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PLAN CHECK APPLICATION
C11Y OF TIGARD CITYOFRD PLAN CHECK
COMMUNfTY DEVELOPMENT DEPARTMENT o clo " PERMITf_� 0
i.j,25 SWI Hd BMd P.O.FR=21 9',Tlganl,Oregon 97M(60.7)6W4176 �f
DATE ISSUED _
13 A?
JOB ADDRESS:
TAX MAP/i3OT
SUB: j�c.� r LOT: LAND USE:
VALUATION: 2 SdC,�- SETBACKS: FRONT: REAR: LEFT: RIGHT:
WORK CLASS: HEIGHT: = ��— TOTAL AREA:
USE TYPE: FLOOR LOAD: Z 1ST: �Cic.,
CONSTR TYPE: Vl� HEAT TYPE: 2tM=
OCCUP GROUP: -P'— DWELL/UNITS- 3R.D:
OCCUP LOAD: NO BEDROOMS: BASEMENT: -
NO °TORIES: I NO BATHS: _ GARAGE:
IN.•c' SURFACE:
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING: REISSUE. OF: __ LIST SUBCONTRACTORS:—
F.NGINEERING: —-- LAST REISSUE: BUS TAX:
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND,: TRUSS DETAILS:
PARKING PIAN:
IANDSCAPE PLAN: _
PIAN CHECK BY: OTHER: —
COMMENTS:
.n . ..3, -
ACCT f DESCRIPTION SUNT
OW ER 10-432 Building Permit Feer,
NAME: Par ki U:�-- 10-431-600 Plumbing Permit Fe6s
ADDRESS: 10-431-601 Mechanical Permit Fees
10-230-501 State Building rax (5%)
_ 10-433 Plans Check Fee
PHONE: 30-443 Sewer Connection (20X)
30-202 Sewer Connection (80z)
CONTRACTOR 30-444 Sewer Inspection
NAME: .51-448 Street System Dev. Chhrge (SDC)
ADDPZSS: 52-449-610 Parks I System Dev. Charge (PDC) _
52-449-620 Parks II System Dov. Caarge (PDC)
31-450 Storm Drainage Syst Dev Chrg(SSDC) S
PHONE: 10-230-505 TRFU (95x) 4-3
10-43.5 TRFD (Sx) Ic7.�1c 7
ARCH/ENGINEER 10-230-506 Washington County Fire I1 (95x) s
NAME;_ "' 1 MEl 10-435 Washington County Fire #1 (5x) —
ADDRESS, ' 1' �l�)_ C3nnr',�t�( � 10-220 Amart/Wedgewood
C604�- ' f,r� 1 .i1
• ^ TOTAL $
LL, PHONE: t yo.y3
J PREPAID
REQ; d 3�,z2U
BALANCE DUE '90 fZ
APPLICANT SIGNA JRF -"
ceived By: Date Received:-,/
r
CITYOF TIFARD
i BUT.1-DIM3 PRT
EMI
' ARD
CITYOFTIGll"EPIMI'T NO 8
ORIGO RD
BU80713
COMMUNITY DEVELOPMENT DEPARTMENT N
13125 S.W.Hall Blvd..P.O.Bk x 2339' Togiod.Oregon 97223.(503)639-4175 DATEE ISSUEID: q/22/88
____—__ — PT FI M-PFrr—.1RT_. __TF@_U7J.3
JOB ALA)Mi:55 : 1-6126 SW '72141) AVE
TAX MAI'-'/I-.C)T SUR: QR[.*9ON BUSINESS PAPK 1 131 DG 1. 1...'T: BK :
LAND
I_0 T, S I Z F - VALUATION: 0 'c? ,'500 SF-KTOACKS
F'RONT : PEOP :
WORK (','LASS : ALTEPATION DWELL.UNITS : I EFT : 1:,41
USE TYPL : COMMS rICIAL N0. BEDAO0M5 : 1EXT . WAL.1 CONST :
CONST . TYPE : VN NO. BATHS: N: 5 : E : W:
OCCUP, GPP. B2 PPOT .OPENINGS :
(XCLJII�. LOAD 11 N: S : E* W:
TO*roi... Aniii.,e)
NO. 5'T OPT E-5, IST 2500 POOF CONST : F IPE PET?
