 250"1
j. 1'E ODDRE3G. . . : 12100 SW I;IPJG RICHA DR
SUBDIVISION. . . . : ZONING:
BLOCK. . . . . . . . . . . LOT— . . . . . . . . . . .
' LASC� OF WORK. . :1NIE.W GA
R
BAGEDISPOSALS. . MOBILE '10MC G -'ACE :
' VPE:. OF USE. . . , ;SF WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . :
OCCUPANCY GRP. . :R3 r LOOK DRAING. . . . . . . . TRAPS. . . . . . . . .. . . . . . .
STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . I CATCH BASINS. . . . . . . I
rIX-URES-,_..__._____ ..,_._.......___.... &-OWN5r<Y TRAY'.-. . . . . „ s Sf" RAIN Di% )T►'!3. . . . . :
13ih,i;S. . . . . . . . . . .. URINALS. . . . . . . . . . . . . CREASE TRAP . . . . . . . .
LAVATORIES. . . . . . OTHER IXTURE3. . . . . :
TUB/SHOWERS. . . . : SEWER LING (ft ) . . . . :
IaAIER CL-7,5ETS. . : WATER LINE t'Pt ) . . . .. : l
DISHWASHERS.....— RAIN DRAIN (ft ) . . . .
Remai1is : Addition of 1.00' Water- Service
L,wncr,: ___.___ __._.__-- FOES
FULLMAN C011PANY tyf3e alnor_tTt by date r•ecpt
J3%15 SW HOOD PF'M'T' +t 30. 00 JDA 08/02x'95 KING CITY
'1PCT $ 1. r0 _JDA 08/02/95 KIINIC CT T'Y
M, 11'ORTLAND OR 97101
Phurie #:
rULLMAN COMPANY
5805 SW HOOD f
i OR'rLAND OR 97201 I
Pl-i o n e yl: 214 52111 +l 31. 50 'TOTAL i
."eq 1w. . 900445
RE CSU I RFD INSPECTIONS
-+tis permit is issued subject tc the regulations cortaYned in the Wat ,�r- Ser-vic:e In
Tigard hunicipal Code, 'Rate of Care. Specialty Codes and all other Fir ;l Ir+speca- .ion
applicable laws, All work will be done it accordance with
approved plans. This permit will expire if work is not started
"ithin 160 days of issuance, or if work is suspend--d far. more'li
ar,
18it days.
Permittee 30irr�,+ +sr
- Gc.11 for inspec:t ion 639-4175
,
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JLL-26-195 WED ?0:56 ID: FAX Nd". }i329 d1
Post-Itm brand fax transmittal memo 7671 001P"
►` C, (('�� -{ �� �',
1d ST — Plaanck/Rec. #
C*pof Tigar f Permit# ? 'K
1 ,025 SW Hall, Sind. Apr. .tens
Tigard, OR 97223 � -
(503) 539-4171 MINIMUM$25.00 PERMIT FEE+ST.SURCHARGE
so.•+�r.. l�iwRNI�o� Or1N
❑ 1 M'H HOU311!$140.00 d 2 BATH HODS@ 5103.00
Job S_ .�. 0 3 BKTH HOU39 1225.00
Addles. nrar. - . Vw Inca Jes an pltxrtbkfg fodum In do dwo*v arx'"1111m, 100 ted
of '4ahx asrvYa, sanitary se—and alomt Seveso. See fens below.
tap;., ..... FiXTURES (]TY RRICB A
MY
"dnk _ 9.00 ■
r.a.Aw,.: - -- Lavatory 9.0r
Owner rub or Tub/Shower Comb. 400
a Showar Only 9.00
Watar kmat _ 9•
01
lsflwasher� 9.00
Garbe" Dlaposal 9,00
Occupant „s,.., n.. Wnshing Machine 9.00 _
Moor Drain 9.00
A Wager Rea* '_ R
Laundry Room Tray ►xi 1
_ 1
_ ... - Urinal �2 f
Other Fixtures (3pedy) r2soo
�.1
�.
