10521 SW RIVER DRIVE 10521 SW RIVER DRIVE
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CITY OF TIGA RD
LP
MECHANICAL PERMIT
PERMIT NO. : 1'IE✓�92101
COMMUNITY DEVELOPMENT DEPARTMENT TE ISSUED: 10/10/89
131,5 S W Bell Blvd.,P.O.Box 23397 Tigard,Of%!gon 97223,15031639-4175 T� I M.PMT.N0. 89,-2101
JOB ADDRESS: 10521 SW RIVER DR
TAX MAP/LOT SUB: DOVER LANDING LT: BK:
LAND USE:
LOT SIZE:
ITEM: NO: NO:
WORK CLASS: ALTERATION FURNACE (100K AIR HANDLR (10
USE TYPE: SINGLE FAMILY FURNACE'. 10OKi AIR HANDLE' 10K
CONST.TYPE: FLOOR FURNACE EVAP.COOLER
OCCUP.GRP. : HEATER VENT FAN
VENT VENT.SYSTEM
PLR/COMP (3HP HOOD
NO.STORIES: BLR/COMP 3•-15HP 1.ICINERATOR(DOM
DWELL.ONITS: BLR/COMP 15-30HP INLINERATOR(GOM �
FUEL TYPE BLR/COMP 30.50HP REPAIR UNITS
MAX. INPUI BLR/COMP 50+HP OTHER 1
FIRE DMPRS' GAS PIPING OUTLETS
HIGH PRESS?
LOW PRESS?
REMARKS:
Install fireplace insert
FEES:
W BtttruiIIp John R Susan PERMIT $10.00
N 1.0521 sw River Dr PLAN REVIEW
Tigard OR 97224 FIXTURES $4.50
PHONE (503) 624-1325 STATE TAX $. 73
OTHER
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0
N ANDIRON FIREPLACE SHOP'
R 11955SW 11A,:IFIC HWY
A
c ti9 and or 97223
1 PHONE (503) 62.0--0262
F3 REGISTRATION NO. 43326 TOTPL: $15.23
RECEIPT NO.
This permit is issued subject to the regulations contained in title 1A ___-__._.----__________..__
of the TMC, State of Oregon Specialty Codes.zoning regulations REQUIRED INSPECTIONS
and all other applicable codes and ordinances, and it Is hereby FINAL
agreed that the work will be done in accordance with the plans and
specifications and In compliance with all applicable codes and
ordinances. The Issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits. This permit will exrire and become null and
void if work is not started within 180 days,or if work is suspended or
abandoned for a period of 180 days any time. after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved.
Pernuttee Signature /
Issued By I CALL FOR.-INSPUTION-finA-1-75-
SEPARATE PERMITS REQUIRED FOR WORK
OTHER THAN DESCRIBED ABOVE
City of Tigard ---
1312._5 S.W. Hall Blvd. 'MECHANICAL PERMIT
P.O. Box 23397
Tigard, OR 9722.3
Tab a]A Mecfian'ul Code QTY PRICE AW
639-4175 ---__ _ _-
1) Permit Fee -0 4 10.00
�A1°fL0. ,,a ; 2) Supplemental Permit 3.00
Job \
'�- a r �1- — 1 Furnace to 100,000 BTU --
Address - � t) J t b ) indd
.ducts&vents 6-()D
` , .,�c.r r
T&KLC( M+P No. 2) Furnace 100,000 BTU+
incl.duds&vents 1.50
Lot BkYA Srb*4bbn - ---- --
--- Floor Furnace
Nar"(a none of busrrgas) 3) 6.00
ind.vent
Suspended heater.wall heater
Oar �a"a h Addren 4) rx floor mpunted heater 6.00
" ,S' � --- Vent not ind.in
�) appliance permit 300
Repair of heating,refr ig.,
6) cooling,absorption unit 6.00
( 417ress� S Qt.�p"� �✓•�`�-).3.�"5 - -Eioiler or comp to 3 HP - _ `----
F'thune 7) absorp.unit to 100,000 BTU 6.00
