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9567 SW WASHINGTON SQUARE ROAD t r �► t 9$59 SW WASHINGTON SQUAkr: ROAD Z b 3 h b H ' -0I i 1 NV z ' �+o Lr, s °0° d w f l . E-• q O0 4" O En fn ►moi/M J �] °? O Ln J O w r- 0 1� rn > m q V 7 «+ �' do to 14 1 INSPECTION NOTICE City of Tigard Building Department Pd, Box Tigard, Oregonon 97 97223 Phone 6394175 Type of Intpeetbn -- _ -.__-_ Date Requested ___ J Time A.M.--P.M. Address �jr'7 rtc "L _ __� Permit 21 L. Owner Lot Z Z Builder _ - The following Building Code deficiencies are required to be corrected: Presented to — Approved Inspector _ _ Cl Disapproved Date J CALL FOR FOR REINSPECTION W s =Ar111!JEF w _ -- MECHANICAL. PERMI1 CITY OF TIVA RDPERMIT' NO . : MESa023:3 CfTyC;LrM OATE ISSUED: 3/:31./88 COMMUNITY DEVELOPMENT DEPARTMENT PRIM. PMT .NU. 880232 13125 S.W.Hall Blvd..P.O Bow 23391.Tigard.Oregon 97223A503)839.4115 ..ICIF.i ADDRESS : 9567 SW WASHINGTON SQ RD --- - —- 'T AX MAF>/I...(IT SUR : WASHI.NGI ON SQUARE'. LT : BK : L-AND USE 1-.OT SIZE : NO' NO: WORK (A-ASS : Al-TERAI ION FURNACE ;.100K AIR HANDL-P <10 USE: TYPE. : COMMS W"IAI.- FURNACE- 100K+ AIR HANDL.R 10K CONS I .'TYPE : 1:1.F F'1 FI—OOP F11RNACF E:VAP . COOL.-EA OCCUP ,GRP . 1312 HEA'T't:P VENT FAN VENT VE.141 . SYSTEM k3C_FT/Comp <3HP HOOD NO . STORIES : 1. RLP/COMP ',3-1.314P INCI NE:RATUR(DOM DWE L.I... .UNI T'S : HLR/C:OMP 13 30PP INCINERATOR(COM I- UFA- 'T'YPE: GAS 91-R/C:OMP 30•-50HP PE:PAIR UNITS 1 MAX . INP(.1T HL..R/(:OMP 30+HP OTHER FIRE. DMPR57 GAS PIPING OUTL..E:1'S HIGH PRESS7 I._.OW V�PE.S57 REMARKS : 'T r-ri ft n t M rt d •- a l t rrl.r cn x i 1a t i.n U am y to t IM tr, . Matc:•halnivarl I"ver ino.hicl ld to 81ciU P*ir• #*Aa Wi.nmear CnMPmrmy C="lac- shrtima 5hon PE'NMIT ♦10 . 00 W FLAN RE:V1'E:W •4. 00 N T IGARO FIXTLIRE is •6. 00 F STATE. l AX • 90 rt OTHER C SARRY BIL.L N S;PEI.IAI.' Y RE:MODi. -IN(-. T 1 1FIiy"15W 'PEEN IPG AO . R TiUmarri (1R 97P-P3 A C PHOW (10' 20�-"7w 1.1. T RE U 113 114 ION 50 130 TOTAL.. : $20 90 t) I RjjCE:IPLT1 No This pprmit Is Issued subject to the regulations contained In Title 14 RE Q1.II RE:D INSPECTIONS of the TMC State of Oregon Specialty Codes toning regulation% And all other appllcablp codes and ordinances, and it is hereby IN5Ul.ATI(:IN agreed that the work will be done in accordance with the plans and GYP HOARD specifications and in compliance with all applicable codes and MECHANCL . SYSTE:M ordinances The issuance of this permit does not waive restnctivp SUS VEND.CEIL.ING covenants Contractor and subcontractors shall havp current ON FINAL business tax permits This permit will expire and become null slid void If work Is not started within 180 days.or If work is suspended or abandoned for n period of 180 days any time atter work has commenced It%hall he onsibility of the permittee to assure all required I wr.0 pre uested and approved per tee Signa Ilrr' CALL.. F 011 1 NSPE.171 ION tSA9. 41 1*$ is%upd By -- SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE E)I.11 L.1:1IN(; PERMIT CITY ®F TIFA RD I'E ftMl Y' NO E�UE3(HOi?32 CITY Of TT6AND COMMUNITY DEVELOPMENT DEPARTMENT O1f°°" DATE.. ISSUED : 3/31;88 13125 S.W.Mall Blvd,P O Box 23397,Tigard.Oregon 97223.1503)639-4175 N R I M. PMT . NO . 