Contractor w
a WON”
00'nr T.ri. Sewer-ea.AddR, 100
-�. Water"ryfee lat 101Y _ 30,00
I Iwreby .-I--Aed9e un d he,,*read this this sp�lon, that the Water service aa.AddN. 200' 25.00 d
Infnrrrurtion glean Is cormdt, 81st I am the owner or.:0ortxed agent of Storm a Rain Main 1st 100' 30.00
the owner, that plana submilif (I era in ocavillance rrdh State leers,that
I em regkrbrad with ins Corndruction Contactors Bmud, that the Star111 b Rain Drain Addit 100' 25.00
number given is correct. (H arenpt ftm State registration, please Mobile Home space 23.00
pi eeefon bol le►�1 -- Back Flow Pravmftn -
IF= Duke of Anti-PaYurlon Device A,90
-- — o+ Any Trap or Waste Not
Cnnnedad to!f lxtu�e 9.00
Deteribe wnrl n+w addltton () 411e761repair at Basin 9.00
b be drat* residential tJ non•resk*021 C) Insp. of Exist. plumbhg 40.QOThr
Specially Requ-09d Inspeeftnu 40.00lhr
Exleting use of �_ r Rain Drnin, S-gk hinny AweMing 30.OU
building or property --- - -
(3eabennol backfkr�r p.weMion
devices 15.00 +
Proposed U*n of
building er brtrple ly •(steep(r.Udantle/hackfloN
prrevenrron o!•r(es)
NOTICE 'MlNmum Rea$25.00 SUBTOTAL
PFRMITS BECOME VOID IF WORK OR Cu.*!STRUCYION IV%SURCHAROE
AUTTIORIUD IS NOT COMMENCED WITHIN 180 DAYS,OR IF
CONSTRUCTION OR WORK IS 81-18PENDED OR ABANDONFD ----
FON A PERIOD OF 180 DAYS AT ANY T1MC "r ER WORK IS PLAN R"EW 26%OP SUBTOTAL
COMMENCED.
TOTAL
Special Conditions _---- - -— —
Date IRsued _._by
I
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CITY OF TIGARD BUILDING INSPECTION NOTICE
K
Inspection Line ;r3ec-C-Phone): 639-4175 Business, Phone: 639-4171
Inspection: —
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace ,
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL.
Post/Bearn Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
—r
Alarm ater Lir
Insulation -Mech.
Undedir. Insul. hear Wall Gyp. Bo. -Elect.
/ PM
Date Requested: ':�5 ! Time: I
Address:�L� �ir
�-c+l Jrit #:
B dert
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Ins ector: �� _ Date:
PPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
/—\ Call For Reinsp.
h4 apt.,A�1f1�,
4y n w;l
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+ s CITY OF TIGA14D BUILDING INSPECTION NOTICE
' 1 Inspection Line (Re O :'hone): 639-4175 Business Phone: 639 41 1
�Y t Inspection:
ytr Footing �) Susp. Ceiling Sprink. Rough-in ApHriSdwlk
Foundati Plbg Underslab Mach. Rough in Fireplaca
Post/Beam Struct. Plhy. Top Out Elec. Rough-in FINA n�,f
-Bld
Post/Beam Mach. San. Sewer Gas Line
M r ,
Plumb. W
P Underfloor Rain Drain
Framing t�t �a �w�9
Jsr
Alarm Water Line
Insuiat�on Meeh. 611 "t Underflr. Insul. Shear Wall Gyp. Bd. Elect. t t
PM
Time: AM l`"�,
Date Requested:
'4
LJ No",
}Address:
C'J �� Permit#:
Builder. l� Z �Z — —
E FOLLOWING CORRECTIONS ARE REQUIRED:
1,� �, >1,Eev 3•,r
j�ij. ,
1 rah) {F ,�l�ff�slt
i
ly4 .ry�n..jfA
s � +
d4Y`A ,
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Inspector: % ----�- Date:
ti n. s�+`
+DROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
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CITY OF T I GARD MASTED F"'E.RMiT
COMMUNITY DEVELOPMENT DEPARTMENT r'EF2tdl'i #. . . . . , . : trial'ti: -v�1iL�4
13126 RW Hall Blvd.Tlgard,Oregon 97223.8190 (603)839.4171 DATE' 1 S SUE.0: iZ 3/eO/95
�. E'ARCI':_.;, L511�1.�(1.,1.'��IZI
TTI f•�1:>I REM3. . . : 1 -120SWKING RICHARD 1;�R �
UPDIVI)ION. . . . : ZONING:
i_-L_OCK. . . . . . . . . . . LO'l . . . . . . . . . . . . . .