Occupant City%Stare -- zip 0) Boiler o(c omp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
--— Ha11tee� Boiler or comp 15 15.00
30 HP __-
r` I! o �,, ' �)c� a 9) ab_;orp.unit lh-1 million --- --
W&V Addreft 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1.1.75 million - -^
CrxHrador to ZIP 11) Boiler or comp to 50 HP 31.50
-j absorp.unit 1,750,000 BTU _
ngrcl d
cute P4119151ralion No. city sus.rax No. 12) Air handling unit to 4.50
�3_�tA 6 10,000 CFM —
I hereby ada"wledge that I have read this app"ion that am information gam+IS 13) Air handling unit 750
Coned,tut 1 am the owner or ahRhorOed agent or the miner.that pans submired aro in ___ 10,000 CFM +
eomilianoa with State Laws.that 1 am registered with the state W kdes'Bond.that the Non portable
r—ber ON—is rvmset.(t emrnpt from State rwgistration please give reason bekrv) 14) evaporate cooler 4'�
--------- -- ----
Vent fan connected
-- ___------ - _-.. --------- - --- ------ 15 to a single dud 3.00
-._
_— --.- _ - - - Ventilation system not
16) included in appliance permit 4.50
17
-) Hood served by 4'4.50L h mechanical exhaust
lure(owner or&gem) ��T/Daub Domestic
type
Describo work p addition L l alteration [I repair L-118) incinerator 7'50
to be drxhe residential p non-residential p 19) Commercial or industrial
- type incinerator 31).00
Existing use of - ----
Imildi,ng or properly ! _�- Other i.e.,woodslove,water
20) heater,solar,clothes dryers,etc. 4'J0
Proposed use of
-
txdilding or properly -__ _ 21) Gas piping one to lour outlets 2.00
Typ i of fuel- oil p natural gas [] LPG O electric I - -
-` - 22) More than 4-per outlet
NOTICE SUB-TOTAL
THIS PERMI r BECOMES NULL AND VOID IF WORK OR CON --
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 51A SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL _ �
ABANDONED FOR A PERIOD OF 160 DAYS AT ANY TIME AFTER - --- -- ----
31
WORK IS COMMENCED. TOTAL
Special Conditions
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23
Tigard, Oregon 97221--.'--
Phone: 639-41
Type of Inspection
Date Requested Time A.M. P.M.
Address2
Moe/ Permit *46;6P—Q&�:
Owner sem, Lot #__Or
Builder 774-
The following Building Code deficiencies are required to be corrected:
..........
Presented to Approved
Inspector
Disapproved
Date
CALL FOR REINSPECTION
0 YES Cl NO
c TY-6F 6-ARD
IT�
BUIL-DING PFAM'I'.*t
CITY OF TIG,A RD I:*'EPMI*T* 140 . B(MP01583
cl Orn
COMMUNITY DEVELOPMENT DEPARTMENT 09100N
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223,(503)639AI75 DA11: ISSUED : 3/29irie
PAIM. PM*T*.NO. 880585
..106 ADDRESS : 10521 SW RIVED DA
TAX MAP/1-01' 251 15AD 5L)H: DOVER i AND'TN(.', L.A' : 159 BK :
I-AND USE: pej. 5p I:)
L..01' SIZE : VAI UnTION : S)E I'H A C,K S
FPONT : P.0 RI-i7AP:
WORK ('.11-ASS : NEW DWEL.I.—LIN I TS I-EFT : t5 R I GFI'T 20
USE.F. 'YYF*)F-':: SING L.E FAMII..Y NO . BEN)WOOMS : 3 EX'T' WAI L.