HE. (.,H'T* : 2 P 2ND MEA SE�')AA'? PATED:
B A S EM Ei:N T NO 3PD (JCC(. P . SEPArQ,? RATED
MEZZANI',-41`.;'.'7 NO DASF.::M I T
FI-O011 I OAD 125 1II'41.'.:: SF-',PKI P? ALAPM?
FLOW(("PM)
PLAN CH''-XK BY : if-ii
I4l::'MAr4K5 :
.1.e-rintrit, Mnd : Abr-nimi.vc.-im 01-111A.Inited NW. REISSUE OF NO .
I-AST REISSUE:
FEES :
W
N 4.1 PEPmrr
E P1 AN REVIEW $ 15
n
r-IPF DEPT $15 .A0
S'TA'TE: TAX 1. 9
C OJrI_lEI.J
0 I)EVELOPMENT (: HARGlIKS :
N
T G,R E E14 HOWAPD SOIL,( STOPM)
R H L Grl!_�--EN SUMSTREET)
A 111. SW rTFTH PDC(#
C
T P(1r,t1atirid an 51204 <
0 PHONE (303) 2�!10020
1 41,11 r.r raJ J_ T t i q1,q0 AJCs
This permit Is issued subject to the regulations contained in Title 14 PErEIPT NO. 3:I.2 2 0
of the TMC. State 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 PEQUIPED INSPECTIONS
specifications And in compliance with all applicable codes and FRAMING
ordinances The issuance of this permit does not waive restrictive INSULATION
(ovenants Contractor and subcontractors shall have current city GYP . BDAPD
husiness tax permits. This permit will expire and become null and MECHANCL . SYSTEM
void it 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 SUtSPEND.("Ell ING
commenced It shall be the responsibility of the permittee to assure 1:7 1 NAL
all required inspections are requested and approved.
lk�lt,.W lgn;ure�
issued By:
LAI_I. F!'Drl TNSPF1*,"1'TDN 639-411.7n
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
, ►� PLAN CHECK APPLICATION
CITYOFTIFARD
IMMUNITY DEVELOPMENT DEPARTMENT , PLAN CHECK
is sw►tan e,rd P.O.sax 23397 np,d.o nrM(ew)M 4,76 PERMIT #_&7. / —
DATE ISSUED
JOB ADDRESS: TAX MAP/LOT
SUB: ' LOT:'—� LAND USE:
VALUATION: �SC��— SETBACKS: FRONT: REAR: LEFT: RIGHT:
WORK CLASS: HEIGHT: _ TOTAL AREA:
USE TYPE: ,^L�c,c�1 FLOOR LOAD: 1ST:
CONSTR TYPE: \j HEAT TYPE: 2ND: �+�---
OCCUP GROUP: DWELL/UNITS: 3RD:
OCCUP LOAD: NO BEDROOMS: BASEMENT:
NO STORIES: I NO BATHS: GARAGE:
IMP SURFACE:
APPROVALS F.EQ'D SPECIAL NOTES ITEMS REQUIRED
PLANNING* REISSUE OF: LIST SUBCONTRACTORS:
ENGINEEFL NG: — LAST REISSUE: BUS TAX:
FIRE DEPr. : FLOOD PLPdN/ CALCULATIONS:
OTHER: SEN LND.: _ TRUSS DETAILS: _
PARKING PLAN:
LANDSCkPE PLAN:
PLAN CHICK BY: OTHER:
COMMENTS: ex VJ Q I ' _
ACCT f DESCRIPTION AMOUNT
OWNER 10-432 Building Permit Fees
NAMZ: _ 10-431-600 Plumbing Permit Fees
ADDRESS:_ 10-431-601 Mechanical Permit Fees f
10-230-501 State Building Tax (5x)
10-433 Plans Check Fee _ 3
PHONE: 30-443 Sewer Connection (20%) _
30-202 Sewer Connection (80X) s
CONTRACTOR 30-444 Sewer Inspection t�
NAME: .51-448 Street System Dev. Charge (SDC) �
ADDRESS: _ •52.-449-610 Parks I System Dev. Charge (PDC)
52-441�-620 Parks II System Dev. Charge (PDC)
31-450 Storm Drainage Syst Dev Chrg(SSDC) t
PHONE: 10-233-505 TRFD (95%) ....................;7q. -
- -- 10-435 TRFD (51) �2—
N ARCH/ENGINEER 10-230-506 Washington County Fire #1 (95X) s
NAME: 10-435 Washington County Fire #1 (5%) t
,�-
ADDRESS: - 10-220 Amart/Wedgewood
J
4, TOTAL. $
c!i PHONE:
PREPAID 90 y3
REC
BALANCE DUE �
APPLICANT SIGNATURE
celved By: Date Received:' �ys
CITY OF TIGARD MECHANICAL PERMIT Receipt#?2)