BUILDINC7
FZ`E,I fa SIJE: DWEf_L I NF.) UN i r5:V! DOGEME:"NT. . . . . . . . :0 s 1=
_k'3S OF WURK. :NE.W BE.DRMS:0 HA7•H5.0 GARAGE.. . . . . . . . . . a L71s f
i'PIC' OfU�E. .. . :'SF F=LC?CIR ARC.(Ar.,.. . .___... REQUIRED aETEAACKS-
1 /PE OF CONST. :5N FI RSI'. . . . : 126 f LEFT. 5 ft RIGHT. .,E. ft �
OCCUPANCY GRF='. tR3 SECOND. . . :0 sf FRONT. :0 fit- RE:AR. . ; 15 -Ft
I URIE'S. . . . . . . . 1 F INNSME N1 •0 s F REOUI REI)-•-
'�.I GHT. . . . . . . . .. 9 f-1, 'TOTAL _•. •- - :0 s f 311OKE DC'.TL'::CT'JRS.
-OOR LOAD. . . . :0 psf VALUE.. . . . . t; : LA PARKING SPAC:E.S. . :0 r
12em r I•<5 : bl.tildiny s+.In sct,een 1 . x t�
_....... F,L_UMBINU •_.._.__. ___._____�._.__.__._.._,_ ___..»_ _.__ ___.
INI'�5. . . . . . . . . .• :ii ►-L.00)R DRFiIIVTi . . . :I1 VA(_'KF=1_OW 1''REVNTRS. . :IZI
OVFITOFRIES. . . . . .0 WATER HEATERS. . . :0 TRAP S. . . . . . . . . . . . . . :0
_JP/SHOWE.RS. . . . :0 LAUNDRY TRAYS. . . :0 GAT(Ji B A:SINS. . . . . . . ..0
,:4I ER CLOSE I i. . :0 �C:WER LINE (ft) . :0 GREASE TRAPS. . . . . . . :0
i�SHtwRa. . . . xv) W411`f F�' I—' :tt ) . WIC OTHER F•IXTURE�3. . . . . .0
1izE DI SP. . . ;0 RAIN DR14IN (ft) . 10
FiING MACH. . . «0 St RAIN DRHINty. . :+LI
MECHANICAL -- --- ._......._..._.___,.....__...__......._.._..__._- _-___ -._ F=EES -•--____ _._.._._.... .
IJEL I Yp'E S- -__ ...__ _......._._ UNIT HTRS. . :I type tamo+ant by (dat? r,er_pt
VENT'S . . . . . .III BP,R•r s 25. 00 J 03/20/95
MOX INF Ur:0 BTU VLN'r FANS. CA 05PC 't 1. wb JF' 0,3/20/95
i'URN { 10IIIK . . :N H,UDEi. , . . . :12 IrPLC $ 1C:,. 5 JF 03/2'0/95
f..0.IN )==1110K . . :u:! WO!_JDS i UVE.S. :0
F LLJUFi F=URN. . . . :0 LLO URYLRS. : 0
l�C)Ii_./C;i'rIF=' ( ;;;1-!F�':k� C:11•NI:_Fi UI�III'.r"i:rh
BA,3 OU'TL..E_IS:0
laWnf3r�:
j .JUANITA SOLUM
j 1212121 W KING RTCHARD DR
l r:ItVG CITY OR 97224
i
Phone
' antr�ctor^:,
UN CAN DO IT
�a3bl SW SCOTTS NRIDE'l : Dk.
I T G A f i D C)R 9 7+ 24
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i `lis pvmit ie issued subject to the regulations contained in the - ----- - REQUIRED TNSF,EcCr1ONS - -
!igart 01uricipal Code, State of Ore. Specialty Codes and all other Footing Insp F'llifob Top PLIt
applicab'p laws. All work will be done in accordance with approved F•o i_indat i ort Insp F•r,am i.n g Ins o
plan,. This permit will expire if wo-k i*119t stared within 160 Post/Be-.,m Strl_Ict Fi1^eplar_e insp
days of issuance, or if work is suspendmore than let days. post:/Renm Mechatr1 Ga!: Line Insp.
c�'" C�••avl). Dvaain Insbtlat: ion I11sp
r,r m i'e t:e e !73)i gnat .I r e: _ ^�?�� '�-, !: 1 In• .i n c1';;4ti li I r p ( y p m o ai rw eJ Insp
E'L.ht/l+ncter,f1vor, Putin cWain Insp
ded Lsy : Me .