CONST' . 'TYPE' : VN NO . F,.%A'Y'HS : 15 N: W:
occur).(;,i:n)- : n3 P1401' . (:)PENI:N(.,S :
OCCUP . I-OAD N: E: W:
IE160
NO . STORTES : P I S'Y* 1.086 ROOF CONS'r : FIRE PE*r'?
HEA:It'..'H'T: PO PNE): 'T'le.1 AREA SEPAP7 PAI*F-11:
13ASEHEN'r7 3RD: (:)(:',CL)P. SE PAP7 PA*rEi,:, :
MF:ZZANINr.-:'? BASEM'*I*
FL-0011 I-OAD: (.,ARA(*,-'&*.: ::106 F'114-K SPnK1 147 Al.-ARIV?
FLOW(GPM)
i =1-10PE, 114A-4 ------
11-4-AN CHECK BY : r-It
REMARKS :
PEISSUE' OF NO .
0 I F F E,S
W $308 . 00
N MII-I.A."R dAY PERMIT
E I-) . m . BOX 23291 PI-AN REVIEW 11621,11P 20
R 'TIGAIPID C"R 97223 FIRE UEP'T
PHONE' (503) 68*1-75413 Fil'Alli. 'TAX 11119 .
0 DEVEL.OPMr-i'N'T ('.1HAr4GF:5 :
N $P50 . 00
T MILAXII .JAY Sll*0 R M)
R .JAY Mll...L,,r-.:R BUILDER SOC115,TPEE1,11 $600 . 00
A $250 . 00
C BOX 2,3P91.
T 13:G A P D up 972H3 P P I-'P A 10 < $1.00 . 00)
0
R 0�3► $1. 659 ' 60
No. 30109
!his permit IS issued subject to the regulations contained in Title 14 RECEIP-1- NO.
of the TMC, State of Oregon Specialty Codes.zoning regulation,,
and all other applicable codes and ordinances, and It is hereby
agreed that the work will be done in accordance With the plans and REA)*111F.A.) INSPEE-rIONS
specifications and in compliance with all applicable codes and F0011:NG S I.--.W E.F I
ordinances The issuance of this permit does not waive restrictive FOUNDAI'TON WAI.A., PATN DRAINS
covenants. Contractor and subcontractors shall have current city P(:)S*t & 6FAM WATER L.INE
business tax permits This permit will expire and become null and PLS.UNDEP"'iL.A1191 crry APPRCH/SW
void if work Is not started within 180 days,or It work is suspended or
abandoned for a period of 180 days any time after work has 51-A" FINAL.
commenced, It shall be the responsibility of the permittee to assure PL.9 .I'OPOUT
nil required Inspections are requested and approved PPAMIN(1
FIREPLAC'F
LiAS I.-INE
Pt! tee I' at-u*re'
I
`1/a U IGYP . BOARD
Issued By
CAI L. FOR ]'N!51.-,F-C'T'I()N 639-41175
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
PLUMBING F-ILPMIT
CITYOFT16ARD CITYOFTWAND PERMITNO. : PLIE180506
COMMUNITY DEVELOPMENT DEPARTMENT 0111100141
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard.Oregon 97223,(50Z,)639-4175 DATE ISSUED: 3/29/08
a 0,5 8�
F)PIM . PMT.NO.
-.10181 ADI)WESS : SW AIV11:34 D11.
TAX MAP/1-01' PS1. 1.50-1.) DOVEP 1...ANI.')]:N(., I-T : .5 a B:K
LAND USE :
I OT SIZE:
ITEM: NO: NO:
WORK C.LASS : Nl;:'.W WATER CLOSET 3 'T'RAP
LISE TYPE": SW31.-F. F-AM11 Y URINAL 1-*.31 K FA OW PPVNTP
CONST .TYPEK. : UN LAVORAToriy /I TUIAP PRIME44
'1111-). TUB 51-1010111-:1", "'y GREASE TRAPS
011'CL)P.G 14,3
DISHWASHEEP
('a'ARBAGIE DISI-*)OSAI_
NO. 1:01.111141E.S : 2 WASI-11W., MACHINE 1.
