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INSPECTION NOTTE
City of Tigard Building De,)artmerit
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Time ___A.M.__�P.M.
AddressC/
Permit #
Owner_ --- — t— -«JZ Lot # _
Builder
The following Building Code deficier.:ir,s are required to be corrected:
I•r sented ! `. fl `-Approved
Irsprctor — — --. �_� Disapprovpd
Date ZZ
CA FOR REINSPECTION
O YES ❑ NO
P.O.Box 23397
CITY OF TIGARD PLUMBING 1a125 SN "311 LUW.
ApplKants must hoW Oregon Registration to conduct a plumbingPERMIT Tigard W 9722✓
business or must be property owner/operator not hirinp outside help. 639-4175
Narrte of Development
6//3
y Plumbing Permit No. _
Addross Description -
Job l �) U 17 C U Pte_ ORS 914.21.610 WAN. PRICE AMT
Tax LM Map.No.
Address
--- - - - - FIXTUIIES
tD1 J [llocic Subdivtslon -------- - - -
f'. D Sink_ 7.50
Name n name o wfiTsrnesj-��- Laval y 7.50
a� L �/Y7 Tub a Tub/Shower Comb. _- 7.50
ng fess
Shower Onl y -- -- L- - 7.50 -
Owner (atyi,tele ZIP Water0oset _ 7.50
_ Dishwarher 7.50
Phone Garbage Clisposal - _- 7.50 _--
Name --- Washing Machine �- 7.50 - - - -
Flo r in - - 7.50 _- - -- -_
Mailirfg Address I Water Fleeter �s 7.50 -
CFty/SIe1e Zip
Occupant - -- Laundry Room Tray- 7.50 !--
- - ---- . _
Urinal _ 7.50
arae "1.L11 Phone Other Ftxlures(Specify) _ 7.50
ress
1 „L/lar_-_�r+one 7.60
7.50
Contractor tity/State -- ---- --�}p -- --- 7.50
MISCELLANEOUS
City five Tax No- - svww 1N 100' 90.00
Meq""'M' lei"- No-- - tate s�iaa Uc-No � tea.AddN.100' _ _ 15.00
(Residential) �- Water Service 1st 100 l - 20.00 ---
I hereby&,*nowlsefge Mut I have read this application,that M»kdormadon Water Semite ea.Addh.XDr 15.00_
given Is correct.Meat I an raositerad with Mee fila»BtWxWs fiord,and also Slomt b Rain Drain 1 at.100' 90.00
have s State Pkxnbktg license Mut the numbers ghren ars correct,that all --
plurnbirq wok wte be done in accordance with applicabls provisions of Ore- Stone 8 Pyn Drain Addll.100' 15.00
gon Revised Statute$Chapters 447 sect 993 w-od applicable axles and that -
Mobile HomeSpew25.00no help will be employed urAeasac » d antleORS 893 (f►exempt from --
..
State registration,pleasw give reason below). Back Flow Prevention
HGMEOWNERS-I hereby cert.'fy that I am the owner M the property 69- Davios or Antl-Polkilion Devlos 7.50
sorbed above.e•„Bach tocaMan 1 pmpoee to maks a pkovt Mg ktatatlatla,for Mer Trap or waste Not
M own use and Meir property le not bring eonabuctad 1a sale.iesss or rent Connacrlarre
A to a Fixp7.60
Catch Bain 7.50
InW.of Exkd.Phxnbkg 40.00 Per Hr
--- ____------ --- --- -- SpeoiaN k"scMons 40.00 PN Hr
_ .----------------__�- __-- -------- Ater.of PkrnbMtp W11116t -
an Exk*v Bldg 15.00 nwn
AUT14MtZED SIt1NATU6E - -- --- Oair -Now".Or Rued.Adtltlon 16.00 than.