Permit#E 17n
Description
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard —��
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397 ---
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 f 11 Furnace to 100,000 BTU 6.00
incl.ducts&vents
2 1 Furnace 100,000 BTU +
incl.ducts&vents 7'50
Name of Development ^ Floor Furnace
0 8p-" / / 3) incl.vent �— 6.00
Job Address d Suspended heater,wall heater
Address 6L,,2- Iw �z"id �/ 4) or floor mounted heater _ 6.00
Tax'-of Mar,No. Vent not incl.in
5) appliance permit 3.00
!of Block Subdivision ---
Name or name of business) Repair of heating,refr ig., 6.00
N60) cooling,absorption unit _ `—
Mailing Address Phone 7Boiler or comp to 3 HP
Owner ) absorp.unit to 100,000 BTU 6.00
City/Slate 7;p—`,- Boiler or comp to 3 HP-15 HP
8) absorp.unit to 500,000 BTU 11.00
Na a Boiler or comp 15-30 HP
Gr 9) absorp.unit 1/2-1 million 15.00
Mailing Address Phone 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1 -1.75 million
Contractor city/State Zip i 1) Boiler or romp to 50 HP 31.50
absorp.unit 1,750,000 BTU
Mate Registration No. City Sus.Tax No. 12) Air handling unit to 4.50
10,000 CFM _
I hereby acknowledge that I have read this application that the Information given is 13) Air handling unit 7.50
correct,that i am the owner or authorized agent of the owner,that plans submitted are in 10,000 CFM +
cnmpliance with State laws,that I am registered with the Slate Builders Board,that the 14) Non portable 4.50
number given is correct.(If exempt from State registration please give reason below) evaporate cooler
15) Vent fan connected
to a single duct 3.00
- -- _ Ventilation system not `^
13) Included in appliance permit 4.50
—� ----�" -
17) Hood served by
mechanical exhaust 4.50
Signature(owner or agent) Dale ) Domestic type 1
Describe work ❑ addition I I alteration 1 repair Ll 18 incinerator .50
to be done residential O non-residential ) Commercial or Industrial
Existing use of 19 type incinerator 30. I
building or properly ) Other i.e.,woodstove,water 4.50
~ PI oposed use of 20 heater,solar,clothes dryers,etc. —
building or property — 21) Gas piping one to four outlets 2.00
11z
c.a
Type of fuel- oil F-1 natural gas C] LPG I ) electric -
LL, 22) More than 4-per outlet
J
TICS
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S% 406 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER —
WORK IS COMMENCED. TOTAL
Special Conditions
Date issued ____by
E"l DA" PERI 7 APPLICATION TEGAR',) D-TE & -" . ,9� '�'°
HERESY APPLIES FOR APERMI? FOR THE NORK HEF EIN INDICATED �,q / J�
OR AS SHOWN AND APPROVED IN THE ACCO'JIPA jV� l; a-ANDAZECCAJIGe+ rwNER PHONE �[. 1
WNER CQG.� sQ' ADORESS (, VZ.tJ BU!LDER PHONE �LZI'DC�Z�
ur. lrucr.R 1*.?;!!�
ER ,.�-
AU!LD •�• C�L`V r'"rC ^!CT ��S � J _ DESIGNED 'i - -
STRUCTURE CNEW E REMODEL ❑ADD!T!ON CPEPAIR _❑!IcNEWAL CFIRE DAMAGE_ ❑DEVOLI'!ON
RES!DENCECGMM ❑EDUCATIONAL ❑GOV'T CQELIGIOUSDPATIO ❑CAR PORT (2-GARAGE ❑STORAGE ^SLAB ❑FENCE
_^BOND J MOVING CCONDITIONAL USE CDESIGN REVIEW ❑COUNCIL APPROVED _^SIGNS
OCCUPANCY. LAN? USE ZONE BLDG.TYPE-- _�FIFIP.F ZONEPLAN CHECK BY--,& HEAT _
�l�,u�►.
