10745 SW 71ST AVENUE I
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INSPECTION NOTICE '�y�^"'--�,
City of Tigard Building Department
13125 Sit Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec -Phone): 639-4175 Biiaineas Phone: 539-4171
Inspection:
Footing plbq. Underslab Mech. Rough-in Appr/Sdwlk-
Found. Plbg. Top Out Gas Line
FINAL:
)-poet/Beawo Struct. San. Sewer
Frar--g -Bldg.
Poet/Beam Mech. Rain Drain Insulation
-Plumb,
Plbg. Underfloor Hater Line Gyp. Bd. -Meeh.
Date Requested:
Address•
Builder:
THE FOLLOWING CORF4CTIONS ARB REQUIRED:
Inspector: i'
X-i-_ .APPROVED DTSAPPROVPr) �w APPROVED SUB,TWCT TO ABD"
_ _Call For Painsp.
INfiPEL'f�ON NOTICE C.y•�•�,
City of Tigard l4viiding nepar'Luent
13125 RR 11aA Blvd. Tigard, Oregon 97223
Inapecti.on Line (Rec-O-Phone): 633-4175 Business Phone: 634-4171
Inspection �—
rooting Plb3. Un6ersiab Mech. Rough-in Appc/Sdwlk
Found. Pl.bq. Top Out GaLine FINAL:
Post/Beam Stru.`t. San. Sewer Framing -Bldg.
Post/Bean Mech. Rain Drain Insulation -Plumb.
Pibg. Und-irfloor Water Line Gyp. Bd. /-Mech.
_ LtJ
Date Requested: _y�"��/ T AM PM
Address: _ Permlt. #: _�___-�� _
HuJ-Aer:�7��-
TT.B FOLLOWING CORRECTIONS ARE REQUIRED:
7
dam!
Inspector , —_-� _ Data:_ e3
APPROVED +` DISAPPROVED —__ APPROVED SUBJFI.r TO ABOVE
!_Call For Reinsp.
mill
CIWOFTIGARDe1Y,( 7WARD MECHAN I CAL
COMMON" DEVELOPMENT DFPARTME�!-# on PERMIT
131,26 SW FWi k3tvd. P.O.Sm 23397.TiQaM,OrSOM 97223(SWJ i$.�f-x-4175 PE R14 I T 4. . . . . . . : AEC93-0041
639-4171 DATE ISSUED: 03/04/93
SITE ADDRESS. . . : 10745 SW 71ST AVE PARCEL: 1SI36AC-03200
SUBDIVISION. . . . : METZGER ACRE TRACTS ZONING. C-P
EkLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :5
CLASS OF WORK. . :ALT FLOUR FURN. . . . : EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . :
UCCUPANCY ORP. . :R3 VENTS W/O APDL: VENT SYSTEMS:
STORIES. . . . . . . . :* BOILERS/COMPRESSORS '-1OODS. . . . . . . I
FUEL TYPES------------- 0-3 HP. . . . DOMES. INCIN:
: /GAS/ 3-i5 HP. — COMML. INCIN:
MAX INPUT: STU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?. . : 30-50 HP. . . . : 140ODSTOVES. . .
GAS PRESSURE. . . : 50-1- HP, . . . -. CLO DRYERS. . i
NO. OF UNITS----------- AIR HANDLING LIN['f S OTHER UNITS. .
FURN ( 100K BT11: 1 l= J0000 cfm : GAS JUTLETS. :"S
FURN ) -100K BTU: 3 10000 cfm:
Remarks : OIL TO GAS CONVERSION OLO-5 f-1 r- �
I-,eA lep- ,i-- qa-5 dry er -4 elAs 1- 40 e
Owners ----------- ----- ---- FEES
RUSSELL ARCHER type amoi.tnt by date recpt
10745 SW 71ST AVENUE PRIAT $ 25. 00 JH 0:;/04/93
5PCT $ 1. 25 JH 03/04/93
TIGARD OR 97223
Phone #:
Contractor: -----------------------------------
OWNER
-------------------------------------------
Phone #: $ 26. 25 TOTAL
Reg #. . - 00000 REQUI RED INSPECTIONS
This r-mit is issued subject to the reg-ilations contained in the Gas Line I n s p
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. this vermit will expire if work is not -'.arted
within 180 days of issuance, or if wc-k is suspended fnr sore
than 180 days.
Perm i t t e Si gnat 1.kre
I s%1.t e d B
Call for inspection 639-4175
--Permit N o: L21�JL---
Address: L(_
Issued by:--- -1 Date:
OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSle;LITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued.This state-
ment ;s required for residential building, electrical, mechaniciand plumbing
permits Lirensed Arr .,ieci ane Engineer applicants, exempi from registration
under OHS 701.0,10, ), need riot submit this statement. This statement will be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1 . [0�� I own, reside in, or will aside in the completed strUCtLim.
2. 1 understand that must register as a construction contractor if the structure is sold
or offered for salE before or upon complei,un.
3. A.1 1 My general contractor is
Contractor registration number
I will instrLiCt my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3 BT?%_'1 I I will be my own general contractor.
It I hire subcontractors, I will hire only subcontractors registered V,ith the Construc-
tion Contractors Board. It I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of 'ie name of
the contractor.
I hereby certify that the above information is correct and that I have rei" and understand
thv Information Notice to Property Owners about Constructioo Responsibilities on the
reverse side of this form.
7�
Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244.1 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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c I l Y C)F T I UARD — R CL I PT UV P tYMEN1 RLG'F I -1 i NO.
CHECK AMUUN V 25
NAME a ARCHCR, RU:?rSUA-I.. CA'3H AMOUN F s 0. oel
t::ll)nRE Circa K 1 0 i 4Z5 SW 71ST AVE. PAYMENT VATL s 03/04,"93
SUBDIVISION
TIC3a PID, OR
i l If7POSE OF PAY'MF NT AMI:IUN'T' PA I C' PURPOSE. OF P0Yrylr--hl'T AMOUNT F'H I D
1#1NiC:AI., "P-1 E—
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TU TAI.. AMOUNT PAID