17015 SW VERSEILLES LANE VeR,�� �L.ES LA$46
ADDRESS:
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INSPECON OTICE
City of Tigard Building Depnrt's'"t
13125 SW Ball Blvd. Tigard, Oregon 97223
Iner•ction Line (Rec--o-Rhone): 639-4175 Buniness Rhone: 639-4171
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Inspections —"—'—"�— �
Footing
Plbg. Underslab Mech. Raogh-in 1►ppr/Bdwlk
Pound.
Plbq. Top Out Gas Line FIN11Ls
poet;/Beam struct. San. sewer Framing -Bldg.
post/Beam Mech. ReLn Drain
Insulation -Plumb.
water Line Gyp. Bd. -Mech. C� Q /�
P1':g. Underfloor
_ �,�` lay _
Time: MI�_�PM
Date Requested: '�
Address- _ permit It
t
Builderdl��— � )
THE FOLLOWING CORRE IONS ARE REQUIREDs —
:��
w 11 v
Inspector:
1%,
,_
- 2 S4
"ppn►ED DIg" POVED � 11PPRWED SVWZCT To ABOVE
^ Call For Poinep.
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CITY OF T I GARD 11ECHAN I CAL.
PE RM IT
COMMUNITY DEVELOPMENT D�PARTMqNT PERMIT #k. . . . . . . : MEC94- 0180
DATE ISSUED: 06/29/94
13125 SIN Hall Blvd.Tigard,Oregon 97223oe199 (503)639-4171
PARCEL: iRS115CB--90062
SITE ADDRESS. —; 17015 SW VERSEILLES LN
SUBDIVISION. . . . : 1<41'0','A (A I'T,.) ZONING:
PLOCK. . . . . . . . . LO ,-/ . . . . . . . . . . .
CLASS OF WORK. . :AL.T FLOOD TURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . . VENT FANS. . .
OCCUPANCY G R- P. . ,R3 VENTS W/O ADPL: VENT SYSTEIYIS
STORIES. . . . . . . . : BOILERS/COMPRESSORS HOODS. . . . . . .
FULL TYPES------ 0-3 HP. . . . D(J1*1ES. !NCIN-z
- /GAS/ 3-15 14P. . . . : CG11ML. INCIN-
11nX INPUT- BTIJ 15-30 HP. . . . : REPAIR UNITS:
FIR"_: DAMIERS"). . . 30-50 HP, . . . WOODSTOVES. .
GAS PRESSURE. . . 50+ HP. . . . CLO DRYERS. .
NO. OF AIR HANDLING UNITS OTHER UNTTS. -
f.,7 URN ( 100K BTU.' 10000 r-fm : GAS OUTLE=TS. : 1
FURN > =1004/, BTU: i 10000 cfm :
Remar-!(s : RUN EXTERIOR GAS LINE INTO EXISTING FIREPLACE
Owner- FEES
JAN THENELL. type amoi-int by date r-ecpt
17015 SW UERSEILLES LANE PRMT $ 25. 00 SW 06/29/94
5PCT $ 1. 23 SW 06/29/94
TIGARD OR 97224
P 1-1 a T1 P #:
C C)11 t ir-act a r,- —
HOT SPOT r'IREPLACE A PATIO
I1525 SW CANYON RD
UL.(.)'--:-'RTON OR 97005
Phone a i.26- 4652' 111 -26. 25 TOTAL.
Reg 71702'
------- REUUIRED INSPECTIONS
This permit is issued subjF,:t to the regulations contained in the Mechanic�Al Insp
1-yard Municipal Code, Stat if Ore. Specialty Codes and it) other f' inal Inspection
applicable laws. All work wiH be done in accordance with
approved plans. This permit will expire if work is not s,:artf-d
within 180 days of issuance, or if work is suspended far more
than 180 days,
ret-mittee
By .
Call for inspection 639-4175
City of Tigard MECHANICAL PERMIT f lanck/Rec. # ,--
13125
__13125 SV11 Ha!I Blvd.
APPLICATION Permit #
Tigard, OR 97223
(503) 639-4171
_ .. escnpuon OTY PRICE AMT
Table 3A Mechanical'ode
-
.0. •01 10.00
Job 1) Permit Fee
3.00
Address _� I 2) Supplemental Permit
Q v"V �/ umace
- - Incl,duds&vents 6.00
umace + 7.50
2) incl.duds&vents
Owner Q ac I'lloor rurticumm 5.00
�- 3) incl. vent -
f ___ a er,wallmeater
..». 4) or floor mounted heater 6.00
{IM 2 -�,,. - en not
� ,v ... to 3.00
Occupant 5) applianoe permit
----z - epau o as ng,re ng. 6.00
L�..
