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BUILDING PEPMIT
F+.:PMIT NO. : BUE381.96".5
C17YOFTIIFARD C11YOt MARD
oafoow
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED : 10/ A/C-M
13125 S.W.Hall Emd.,P.O.Box 23397.Tigard,Oregon 97223.(503)639AI75 P 141 N P M r .NO 1-3 R 12&L
JON ADOPLKSIS : :1.64135 �,W V1A(:,IFT(.-, HWY
VAX MAP/l (11' GLICI: KING (,.I:I,y I T UK
I—AND LISE ;
L-01, SIZE : VAI.A.)ATION : fill Ell 000 SETBACKS
FRONT : Rl*--Ap .
WORK CI ASS : PEP()TRI DWK.L.L. .LIN ITS : 1-.I'--F'T' : Pl(;H*T* .
USE. TYPE : CX)MMi:-.-QCJ.AL- NO. CIEDRUOMS : EXT . WO-&J— M)N51' '.
CONST I*YPE . VN NO. 1.)ATHS : N: S : E W
(..,;14p . : VIPOT .OPE'NINGS :
(RX3.11D .I—OAK) N ',;i . E W
IT)TAI ARr.;'A:
NO. STOPIES : IST : WOOF (:1UNST : A FTPE PET7 YES
1•I (A-I 1, P.ND: AREA SEPAP"? P ATI--J.)
UAt5F.::MF.:'NT ' 3PD : OCCUP . SC,PAPI? 1:1 ATED
MI::7ZANINr:-:? CIASEM I I
V-1-0(:P 1 ('.)AT): A 1-4 A GV I:.- . I::*1I*-U:.* tiPPIO-PI? AI—AAM?
FI—OW(GPM) Mi:TEC,T7
Y.Q E
I-1—AN (:,I--IC',CK BY : JH
IQI'**MAIII05 :
PR1401131---' ONI Y PEISSLIIE'. (IF NO.
I AST' PEISSUE
VFES :
W I"4F.VC PL.y ENTV141:441 SES r)C:nmxT 11139115 00
N 1U.1f.20 1:?W YU:MMONT PLAN PEVIEW
E
P(JR11 A140 (:1111 97VJ.9 1,7114E I)EPT
PHIIINI;.: 0503) 620--51,11. %1 ATE TAX 11111 19 . 2.15
0 t*HC:n
G DEVU11—OPMENT LIHAPGES :
0
N SIX,(STOPM)
T
R
A 681.::1 SW PM 01111s
C 1:311-i-AVI.:'.IT1 ON OR 9700'> PREPAID < >
T
0
R M-13oISTPATTON NO. 9P5 TOTAL. : *Z101. eb
This permit is Issued subject to the regulations contained In Title 14 .. INIC) . A10 F 7-3
........
of the TMC. State of Oregon Specialty Codes.zoning regulation3
and all other applicable codes and ordinances, and It Is hereby P1.-:QLJ I III*.-*:D INSPECTIONS
,agreed that the work will be done in accordance with the plans F. d FRAMINU,
specifications and in compliance with all applicable codes and T.NS1.JI...A'1'1:()N
ordinances The issuance of this permit does not waive restricti%3 POLO: NAII ING
covenants. Contractor and subcontractors shall have current 64
business tax permits This permit will expire and becorne nul!and
vold If work Is not started within 1180 days,or if work issusuendec or
,ibandoned for a period of 180 days any time after work has
cunnioenced It shall be file responsibility of the permittee to assure
'111 required ins ns are requested and app,oved
elmitte nature
Issued By (40 ("Al.1 I':nP Tt1t-,PG*-,TTT0N 6-39--r-1171
SEPARATE PERMITS REQUIRED FOR WORK OPAIE9 THAN DESCRIBED ABOVE
IN:°ECTION NOTICE
City of Tiga.J Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639=417 /
Type of Inspection - - el ---
Date Requested 129 Af TIme_—G xv P.M.
Address Rirmit —
i I
Owner � �,� Lot #
Builder �.� �.._ - —
The following B&jilding Code deficiencies are rec4lir to be coi rested:
Presented to [ Approved
Inspector _ �� ❑ Disapproved
Date -
CALL FOR REINSPECTION
F-1 YES FJ N0
4
VI ! Y Vr 11UAhU IVILlir1HI411.AL VLhfIVII 1
/ \1 Description — �— -
Table JA Mechanical Code— -- - -- 0TV R_RICI AMT
City of Tigard
u
9 1) Permit Fee •0• •0• 10 00
13125 S.W. Hall Blvd. r
P.O. Brix 23 397 2) Supplemental Permit 3.00
Tigard, OR 9722: __ __..._•. _.__ _ _ .