DWEI L.. UNJ:T'S : 1. LAUNDRY TRAY 1. HLOG. DRAIN (DJ.A
FLOOR DPAIN
SINK 3. SEWER (r.:**I,)
WATER HEATER 1. STORM/nAIN (FT
OTHER
PUMARKS :
F EH:ES)
W
N M.1,I L.k L,r I .;AY P E,R 10111,T $1.515 . 00
E 13 . 13 . SOX 23291
R OP 9*72P3 FIXTUPE-.:S
PHONE (503) 68,675AII STATE. 'VAX
C 01 H E*F 4
0
N
T WATTS KEN
R KEN WATTS PL,I)MBINIII.,
C
.A pa BOX 23C9215
T tiilk ir'd 1:)r
0
PHONE. (503) 6(34--66Pa
TOTAL.,: 111116e.75
This permit Is issued subl,ict to the regulal r,19 contained in Title 14 Pr-.(:,EIP-T- NO.
of the TMC. State of Cir,tgon Specialty Codes• zoning regulations
and all other applicable codes and ordinances, and it Is hereby
agreed that the work will be done in accordance with the plans and nF.:Qui Rem INSPECT IONS
specifications and in compliance with all applicable codes and PLS.LINDEPSL.A191
ordinances. The 99vince of this permit does not waive restrictive FIOST & OEM
cuvjnants. Contrac,jr and subcontractors shall have current city WATR'R LINE
business tax permits This permit will expire and become null and PL H . TOPOUT
q-)Id if work is not started within 180 days,or if work Is suspended or
abandoned for a period of 180 days any time after work has PAIN DRAINS
commenced. It shall be the responsibility of the permittee to assure F''INAL.
all required inspections are requested and ipproved.
Issukid By:
CALL FOR INSPECTION d)39--11,7.'5
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
Mk'::CHAN:r.(,AL. PERMIT
CITY OF T'GA RD MYOFTWARID PEP*MIT NO. : Mli-':800307
MOON
COMMUNITY DEVELOPMENT DEPARTMENT
13125 S W Hall Hlvd..P.O.Box 23397,Tigard.Oregon 97223,(503)6394175 DATE I c-i 5 1.J E D 3 29/8(3
---- PRIM. PMT .NO. (31130583
1.0521, SW PTVV.P D11
TAX MAP/LOT 251. 15AD SUB: DOVEW LANDING L.T 58 Bl< ;
I-AND LJ5V. :
1-01, SIZE :
ITEM: NO: NO:
WORK (:*I..ASS : NEW FL)PNACFi: (100K 1. AIR HANOLP <10
USE TYPE: SINGLE FAMILY r-1.114NACE 1001K+ AIR HANDLR 10K
CONST . TYPE : VN FLOOR FURNACE. EVAP ,COOLER
OCC L)P . UPP . HEATEP VENT FAN
VENT VENT . SYSTEM
HL.P/C.OMP <314) HOOD 1.
NO , STORIES - 2 01..,11/COMP 3 1.5- HP I N(:'INF-.:;IAI*OP(DOM
DWELL .UNITS : 1. 11311-A-1/COMP :1..x-:301- ) INCINEPATOP(COM
FURL TYPE GAS 01-11/ICOMP 30-50HP PEPAIII UNITS
MAX . INPUT 131-1:11/Gamp 50+14) OTHER 2
FlPri-E DMPR'--s'? ('.,A5 PIPING OUTLETS .1.