Desaibe wor4c new( addiI IH ttllfwatlon L7 repair 0 coal 1;r1Q15.00
be Bono reek9enttat non-rsebendal -_-
Exlat;np use of
buMtirtp or Property 11 MTO'fAL
MU"o1
btft -- - _' NNIOhAlIOR
o/P10fxfwlY - - - TOOT" L�
P10T1c.� � __--_-• _
T?*Pain beotunes Moo.rent u01d M vvork or nn wh uoNm a xhoA ned N not coin
Mail seh WMMn 160 drAW ti oa lOueft orwoAtle Mnill p lad orabarvdoned f or
a psrtod d IMO Aaytt a any ante oar work is O"Milirtoed
"011/i1 OOII[NT1011B
Dao leewed by
CITE( OF TICARD MECHANICAL PERMIT Peceipt
Description 4
Tahte U Mechanical Code OTY PRICE AMT
City of Tigard � T
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 1) Furnace to 100,000 BTU
incl.ducts&vents .00 _
2) Furnace 100,000 BTU +
_ incl.ducts&vents 7.,0
Name of D-volopment -- 3) Floor Furnace
1 _ incl.vent _ 6.00
Job Andreae — 4) Suspended heater,wall heater 6.00
Address �,-�q y ASO e or floor mounted heater
Tax of Map No, 'Zs -e-'r�� 5) Vent not it lcl.in 00
_ Lot .Z , Block subdivision appliance permit
Name(or name of business) 6) Repair of heating,refr ig., 6.00
cooling,absorption unit
Owner Malling Address Phone . ;q 7) Boller or comp to 3 HP 6.00
absorp.unit to 100,000 BTU
City/State Zip Boiler or comp to 3 HP-15 HP
8) absorp.unit to 500,000 BTU 11.00
Name 9) Boiler or comp 15-30 HP
absorp.unit 1/2-1 million 15.00
Phone 10) Boiler or comp to 30-50 HP a
absorp.unit 1-1.75 million 22.50
Contractor cnyisisie — 71p Boiler or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31.50
State Registratkxr No City Bus.Tax No 12) Air handling unit to 4
10,000 CFM
1 hent, �r,aledge that I have ar. Air handling unit
y read thra anuetion that the information given Is 13) 1 U 0�0 CFM + 7.50
'-nect,ftf I am are owner aMxx
euized agent of the owner,that plans submitted era M
compliance with State laws,that I am regists"K,with the State Bullders'Board,that the Non portable
number given is correct (If exempt Iron,State rekistratirm please ghre reason tx*m) 14) evaporate Cooler 4.50
-- - s
- 15) Vent fan connected 3.00
to a single duct
- - _ -'-- Ventilation system not
18) included in appliance 4.50
--- Pp----_-Permit
Hood served by
17) rnecharUcal exhaust --� 4,50 y tom.
Araiure(owner or ageno _ _ - Date Domestic type `--
Describe work addition C 1 alteration O repair El- 18) incinerator _ 7.50
to be done r sidentiA]fi] non-residential p Commercial or Industrial
Existing use of 19) type incinerator _-R 30.00
J building or properly Other i.e.,woodstove,water
Proposed use of �~ 20) Other
solar,clothes dryers,etc. 4.50
building or property___._ 21) Gas piping one to four outlets '
/ 2.00
Type of fuel- oil [] natural gaV_ LPG I I electric L]
22) More than 4-per outlet
NOTICE --
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON ------- SUB-TOTAL S-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 _ $% 4116 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR !
ABANDONED FOR A PERIOD OF 160 DAYS AT ANYTIME AFTER PLAN REVIEW 2s%OF SUB-TOTAL
WORK IS COMMENCED. TOTAL
Special Conditions _� ---
Aby
BUILDING PERMIT APPLICATION DATE ts4964
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE NORK HEREIN INDICATED 5UILDER PHONE 639-6742
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO._
OWN[R jCj ;, jOBADDRESS i �—
. � o�n� S.4?.nQver Ct _
A9(CHITECT 22.5-91[1
GINEER
BUILDER ����n'�' ADDRESS 1084 5 S.W.Dover C:t . DESIGNER Allen Mascord
STRUCTURE jL EW ❑ REMODEL ❑ ADDITION ❑ REPAIR RENEWAL 0 FIRE DAMAGE ❑ DEMOLITION
[*RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ C.ikjPOPT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY R-3 LAND USE.ZONE _Y_t,`_P1LDG.TYPE = FIRE ZONE PLAN CHECK BY _ BCR HEAT Gaa
Construct single family dwelling w/atta4hed gar;-t,ge, a.l..l per ap rmoed Flans . _
Sub ect to 95 rode. Reisaue of 6676 OrJoinal 5602.
SEWER PERMIT N 34060 3 baths, 14 trips (jarnge area
OCC.LOAD FLOOR LOAD 40 HEIGHT 20 NO.STORIES 2 AREA 1111165%q,BEDROOMS 4 VALUE 78,000
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR i i _LEFTSIDE .1 1 '(1" RIGHT SIDF
Permit367.00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
40.00 REGULATiONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan CheckWORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
-'WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PENMIT DOES NOT WAIVE
Su_b•lotal RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
state Tax 18. 35 SSDC: 2.50.
Total 425.35
SDC- 6"O.U U
I I 150.01W LIGAN T OR AGENT
-- PDCN �—-
By — 40.00 --- erwor. if19v46"on
Approvedr
____.,��,2iReceipt No 3 5 pp.
�r.� - �
w
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DAT
Contractor
I Permit No. j l
Floughoin
Fixture
Final
�f. r HEATING
Contractor
Permit No.
Gas or Oil
Rough-4„
Final
—SEWER
Final
DRIVEWAY
--- — Final
----4` Stnrm Dralnepe
(Rein Drain)Final
SidemiA
Curb&Street Final
_ ADproseh
BLDG, DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Fin ---^— —�
CERTIFICATE OCCUPANCY
al
ii
d Zoning Final
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