880232 JOB ADDRESS : 9367 SW WASHINGTON S1;( RD --- _ I AX MAF /L.C.)T 1S126(.:a./101 SUB : WASHINGTON 5GTUARE L..T : SK LAND USL : LL)T SIZE: : Mala VAI_.UA'T'XON : M in ,000 SETBACKS FRONT: PF:AF WORK CLASS : ALTERATION DWF::.L.L.. .UNITS : L.EF'T : 1:41GHT . USE:: TYPE:: : COMMI-i'PU I:AL NO. HF'DROOMS : E::X r .WALL. CONST CONST . TYPE VN NO. MATHS : 1 N : 5 : F• W OCCUP . (.,RP . 82 PNC)'T' .OPENINGS : L)C:CUP . LOAD 20 N : S : E W TOTAL.. AREA : 1,13P. NO . STORIES : 2 IST : 1:317 ROC.)F CONST . FIRE RET7 2ND A15 e4P :A CF.--.:PAP'? YE::S RATED . 1 HR BASEMENT'? NO 3RD: OCC:UP . SE:PAR7 YES RATED : :L HP ML7ZANI:NE'7 YES HASE'M'T FLOOR LLIAO: 100 GARAGE TIRE: SPRKLP7 YES ALARM? FLOW((;PM) DETF.C7 7 1-*'i.A r FYT'E : GAS, HDC.'P. AC'CESS7 YFS CORR7 PI-AN Co"FOCK fly -- - -------- Tw+na►nt. HOd/1-00104101 . "Othrer"ort Pwr•mi.t F we REISSUE: OF NO Srha►dul.el .1.%& I'Iur• Matehan1c!w1 Permit. f.,00. LAST RL:ISSUF F Icirslhati.m ShoeShopss PERMIT 11110 . 50 O 1:3p 50 . Canal. St S1.1i.to 200 PLAN PEV1EW •71. 1�� N Ch-kc-'ago 11 60!104.1 F IRE DEPT MAA.20 E R STATE' TAX 1111-031 , 33 OTHER 1120 80 D";�VEL_OPME::NT C:HA1W;Vs C BARRY 81LL SOC(STORM) S N PE.L'TAL T Y ALMODEL.1N( T' , DC l SRE:I=T 1 N T 1 1"P,15SW G4)P-1 NHIJRG RD. PDC 1 i 1 R Tigard C)Fi 97frP3 A PREPAID i 11111249 . 510> C PHONE (50 1) 620—%'i 1]. T RF.GXS'T'RA'TXI:)N NO. 70730 O T(31 AI_. : 0 P ni.3 R -- RE:CEiP7 No. This Permit is issued subject to the regulations contaired in Title 14 of the, TMC State of Oregon Specialty Codes,ronirT requistions REWLTERE-D INSPECTIONS and sit other applicable codes and ordinances and It is hereby F`RAMING agreed that the work will be done in accordance with the pians and GYP. BOARD A pecifications and in compliance with all applicable codes and MEi:CHANCL . SYSTEM ordinances The issuance of this permit does not waive restrictive covenants Contractor and subcontractors shall havn current city SUSPEND 'L.E 1.L ING business'ax permits This permit*111 expire and become null and OT HE;RI(1 void it work is not started within 180 days or if work is suspended or F"I NAL. abandoned for a period of 180 days any time aftor work has commenced It shall be the responsibility of the rermiltee to assure all require actions are requested and sp ved Perms tea Signature *Am needed Issued By r, (.ALL FLIM IN5PECTIoN 6:3ri.-4t 7:5 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE CITY OF TRt7A RD March 19, 1988 OREGON Rill Barry Specialty Remodel 11825 SW Greenburg Road Tigard, OR 97223 Project: Florshulm Shoe Store Building Permit No. 880232 Dear Mr. Barry: The revised plana for this project have been reviewed for conformity with applicable codes. the plans are approved subject the items specified by Washington County Fire District No. 1 anti the following: 1 . The second floor guardrail shall he at least 42 inches in height. The plans indicate 36 inches. 2. The stairway handrail shall be mounted between 30 and 34 inches above the nosing of treads and continuous the full length of the at-tirs. Handrail ends shall be rP,urned or terminate in newel posts or safety terminals. The Mechanical Permit, No. 880233, Is also ready. The balance due for both permits is 0.95. if you have anv questions or if we may he of assistance, contact us at any time. Sincere , im J us Plans Fxaulner sh/37831) eel Bob Stonehurner David A. lldkow, RA Gene ilirchill 13125 SW Hvll Blvd ,P 0 Box 23397,r1gord.Oregon 97223 (503)039-4171 Washington