HIGH PRESS.? --
1 91011 PIRFR'SSY
--j
0
W
N MT L.1 k::P .JAY P P M T T *I() . 0
R E P . (:I HDX F..1:3£:91 PLAN REVIEW 1 86
I'I(:,A P D 01:1 97203 FIXTURES 111133 .30
PHONE (503) 6841-75A3 STATE TAX 1.0
C DTHVP
0
N
T HE D.1"N 1. 090-.:47*T
R HEDIN' 5s I-IEAY'IN(-.,*
A
C 0415 NW 231ST
T 1971p3
0
R PI-I0Nf:.. (503) 6418-41!59
- NO. -4714.44. T(TrAL: 105 6 . 115 1.5
This permit is lssued.lubject to the regulations contained In Title 14 1. '507'79
of the TMC, State of Oregon Specialty Codes,zoning regulations RET.El"'l- NO. -
and all other applicable codes and ordinances, and it is hereby
agreed that the work will be done In accordance with the plans and REQUIRED INSPECTIONS
*pecifications and In compliance with all applicable codes and GAS LINE
ordinances The issuance of this permit does not waive restrictive POST & BEAM
covenants Contractor and subcontractors shall have current city ROUGH--IN
business tax permits This permit will expire and become null and FINAL..
Void if work Is not started within 180 days,or if work is suspended or
Abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all req,ired inspections are requested and approved
P, t, nature
155 �d By
C'Al-'- f"OP J'.NSPE*(','1A'0N 631; 41175
SEPARATE PERMITS REQUIRED FOR WORK OTHER THA14 DESCRIBED ABOVE
CITYOF TIGARD 5FW1
.-- ,-,P PEAMI*T
(CiTY50FTTWARD V*JIMI-l" NO . : SE86058S
COMMUNITY DEVELOPMENT DEPARTMENT MOON
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223.(503)639-IA75 DA'VE ISSUED : 3/29/88
05,
PRIM . PK . -487 iY' .NOe!li
J(' R ADICIPESS : 10,521 SW PI VEP OR Utir) NUMUER: 3,51.22
'TAX MAI:*-'/L.U'T' 251 160�11]1 SUr.-): DOVE:r� L.ANIXING� LJ ; '38 OK :
LAND USE:
SEC,TION: 1.15 1244 PN('.-', : J.w
WOWK (:',I ASS : Nll�':W
USE SINGLE I:;'AM1L.Y
'Thr.) tet Wi.ti-I U1.11 cif tirlem..
Sk4wer-aLgcr Agtoric:.y . I'l-IG) pwr,rnit lk.?O ChLyfil TI-0111 firer ChWtti J.111191A"d . *TI-ot) t.ritaI
W1.3.1. be J.f ti-le l-.)*?rrn1t 'Tl-iie Ac;Ieiric-y citiciii; melt c m RL r,—
omt(*(I) th*-4 ifl.(Zomtr,irtc^kj I-A! the 1(1C.41Ltj.c11-1 of thv.) 181(110 1fleW1ra1` 1611.t0l"41.1.11; , If tfKA 1ROW01- -i-M
1.1r1t 113c�#Ltcml Hit thv.) j-.IJ,VV.qri , trio J.riintatll.e)r` iiihat"I.J. F)r-tvnpipct 3 f r mt. J.rl
all dir-acti.ciriiii fr,c)in the- T-F r113t 10c) lclt..>ffkted , the inhall.
virl(I S:L(je. V`Iol InIt ;,Ll (:I the) Atlftavlvy WJ.3.3. :1.rim t110..1. M.
INS'TALL. TYPE BU I I DING SVWER IMPEIPIVIOUS APEA:
F IXTUPF-ii. UNIT$ I I::-*NAN T TMPV4OVE'MFN*T
DWIi.-KI-LING LINI'T'S 1.
0 FEES
W
N M I L L.r.-:P JAY PE PMIT 1113.5 . 00
E P . to . BOX 123291 CONSIC."T"TION CHARGE *1 1.00 . 00
1,IGAAD 0R 97223 i LINE P 1:N S'TA L.L.