6) cooling,absorption unit -
u- i er or comp, ea pump,air con 6.00
fs75 7) 3 o abs unit to lo , BTU
1 ---
i or
or comp,, a pump,au co
(l 8) 3-15 HP absorp unit to 500K BTU 11.00
Gontract')( i er or compa pump,au conte 1500
U 9) 1530 Hf'absorp unit.5 1 mil BTU
1..� r ., i er or carp, at pimp,air cot 22 50
' 10) 30-50 HP absorp unit 1-1.75 mil BTU
i er or comp, a pump,air con .
re f ac ow
go a ve ran ns ap kation, a e 11 >50 HP absorp unit 1.75 mil BTU 37.50
information given is correct,that I am the owner or authorized agent ) r ancTli unrt to
of thi owner,that plans submitted are in compliance with State 4,50
laws,that I am registered with the Construction Cantractor's Board, 12) 10,000 CFM -_
istr�ticn, it an Ing un
that the number given is correct. (I'exempt from State reg7,50
13) 10,000 CTMM `-
please give reason below.) on porta
14) evaporate cook 4.50
en an ca►nec 3.00
15) to a single dud __
_ enti ation system not 4.50
16) included in appliance permit
0 swv 4.50
17) mechanical exhaust
C a teraUon repair mmeraa or ins na 30.00
SW, w new a 18) type incinerator
to be done residential sidential O
or i.e.,w s eve,waiar` 4.50
xisong use T- 19) heater,
solar,clothes dryers,etc.
building or property
20) Gas piping one to four out"ts_ 2•00 .w
proposed use of r
building or property --iI - 21) More than 4 per outlet
Type of fuel - oil O natural gas�( LPG O electric 0
Minimum Fee$25.00 SUBTOTAL O�
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5%SURCHARGE I
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR
IF CONSTnUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DABS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED. TOTAL
Special Conditions. J se �QLt;�1-�/-`s-=_ Jam— — -
r �/J4�[I C" UVB_ Date issued by—
VYEg1A11
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KING- CITY
mmmnm� 1M00 S.V. 116th Avenue,King City,Oregon 97204 Phone:639.4082
COMMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instructions an reverse)
DATE - 3 " � ! r
1. NAME OF APPLICANT: J Phone o.
ADDRESS:
ADDRESS OF PROPOSED IMPROV I'I'_��--� —
2. TYPE OF CHANGE, IMPROVU2 oa OR CONSTRUCTION FOR WHICH PERMIT IS REQUESTED.
DESCRIBE BRIEFLY - CH lIV40 PIES OF PLANS OR DRAWINGS OF
PROPOSED PROJECT.
I e '
,II �Pvia[E �EN
l ) CQ V,q Jai3. Z ACID DRESS OFFCCNTI�ACTJR-/ �"` - IIVSr rn.-.Se�
PHOIE NO.
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJECT WILL BE NO`CIFIED Bi THE CITY. 7/ 79'
d
5. APPLICANT OR HER/HIS RE 'RESENTATIVE MUST BE PRESENT AT THE PLANNING CCIvB-lISSION
MEETING NEXT HELD ON -- PHONE NO.
REPRESENTATIVES NAME.
(The Ring Cit; P1a q Comelssion will consider only those applications received at least five (11.) days
prior to a eep L) N�
SIGNATURE
APFLICATION ,?ECEIVEi? BY fiYl �1. �►s+c�- DATE—]
APPL I CABLE FEE, RECE I VFD TOTAL
PLANNING CcmMISSION DECISION: Approved L:_enled
CONDITIONS
L
kppr-ned application¢are valid for sit manths only
Signature_ �__ Date_
NOTE: oregon, 9oeebuilder: Low requires that all persons who contract for work on their residence be
registered with the Builders Board which means the contractor is bonded and insured on the job sire.
Por your protection, be certain your contractor is registered by calling City Ball Ph: 639-408:.
NO'T'E: A permit must also be obtained ran the City of Tigard Department of
Ccrrr,mi t y Deve 1 opnwnt Yes
CITY OF TIGARD INSPECTION REPORTve P
t project has been inspected and APprov
Date Denied__
The bo 3 0 l p Catm-ents im � n
Signat,are
(Bu Ming in spe-C tal. pteaAe a.a tunn on-e- 1 1 ) ropy tD King Com!)
CC 2-3'