.., ;r:�4R{. 111 i.a Water, L.i 1.1 k> 1 n,=p
Call for i.n,5 pec:t +. rn Cy�C�...�►1 rti
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fgL?k91RtW'"11^'..�Q.*R�'F� P•._ ._._ .._..,... _-...__ _..-rvaeRtMK;7M.YKt1'1�'�'ir.b87W94NhYNihXMwM44pwMIMB;aw=r,P11M1... .sur a
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Residential Building Permit Application
Ch
y of Tigard
13125 SW Hall Blvd. ��oj
Tigard, OR 97223
(543) 639'4171
Jobsite Address:
Subdtvisien- l Lot# Office Use Ong
(()
PlancklRec #
Valuation:
Corner Lot? Y
N� Permit
C�
Reissue of
Fla; Lit? Y � CM
Map & TL# Z`A I rx- - 12 OCA
Owner: ��,,)t' L.�. '( _ Approvals Required_
Address. 2.1 7._ Planning _
� -ZX 1 C?Z 1 71 Z_. z — Engineering
Phone: — Zp 7 O .S C L;Pr
Contractor: 10 C�1.0 elkj 2-
.— Items Required
Address: ,l 36 �GC) SCUT� 17k Subcontractors
�Z;L ✓ k"L e)k � �Z�'� — Truss Details
Phone: .7 y L Other
Contractor's License t'. _ 4; Y>
(attach copy of current Oregon license)
Contact Name R Phone: .
f-5 y c.' 9 J Z
Suhcontractors: Architect/Engineer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
l JOB DESCRIPTION
i, C,
�Lo - </ 9
Applicant Signature & R gone number
� I
Received by: . �.( _ ____ Date Received: (f
t
Permit# Account Descr.ption Amount Amt. Pd. Bal. Dine
Bldg. Permit (BUILD) •� S '�1"'' ';
•
Plumb. Permit (PLUMB)
Mech. Permit (MECH) s
State Tax (TAX) ' 2 _
Bldg:
2 >
Plumb:
Mech:
Plan Check (PLANCK)
•
Bldg: 71 �y
Plumb:
Mech:
Sewer Connection (SVVUSA)
Sewer Inspection (SWINSP) _
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT) _
r Commercial TIF (Till-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
"ffice TIF (TIF-0) _
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (F_ROSN)
TOTALS: C�„1 Z �L •Z 7
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FED-29-'00 WED OJ;54 ID: FAX NO: #08080 P01
w
KING CITE'
t
1FAM S.W.116th Avenue,King City,Omgni 81224 Phot.,: 9-40,'!
BLTILFDING PERI.-iZ 'r APEa' LICA.`Z' 1UN
i
DATE._ 7KING CITY BUSINESS LICENSE NO. _
NAME OF A PL I CANT_T_10 PHONE NO.
ADDRESS.��1Z ,�� 2?tIL J Ao2U `�----- ■
NAME AND ADDRESS OF PROPOSED IMPROVEMENT_
_. PHONE NO.
NAME OF CONTRACTOR— 0 AJ OK'/) - 0-0 .- -K %PHONE NO.S QQ - q
t� i'f�Zt, �
ADDRESS_^�•,��� :; z 2 CCR Ll('EASE NO.�S�, �o
TYPE OF CHANGE OR IMPROVEMENT FOR WHICH PERMIT IS- REQUEST".
DESCRIbF BRIEFLY - ATTACH A COPY OF THE
�PLAN OR DRAWING OF PROPObED
PROJECT_ - '� 7
SIGNATURE OF APPLICANT--j _-
*APPROVED APPLICATIONS ARE VALID FOR SIX MONTHS ONLY*
NOTE: Oregon Itnmebttilders Law requires that all persons who contract for work cn
a residence ,be registered with the Builders Hoard which means rhe
contractor is bonded and insured on the job site. For your protection, by
certain your contractor is registered by calling the Construction
Contractorg Board at .t-503-379-4621 Extension 5000.