PHONE. (303) 68,41-7343
C O*THEP
0
N
T M T.L L.E'P JAY
R JAY MIL.L.-ILJ1 BUIL.Illf-"11
A
C P . 13 . BOX 2,3291.
T TIGAFID OP 9,72P3
0
R PHONE. ("50 3) 68A-75413
A li---61 5.4444ATIGN 0419. 304.0 'TOTAL : I 13'"s . 0()---.;
This permit is issued Subject to the regulations contained In Title 14 WCEIVT NO ,
of the TMC. StatF of Oregon Specialty Codes, zoning regulations
and all other applicable codes and ordinances. and It IS hereby
agreed that the work will be done in accordance with the plans and PEQUIRED INSPFX-T TUNS
specifications and hi compliance with all applicable codes and VIOUGH IN
ordinances. The issuance of this permit does not waive restrictive
covenants. Contractor and Subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work Is not started within 180 days,or if work Is suspended or
abandoned for a period of 180 days any time after work has
commenced it shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Permittee ature
Issued By:
(:;Al L f:'J11 INSPECI TON
SEPARATE PERMITS REQUIRED FOR WO'4K OTHER THAN DESCRIBED ABOVE
v/o
CITYOFTIGARDCnYOFTWArsD PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENToRloON PLAN CHECK / ?j
t 3 t 2S 5W HPd Blvd.P.O.Baas m97,TlpW.Onpon OrM(6W)63"116 PERMIT #
DATE ISSUED
JOB ADDRESS: 165-.1 51w. OQ�Upr yr TA}( p/LOT
SUB:_ ., LOT: SIS / -/7 14
VALUATION: LAND USE: T' q. n rj
-` SETBACKS: FRONT: ]r, REAR: .�C LEFT:�r_ RIGHT: 7w
WORK CLASS: �I _ HEIGHT: 1 G,_ TOTAL AREA: �CP
USE TYPE: .�_ FLOOR LOAD: .%U 1ST: iL
GONSTR TYPE: ==� N.naAT TYPE: � 2ND:
OCCUP GROUP: DWELL/UNITS:-%— 3RD: __7 7s1
OCCUP LOAD: NO BEDROOMS: r- BASEMENT:
NO STORIES: V_ NO BATHS: GARAGE:
IMP SURFACE: -- — Sv�-
APPROVALS REQ'D SPECIAL NO.'ES ITEMS REQUIRED
PLANNING: REISSUE Or. LIST SUBCONTRACTORS:
ENGINEERING: LAST REISSUE:__ BUS TAX: —"
FIRE DEPT. : FLOOD PLAIN/ CALC"LATIONS:
OTHER: _ SEN LND.: TRUSS DETAILS:
PARKING PLAN:
PLAN CHECK BY: LANDSCAPE PLAN:�
COMMENTS: OTHER:
�,� Srly
-----:;.gid __ --------
ACCT DESCRZPTIUN
OWNERAMOUNT
NAME: 10-432 Building Permit Fees s �7
10-431-600 Plumbing Permit Fees � v
ADDRESS: 10-431-601 Mechanical Permit Fees a�+��. S S
10-230-501 State Building Tax (5%)1f.,,04:' � 2
10-433 Plans Check Fee 252,u tfu•Yy
PH0NE: 30-443 Sewer Connection (202) V rt 10,3,uY
CONTRACTOR
30-202 Sewer Connection (80X)
�
NAME:_ 30-444 Sewer Inspection 3 j
ADDRESS: t , v
l�,PY J�C ,51-448 Street System Dev. Charge (SDC) $
'52-449--610 Parks I System Dev. Charge (PDC)
a.q 52-449-620 Parks 11 S%,Ptem Dev. Charge (PDC)
d* qj31-450 Storm Drainage Spat Dev Chrg(SSDC)
PHONE:_ (� 10-230-505 TRFD (95x) Z
10-435 TRFD (5%) s
ARCH/ENGINEER 10-230•-506 Washingtor County Fire #1. (952) s
NAME. I0-435 Washington County FirQ #1 (52)
ADDRESS: 10-220 Amart/Wedgewood
PHONE: TOTAL t o o np, 4
�V S 61 PREPAID
REC N .3n
- �"3.q I
BALANCE DUE 9
APPLICANT SIGNATURE
Received Bs: �__ Date Received:
CITY 01= TIGA R I) I'L,t ►M 13l N( ; 1i311121i1�i.