County Fire District No. 1 ,qJ1kJW ,0,i# �* Cit of Beaverton Fire Department Tualatin Rural Fire Protection District Februnry 18, 1988 Mr. Bill Barry Specialty Remodeling 11825 S.W. Greenburg Tigard, OR 97223 Dear Bill, RE: Florsheim Shoes 9567 S.W. Washington Square Road A fire and life safety plan review wag conducted on the above- captioned project for compliance with the 1985.editions of the Uniform Building Code (IIBC), Uniform Mechanical Code (UMC), and the Uniform Fire Code (UFC) as amended by Washington County Fire District No. 1's Ordinance 86-1. The plans ate approved subject to the following items. I. Existing Service Corridor: Existing service corridor shall be of not less a 1-hour fire resistive construction. Openings shnll be protected with Automatic or self-closing 20-minute fire resistive nssembl.ies equipped with smoke RAsketing. 2. Storage Aisleway: Storage in the Aislewny system is -accep-tab a due to the number of occupants that occupy this tenant space including upper and lower storage rooms, However, siselwnys shall be maintained clear and free at all times for paggnge way through these areas. On the upper level this will be considered as A room. However, it ghnil temnin open and unobstructed. Additional wells shall not be Installed. i 3. A► proved Plaits on Job Site: One set of ntlpr,ived plans bear- ing the stamp% of the Tigard Building DPpnttment and this office must be maintained on the project site throughout all phnRrs of construction and must be made available to build- ing and fire inspectors for reference during required con- struction inspections. (UBC. sec. 101) Mt . Bill Barry Februnry 18, 1988 Pnge 2 4. Inspections Requited: IuspertIon •ind approval of ronstruc- t ion by a rePresentat.ive of titin (if fIre is tefluired: (n) prior to tite cover of any new framing element-, fom,wintt the installation of all utility run-, which will be conce+alpd Within wall And partition cavities; (b) upon rnmhletirttt of ronst.ruetion and prior to occupancy of the tenant space. (TIBC Sec.. 305) 5. Certificate of Occultancy Required: Prior tit the uee clad necupaticy of tiie prit eut (ci�gcPT, a certificnte (+f o ru- poncy or other written insUtiminit of npprovnl must be obtained from the City of Tigattl Building Ueptittment . (UBC Sec. 307) If I may be of any further service to you, 111-ri— feel flee to Kive me n call at 649-9577. Sincerely, WASHINGTON COUNTY FIRE'. PISTPICT N0. 1 V, Gene Birchill Mann Fxnminer ssw cc: Tipnrd Blatt. Dept . Inspector Ray NOTE TO INSPECTOR: This i+. n rerlut i itttt in the overnll size of this uccltpnttcy to R26 sgonte feet of rPtnil -,nle-, ntid rli-,i,lny nren with 400 feet of stoinpe flren on the firm fluor. This hives 1226 vqunre feet of total nren r►n the first fluor nnrl 400 gquni p feet ttf nt of ni, nren nn the nertitid f1,ior rllre,:tly above the first-flour stutat;e nren. An the total it@ ctipnnry due-, nett exceed 12 niM hui ldinr. +'alit, reyuilon twit exlts out of nit nren when SO or ItYtte people ate lurnteft till file Proitlltl, and CAI'volltl %toinge flint nren fines tlttt ext-ret) in, twu exits nre not requited, Ilius, stnt.ige sten 114 V0110dPlOd a Intim nntl only regniromptit Minh he 24-inch tilsle widths are mAintaln-tl :it :111 times. February 11, 1988 Mr. Lawrence B. Berkley & Associates Architects CiTYOF TIGARD 1.37 N. Wabash Avenue Chicago, IL 60602 OREGON RE: Florsheim Shoe Shop Alterations Washington Square, Tigard Dear Mr. Rorklev: The plans for this project have been reviewed for conformity with applicable cosies. The following items were noted as requiring revision or clarification. The code sectiona cited are from the Oregon Structural Specialty Code, 1985 Edition, which is basically the Uniform Building Code. Where sections with Oregon amendments are cited, a copy of the section is enclosed. 