F/OR._OFFICE USE ONLY
APPLICATION RECEIVED BY 4�L I)ATE_�71AS__�_
_ APPLICABLE: FEE RECEIVED � _�,� CONDITIONS/COMMENTS_
SYRen
-
► APPROVED BY ,� -� _ DATE__
`+ --a Note: A permit m,iq so a obtained from the City of Tigard Department of
pL �q Community Development Yes No�«
H 4
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CITY OF TIGA _ INSPECTION REPQ�T_ _
! This project has been inspected and: Approvers Denied
h Comments '� -` a
Signature
_mate_
�^ (Building inspector please return one copy to King City)
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590-4952
";arch 7, 1995
CITY OF TIGARD
BUILDING DEPARTMENT
13125 SW Hall Blvd.
Tigard, OR 97223
RE: BUILDING PERMIT
Please reviei, the attached Plans for a sun screen at 12120 SW King
Richard Dr. , King City, OR 97224 and issue necessary building
permit. if you have any questions, please feel free to give me a
call at 590-4952.
Thank you for your consideration.
Sincerely,
RON,.CCAN DO IT
Ron Richardson
Omer
OCCB #75630
i'igard Bus. Tax Receipt #95--3397
Enclosure
Licensed Insured Bonded
1 .3367 S . W. Scotts Bridge Drive Tigard , Oregorl 97223
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4mmm,cys which may appt"ar hereon.
APPROVL- ) rloN
PERMIT NO �Sf�IS�/G`�
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CITY OF "r I CARD RECEIPT OF PAYMENT REC:E I F'T NO. -95••-,?6 3QAl39
CHECK AMOUNT a 26. 5
NAME" : ROh' CAN DQ IT CASH AMOUNT s 0. 00 �
ilk ADDRESS a PAYMENT DATE 03/20/x..45 u'
SUBDIVISION
x
PURPOSE OF4'AYMEN T AMOUNT RAID F'URF'O£3C OF PAYMENT AMOUNT PAID
VUI1_.I)ING PERM :`x. 00 ST. BUILD PER 1. 23
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MST95-0104
C? i fil_ o01OUNT PAID - - -- _ > 26. L'S
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CHECK t)MOUNT s 1F;. �'b
PIPME RON CAN DO IT CASH AMOUNT a 0. 00
01)RES6 1 PAYMENT DATF a 03/0 /r)`;
t SsUBD 11)1 ST(IN
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i INSPECTION NOTICE
City of Tigard Building Departsmant C
13125 SW Ball Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection:
Footing Plug. Underalab ech. Rough-i Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
'r'�'•'' Post/Bream Struct. San. Sewer Framing -Bldg.
Post/3eam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. ad. -Nech.
,
Date Requested:_ Time: AM PH
Addreas:
Builder: ( ,["s-L,�l 7 L_l
41
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Dater
_APPROVED DISAPPROVED -__ APPROVED SUBJECT TO ABOVE
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Call For Reinap.
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C17YOF71FARD
CM MECHANICAL
COMMUNITY DEVELOPMENT DEPARTMENT immoo" I-,ER11I T
13126 SW Hell Blvd. P.O.Sm23397,Tipmid,Oregon 977223(SM)63o-4176 PERMIT #. . . . . . . : MEC92-0220
6:.39-•4171 DATE ISSUED: 09/01/9'
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SITE ADDRESS. . . : 12120 SW KING RICHARD DR PARCEL: 2S115BC--12500
SUBDIVISION. . . . : ZONING: i
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
___--_._---- __-
CL.ASS OF WORK. . :ADD FLOOR FURN. . . . : EVAF, COOLERS:
TYPE OF' USE, . . . :SF UNIT HEATERS. . .- VENT FANS. . . : �
OCCUPANCY GRP. . :RS VENTS W/O APDL: VENT SYSTEMS: �
1 STORIES. . . . . . . . : BOILERS/COMPRESSORS HOODS. . . . . . . :
FUEL 0-3 Hp. . . . = DOMES. I NC1•N: I
HP. . . . : COhIIVIL. INCIN:
MAX I NF,U T: BTU 15-30 HP. . . . . REPAIR UNITS:
111+ FIRE DAMPERS?. . : 30-50 HP. . „ . : WOODSTOVES. . :
GAS PRESSURE. . . : 50+ HF'. , . . : CLO DRYERS. . :