Applicants must IrokJ Oregon Registration to conduct a plumbing ISI;R M F l E�}f1175
business or must be properly owner/operalor not hiring outside help.
fir
Nartw of DevekspnuM I'lurnbInK Permit No.
Address Doscrlplan
ORS 814-21410 DUAN PRICE_- AMT
Job Tax Lrrl Map,No
Addrea• FIXTURES _
Y
l of Block SdMslon Sink
tb7.50 150
ae ox name liaises
Lavatory _ - -- 7.
nt50
O
Tub or Tub/Shavrer Comb, L 7.50
s' --� Shower Only _ _i - 7.50 �, U
Owner t4__
e-- ZIP Water closet _ ^3 r.`+0 a?•)v
Gry/ a
Dishwasher 7.50 7•)?
Phone Garbage Disposal 7.50 - �Z
Washing Machine - -- �- 7.50
Name
Floor Drain _ 7
—�
Mailing rens - WalerHealer _ — 7.50 7
.__�__-----•-- -
_ —_`-- Laundry Room Tray -- a 7.50 Z 9u
Occupant City/Statezip 7.50
Urinal _ __
Name Other Fiytures(Spedly) 7.50 _
7.50
Address ons 7.50
tiorrtractor Stasi ap
--
MISCELLANEOUS
roily BI a 1'ax No Sewer 1 11100• 30.E
Sewer�a.Addil.100 - 15.00
•e s. lido No. le »rsBus c No` - -
(Residential) Waler Santos Ist 100 20.00
I hereby acknowledge fsal I have read fids ep(>Nr-tdM IM!Itse ird-meu°n Water Ssrv�as ea.Addil r 15.00
given is oorrect,Oral l am reglslered with the State tauildrlr'e Buerd,aril also Storm 6 Rain[rain i at.100' 30.00
he"a SW*PI:rtnFrlrg bosons fun to numbers given ars 00from out all rm 6 Pr3n OraM Addh.100' 15.00 -
pk-bkg walk will bn done In aocoxdeno0 with applicable PrO�Ona d 1Of a- _
V-Revised Starkrtes Ctwoora 417 sod 693 end applicable o0d0s and that Mobile Home Spm
no help wfil be wrrpbyed unless Moerreed rrxler ORS$*I (p eyerrlpl fft—
State reglsuation,please give give roason tabw). Banat Flow PreventionDeviolt 7.50
HOMEOWNERS-I hereby CWtlfy frit I sm the Owner d Nee properly de or MO pOfrrlion OevioO _ -
sorbed above,at sahlah lae4tforr 1 propose 10 mala a pkwld*V kuUAWon lar Arsy Trap or W @ M Not 7.50
wns
ray ouse arid Erle prop"Is not bskV owntursted for 611ust 0.s0aw or rCame g- 100•PAM"
- -
Catch Basin 7.50
� .
Insp.d Extol.Pkx•nbkrq IO.00 Per l'U
_
- -- -- — - SpOdNly ROquseMd krap�ctlone _ 40.00 Per Nr
MW of Fit it Ig wNMn
1 s.o0 min--- — an Extolling Skip
AUTHORIZED SIONATVRE — lists N'Brig.or Buld.Ad~ 26.00 min _..