1. The plans are required to be stamped by an architect or engineer licensed by the State of Oregon. Sec. 302(b). 2. Steps in a private stairway shall have a maximum rise of 8", a minimum run of 9", and a minimum width of 30". Sec. 3306(b) and (c) . 3. Private stairways shall have a handrail on one side, continuous the full length of the stairs. Ends shall be returned or shall terminate in newel pests or safety terminals. Sec. 3306(j) . 4. The second level railing is required to be at least 42 inches in height. Sec. 1711. 5. Wall separating lease spaces from exits are required to be gine-hour construction. 5/8" or type "X" gypsum wallboard shall be installed on both sides of such walls. Sec. 3305(g) . We also note on the submitted plans that no ventilation is shown as being provided for the washroom. Also, thr type of wall finish in the wash-oom that is listed on the room finish schedule does not meet code requirements. Sec. 511)(c). We will conduct a review of the premises to determine how these items mA , he addrea9ed, and will work with you or your representative to Cearli An enrly agreement on any changes. If you have any questions cr if we may be of asAi9tAnCP , contact us at anv time. Sincerely, .a1 G Jim .laqua Plans Examiner cn/3168D Encl. ect Bob Stoneburner, Florahole Bill Barry, Specialty Remodel .'nP Atrehill, Fire District 1.1125 SW Noll Bivd .PO Box 23397,Tigard Oregon 97223 (503)639-4171 -- - ----- w w w Ns CITY OF TIFA RD PLACHECK APPLICATION F �� � PLAN CHECK COMMUNRY DEVELOPMENT DEPARTMENT o�eoowr PERMIT / g yp Z 131256wWwsw Po-*=2nw.rp.A0-www OM60 1n DATE ISSUED A- A33 JOB ADDRZSS: N 5 .� = �l,•sys r-'Al h"« TAX W.P/I.OT— SOB: T: LAND USE: VALUATIONS �O e3SETBACKS: FRONT:-- Rte: LEFT:_ RIGHT: - WORK CLASS: �n/�H _ HEIGHT: TOTAL AREA: USE TYPE: _ FLOOR LOAD: IST: L_ CONSTR TYPE: HEAT TYPE: 2ND' -Z— OCCUP GROUP: DWEUNNITS: 3RD: _ OCCUP LOAD: NO BEDROOMS: BASEMENT: NO STO11ES: NO BATHS: GARAGE: IMP SMYACE: APPItOVALS RWD i�Tte, �C4 014,;T' SPECIAL NOTES ITE SREQU SUBCON'11tD RS: PLANNING: ` 0•+« REISSUE OFT — ENGINEERING: J,11�t T REISSUE: BUS TAX: FIRE DEPT. : OD PLAIN/ CAi,CUIATIONS: OTHER: -- SEN LND.: TRUSS DETAILS: --- -� PARKING PLAN: LANDSCAPE PLAN: PLAN CHECK BT: OTMM: _-- COMKENTS: -- -=� - - �!lOUNT pyM}� 10--432 Building Permit Fee• NAMES Gt�ii���� �>-, 10-431-600 Plumbing Permit Feea _ ADDRKSSs 10-431-601 Mechanical Permit Feas 10-230-501 State Building Tax (52) : 10-433 Plana Check Fee =i PHOWIt 30-443 Sever Connelctiou (202) s 30-202 Sewer Connection (SO2) _ --- CONTRACTOR E.weR 30-444 Sever Inspection � NAMBs r' ,51-448 Street System Dev. Charge (SDC) - ArDRESS: A Parka I System Dor- Charge (PDC) : c gCl 52-449--620 Parka II System Dov. Marge (PDC) _ 31-450 Storm Drainag Syst Dev Chrg(SSDC) _ PROn: l AV - — 10-230-505 TM (932) _ 10-435 TRFD (52) � ARCH/gNG� 10-230-506 