NO. OF UNITS---------------- AIR HANDLING UN 11'i3 OTHER UNI I TS. : 1
FURN ( LOOK BTU: 1 (- 10000 cfm : GAS OUTLETS. .2
FURN ) -LOON, BTU: > 10000 cfm:
Remail<s: GAS FURNACE & WATER HEATER
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Owner,: _.____________.__.____._________.______._-- __._.____________.__ FEES --_--__--._-----
JUANIT'A SOLUM type amount by date recpt
12120 SW KING RICHARD DR PRIrIT 25- 00 JH 09/01/92 - r
5PC:T• $ 1. 25 JH 09/01/92 -. E
KING CITY OR 972;::4
Phone #:
Contractor: --------_._._______________-____________
COLUMBIA HEATING
8900 SW BURNHAM
SPACE F:-110
TIGARD OR 972213 ------------------------------------
Phone #: 634-27O4 '6. 25 TOTAL_ P
Reg #. . : 76359
---_ - REOU I RED I NSf SECT I ONS
This permit is issddd subject to the regulations conta0ed in the Final Inspection
Tigard hunicipal Code, State of Ore. Specialty Codes and all other
applicab:e laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started -
within 188 days of issuance, or if work is suspended for more -
then 188 days.
Permittee Signature :
Issi_ied By .
Call fur inspection - 639-417c;
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SEP-01-'92 TUE. 09:05 ID:CI'"Y OF KING CITY FAX NO:503 539-3771 X267 P03
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SEP-01-'92 TUE 09:04 ID:C?TY OF i<ING CITY FAX NO:503 639-3771 #267 P02 t
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KING CITY
�s 15M SW,116th Avenue,King Citi',Oregon 97224 Phone:639.4082 ry
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COMMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instructions on reverse)
DA a -
1. NAME O APPLICANT: Phone No. C — `7 b 5 --
ADDRESS OF PROPOSED l.s i a c� S c iC r..�,+ t,c�-�c.c t.C_ K
s k -
{ 2. TYPE OF CHANGE, IMPROV3.4MT OR CONSTRUCTION FOR WHICH PERMIT IS ROWESTED.
DESCRIBE BRIEFLY — ATTACHTWO PIES OF PLANS ORDRAWI,NGS OF
PROPOSED PROJECT: o` - •, ,L ri s.F—w ctr�7ttZrr
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3. NAME AND
ADDRESS. Of OON'1'RAC'POR . `"'` < A� e o t
7 LU PHONE PIO. ( '2.)<+ICENSE NO. '*.�
4. NEIGHBORS WHO MAY BE AFFECTM BY THIS PROJECT WILL BE NOTIF^IED BY THE CITY.
5. APPLICANT OR HER/HIS REPRESENTATIVE MUST BE PRESENT AT THE PLANNING COMMISSION
MEETING NEXT HELD ON —
REPRESENTATIVES NAME: T_ ------PHONE NO._
(?he (ling City Planning Commission vill consider only those applications received at least five (Sl days
prior to a meet'
SIGNATUREc —.—
� wwwwwww***wwww****wwwww****www*www**www*****wwwwwwwwwwwww****wwwwwww*wwwwwwwwwwwww
APPLICATIOU RECEIVED BY TE, u— ri`y 2
k APPLICABLE FEE RECEIVED S � J TOTAT
PLANNING OOMIISSION DECISION: Approved _ Denied _ _
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CONDITIONS
Approved applications arc rslid for sil soothe only
Signature Date G 5
1OT9: Oregon BosebA lders Lar requires t — 1 persons rho contract for vork on their midence be
regiskered lith the Builders Board ich means the contractor is hooded end insured on the job site.
for your protection, be certain your contractor is register:d by calling City Hall Ph: 639-4082.
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NOTE: A permit must also be obtained frau the City of Tigard Department of
Ce rnxmi ty Development Yes_, No
CITY OF TJ 3Q INSPIAX.'TION REPORT
The above listed project has been inspected and Approved ^,penied
Date Canments
Signature
(9ud.Linq .ins P@ZtA& PIMAC mourn. en& (1) copy .tom King Cid)
Co 2-B7
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