�CC_L.CAP— FLOOR LQAD �� T HEIGHT K�REAR
NO_STORfESAREAVALUEDEPAPTMENT SET BACKS FRONTLEFT SIDERIGHT SIDE
Permit _
cl---"""" �"' •07I TH!SwPERMIT IS ISSUEC S'JBJEC7 TO THE REGULAT' INS CON-AtNED IN THE BUILDING CODE, 2ON'NG
RFCULATIONS AND ALL APPLICABLE CODES AND CFDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK%'SILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
_
ALL APPLICABLE CODES AND DPDINANCES, 711E ISSUANCE OF 'THIS ;ERMIT DOES NOT 'AAIVE
RESTRICTIVE COVENANTS, CO'JTQACTOR AND SUS CONTRACTORS TO HAVE CURRENT CITY BVS't1E5^
v StaYe�X /� LICENSE, SEPARATE PERMITS REOUI?ED FOR SEWER, PLUN19ING AND HEATING.
nY I� _....L.e�l(�L_._ PF,1►-''� _ / t''�dLKL:1'}�1�+ � 1
- ---y-" APPLICANT C4 AGENt
.luoru+�ed Receipt No,
CL
Lo
LLIF-
t/1
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I,61 Lr-
LIU,JL•DING PERMIT APPLICATION TIGAnD DATE—.2------ 4355
"'HE UNDEHS'GNED HEREBY APPLIES FOR A PERMIT FORT HE WORK HL-REIN INDICATED BUILDER PHONE - n
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONEII�._ 2Q'11
LOT NO..
OWNER Pal- I'nist JOB ADDRESS •,
ARCHITECT
t.• ;.T•n'?rZ
1220 :;' ;- ENGINEER
BUILDER ADDRESS
�rrit3:7'1 DESIGNER }�' •f 7"1�' �14.�
STRUCTURE 1-1-NEW 11 REMODEL ❑ ADDITION 7 REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE ! COMM ' FDUCATIONAL ❑ GOV'T EJ RELIGIOUS ❑ PATIO L CARPORT F-1 GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY .____ LAND USE ZONE -=: BLDG.TYPE ? + __. FIRE ZONr. PLAN CHECK BY _'- HEAT
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SEWER PERMIT N
OCC.LOAD FLOOR LOAD ,. ' I`. HEIGHT " N_0.STORIES AREA ' ' NO.BEDROOMS VALUE
,ul BUILDING DEPARTMENT SET BACKS FRONT DEAR LEFT SIDE RIGHT SIDE
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Permit _ THIS PERMIT IS ISSUED SUBJECT TO THE RFGULATIOAS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES AND IT IS HEREBY AGREED THAT THE
Plan Check WCRK WILL BE DONF IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL AP?UCAPLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
3UIhtCtal RESTRICTIVE COVENANTS. CONTRACTOR .,ND SUR CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED SUR SEWER,PLUMBINU AND IIEATINr,.
State Tax
- SDC-
Total _
- PDCN APP (CANT OR ANN?
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Approved t' ,;i - Receipt No. j / J 7 ADDRESS— - PHONE
GATE INSP, TYPE INSPECTION REMARKS PLUMBING DATE
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Permit No.
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---- --- HEATING' -.
Contractor
--�— Permit No
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Final
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(Rsln Drain)Final
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j Curb&Street Final
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OCCU EfFIR RICATE OCCUPANCY
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toning Final
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