639-4175 1) Furnace to 100,000 BTU 600
incl.dusts&vents
2) Furnace 100,000 BTU + 7 so
incl.ducts&vents _
Name of Development —^— 3) Floor Furndce Ill 00
incl,vent
Job Add 4 Suspended heater,wall heater 6 tv
or floor mounted heat
' , Vent heater
Address
Tax Lot Map N 5) not incl.in 1 Oo
Lot nock Subdivision appliance permit -,
Name(or name M business) 6) Repair of heating,refr ig., ti 00cooling,absorption unit
MailingAddress i Phone 7) Boiler or comp to 3 HP t. 00Owner � S � � ��� absorp.unit to 100,000 BTU - � I
city/slrle z' ip 8) Boiler or comp to 3 HP- 15 HP If oO
_absorp,unit to 500,000 BTU
Name ' �1 9 Boiler or comp 15.30 HP I F 00
absorp,unit 1/7•1 million
Melling Address 10) Boiler or comp to 30.50 HP
g 7,i_ ��3 E� to If/ — absorp,unit 1 -1.75 million
Contractor ciyrState Zip 11 Boiler or comp to 50 HP 11 Fri
absorp.unit 1,750,000 BTU
--
State RegistrationWo City sus lax No 12) Air handling unit to FO
10,000 CFM
1
I hereby acknowledge that I have reed this application that handling unit that the Information given is 13) 10000 CFM + . tit
oorTed,that I am the owner ar authorized agent of the owner,that plans submitted are In ,
-
compliance with State laws,that I am registered with the Slate Bulkiers'Board,that the 14 Non portable
number given Is correct (it exempt from Stale registration please give mason below) ) 4 h0 evaporate Cool r
-- / cq�>✓� u]a- 1 G�P,,-bl d t 5) Vent tan conn d - 3('X)-7- - to a single duct -^f
- - - --- ------ -- - 16) Ventilation system not 4 %0
Included in appliance permit
--- ---- -- _ 17) Hood served by --^-__ 4 SO
mechanical exhaust
g
Sina (owner 0,(owna•awl) --- —-Date 18 Domestic type -_---- ! so
Describe work D addition 0 alteration D repair 1-1 Incinerator
to be done residential 0 non-residential W t9) Commercial or industrial 30 M
type incinerator
Existing use of — -
buildit or property Other i.e„woodstove,war e .
g p p y -- 20) heater.solar,clothes dryers,etc. a �q
Proposed use al -•
building or property --_
21) Oafs piping one to four outlets 200
Type of lue!_ oil I I - natural gas IA LPG, ( i electric I I J - -`- -
22) More than I-per outlet
ROME — BUS-TOTAL
THIS
THIS PFRMIT BECOMES NULL AND VOID IF WC K OR CON --- - - - --- - - -
STRLICTION AUTHORIZED IS NOT LOMMENCED WITHIN 1811 4%SURCHARUE
DAYS, OR IF GONSI'RUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 23%OF SUS-TOTAL
ABANDONED r OR A PERIOD OF 180 DAYS AT ANY TIME AFTER ---_---- - --
W7RKISCOMMENCED -- - TO'iAl �^L
Special Conditions
--.. Dale Issued 1 ---by 't
CITYOFTI ►ARD No. 21444
1312.5 S.W. HALL BLVD.
P.O. BOX 23397
Date
TIGARD, OR 97223
Name
Addresz
I
Lot Block/Map SubdlvislonlAddress
Permit M's Bldg. Plumb Cash Cneck
Sewer Other Other Rec. By
op
Acct. No Description AmoUnf
10.432. Building Permit Fees
10.431-600 Plumbing Permit Fees_ _
10.431.601 Mechanical Permit Fees
10.230.501 State Bldg. Tax
10.433 Plans Check Fie
30.443 Sewer Connection
30.444 Sewer Inspection
51.448 Street Syst. Dev. Char
52.449-610 Parka I Syst. Dev. Charge
52.449.620 Parks II Syst. Dev. ChArge _^
31.450 Storm Drainage Syst. Dev, Charge _
10.430 Business Tax
10-434 Alarm Permit
10•227 Bail-'-�-i---��_�_
10.455- Fines - Trafflc/MisdlParking
10.230- CPTA TrafficlMisd/Vic. Asst.
10.456 Indigent Defense
30.122.401 Sewer ServIce1USA ��-
30-122.402 Sewer Service/City 30%�
30.123 Sewer SevlcelCity Maint.
30-125 Unmatched _
31.124 Storm Drainage
40.4 Bancroft Prin, Pyml.
40••471 Banaoft Int�y-m't.
TOTAL
CUSTOMER CUSTOMER
rriirro : 5•i MLGIL —mom