1 LUI' i.l E' (chill
Describe work new[] &Millon❑ atW*tun❑ nl M11
to be done residential n non-rookfenNal
Exls&sp use of
bL4i*Vorproperty F
__ 511�TOT/1l �J�S GV
til u" -__ ___._ _ SIIpOf/AlILI! �_ 7s "-
txpl0perty TO11Al b JJ
Thin pm, beoolnea mA and%VM N wrsk a OWWVuWan atilhwrtced iontA oom
rrsersoed untie 150 dayawr N otKs�ur+SWs or stork M M,Iaparsrl0d a eb6rsrSawd(r.�
a period Df 150 dltys a1 any NrrW NMr war to aermixii iced 1
"CAM,oOMOdT10Ntf _ - -
ICA YIRi 1 1 .-_ by
' Ihn,ugd r
CITY OF TIGARD MECHANICAL PERMIT Pormil w ,fid Sb� 7
------
Table SA Mechanical Code Oty 0-11110 a4 r
City of Tigard 1) Permit Fee -0• U 1 u tNI
13125 S.W. Hall Blvd. --- - -
P.O. Box 23397 2) Supplemental Permit 300
Tigard, OR 97223 ----
639-4175
----639-4175 1) Furnace to 100,000 0 T 6.00 G u
incl.ducts 6 vents
2) Furnace 100,000 BTU 4 50
incl.ducts&vents
Name of Development 3) Floor Furnace g 00
incl,vent
Job Address 4) Suspended heater,wall heater 6.00
Address or floor mounted healer
Tax Lot Mep No. 5) Vent not incl.in 300
appliance permit
Lel Btucw Suhdivieion
Name(a name o1 business) 6) Repair of heating,relr ig., 800
cooling,absorption unit _
MaG q Address phone 7) Boiler or comp to 3 HP 6.00
Owner absorp.unit to 100,000 BTU —
cltyrstale Zip 8) Boiler or comp to 3 HP-15 HP 1100
absorp.unit to 500,000 BTU
Name 9) Boiler or comp 15.30 HP 15.00
absorp.unit lh-1 million _
Mallktg Address Ph" 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor City/State 21R+ 11) Boiler or comp to 50 HP 31 50
absorp.t nit 1,750,000 BTU
Stale Fieplstralbn No. City Sus.Tax No. 12) Air handling unit to 4 5-0
10,0_00 CFM _
Air handling unit ,
I hereby actrnowtedpe filer I have read fids swicat on that Mtrt wilwmatiorr given is 13) 10,000 CFM +
orxreci.that I am file owner or aut)wrized agent of Itw owner,that plans submitted are in --
axnplMMe wMh State laws,that I am raoslered wilh file Slate Builders'Board,that ita 14) Non portable 4 50
rwmber given Is conerr (11 exempt from Stale ragistralinn please give reason tte4ow) evaporate Cooler — _— -_-
— - ) Vent fan connected
15 3 00
to a single duct .�- Z
----- Ventilation system not 4 50
16) included in appliance permit -
`v - -
17" ) Hood served by
14.50
mechanical exhaust yl�
slpnabxe(owner of agent) -- 0e1eDomestic type
18) T b(1
Describe work ❑ addition ❑ alteration 0 repair I 1 incinerator
to be done residential d non-residential U 19) Commercial or industrial 1p l4�
_ type incinerator i
Existing use of Other i.e.,woodslove,water
building or properly _ ___. _-__ _ _ 20)
healer,solar,clothes dryers,etc
Proposed use of
_
building or property _- _. 21) Gas,ptlung rent,hl lour nutlet`
Type of fuel- oil L 1 natural gas I I 1-1'61 1 1 electnt 1
_ ?;'1 Mnru Ih;ul 4•{ter oullrl r
SUB-TO1 Al �4 3 .50
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON O 406 SURCHARGE t71 I�
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180
DAYS, OR If CONS'4 RUC'1-ION OR WORK IS SUSPENDED OI1 PLAN REVIEW 25%OF SU9-TOTAL.
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER TOTAL 56
WORK IS COMMENCED. I.
I