Washingtoo County Fire /1 (952) _ NAME: 1REn/`L- AECKLE� rA .40-435 Washington County Fire I1 ADDRISSs 10-220 AmartNedgevood _ - - TOTAL : 2320 PRONS' -/ A3— PREPAID - --— A_ BALANCR WS A PN. CANT SIONATRIt RtL 1 od Rv- 4 ')r nt s CITY OF TIVA RCHECK APPLICATION COMMUNn Y DEVELOPMENT DEPARTMENT MOON PLAN CHP.CK / 13125 SW NA SW P.O.Eke 23397.rid.Oregon arm(sb)630-417b PERMIT —, DATE ISSUED JOB ADDRESS: _ _ TAX MAP/LUT i;;/ ;Z,�cL SUB: LOT: _ LAND USE: VALUATION: Q Q O SETBACKS: FRONT, REAR: LEFT: RIGHT: WORK CLASS: ar—T-- HEIGHT: i TOTAL AREA: /3y/ USE TYPE: ,.,,_. FLOOR LOAD: 1ST: CONSTR. TYPE: HEAT TYPE: 2ND: OCCUP GROUP: DWELL/UNITS: 3RD: OCCUP LOAD: — NO BEDROOMS: BASEMENT: NO STOI:IES: NO BATHS: GARAGE: IMP SUKFACE: APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED PLANNING: _ REISSUE OF: LIST SUBCONTRACTOR51 ENGINEERING: LAST REISSUE:__ BUS TAX: FIRE DEPT. : --- FLOOD PLAIN/ CALCULATIONS: OTHER. _ SEN LND.: TRUSS DETAILS: PARKING PLAN: LANDSCAPE PLAN: PLAN CHECK BY: OTHER: COMMENTS S ; A CTDSFTFON UNT OWNER 10-432 Building Permit Fees NAME: %/���r,,.;, 10-431-600 Plumbing Permit Fees ! ADDRESS: 10-431-601 Mechanical Permit Fees ! 10-230-501 Stai:e Building Tax (51) _ 10-433 Plans Check Fee ! PHONE: 30-443 Sewer Connection (20x) ! 30-202 Sewer Connection (80X) ! CONTRACTOR -444 Sewir Inspection = NAME: vnc. .51-448 Str-set System Dev. Charge (SDC) ! ADDRESS: �, a_ .. '•52-449-610 Parks I System Dev. Charge (PDC) _ 52-449-620 Parks II System Dev. Charge (PDC) _ 31-450 Storm Drainage Syst Dev Chrg(SSDC) ! _ P11ONF: 10-230-505 TRYD (951) _ 10-435 TRFD (32) ! ARCH/ENGINEER 10-230-506 Washington County Fire /1 (951) _ NAME:_ r _ r1 e.41 10-435 Washington County Fire /1 (51) ! ADDRESS:--- 10-220 Anart/Wedgewood ! v TOTAL ! •O S PHONE: PREPAID =� 9f W_ RFC / BALANCE OUR ! 2, 9 A—PP I, C—.A'-R7 F S1aNATURF .. p �9Al . s S�av oh Qom'� #,2.64 ?.S o� intro• . Ire?- 4�a wr abort Received By: Date Received: ■ PLAN CHECK APPLICATION C17YOFTIGARD 0Fn6A; RD PLAN CHECK COMMUNflY DEVELOPMENT DEPARTMENT 171:5 SW iiW BOM P.O.Sm 23)97•Thud,Orogm grM(UM)&V A 175 PERMIT DATE. ISSUED JOB ADDRESS: � ,;, , � ='— TAX MAP/LOT SUB: LOT: LAND USF.: VALUATION: , SETBACKS: RONTS REAR: LEPT:_ RIGHTS WORK CLASS: a�T. _ HEIGHT: TOTAL AREA: USE TYPE: FLOOR LOAD: 1ST: CONSTR TYPE: HEAT TYPE: 2ND: OCCUP GROUP: ,Z DWELL/UNITS: 3RD: _ OCCUP LOAD: „e NO BEDROOMS: BASEMENT: _ NO ST011ES: ; NO BATHS: _-� GARAGE.: IMP SU::FACE: APPROVALS REQ•D CIAL NOTES ITP1fS REcJUIRED PLANNING: �Q1REISSUE OF: LIST SUBCONTRACTORS: ENGIKEERING: '*" Sp '/ LAST REISSUE: BUS TAX: FIRE DEPT. : _ - _ �� I�XLOOD PLAIN/ CALCULATIONS: 0111ER: ( SEN LND.: TRUSS DETAILS: 2ARRING PLAN: _ LANDSCAPE PLAN: _ PLkN CHECK BY: _ OTHER: COMMENTS: n.h�,t Al CT f DESCRIPTION - 1MOUNT OWNER 10-432 Building Permit Fees NAME: ZN,�>,r,1�� ` 10-431-600 Plumbing Permit Fees s ADDRESS:_ _ 10-431-601 Mechanical Permit Fees = _ 10-230-501 State Building Ta: (52) _ 10-433 Plans Check Fee r- _ 7-ty SIL PHONE: 30-443 Sewe, Connection (20x) _ 30-202 Sewer Connection (80x) _ CONTRACTOR ,t.4. 11... r, 30-444 Sewer Inspection = NAME: ,,� r4� ;_o, .51-448 Street System Dev. Charge (SLC) _ ADDRESS: . - 'h' -> �. r,•f f-,L���t, :•52-449-610 Parks I System Dev. Charge (PDC) _ w:.. �_ '��• 52-449-620 Parks II System Dev. Charge (PDC) "►,^^W. 31-450 Storm Drainage Syst Dev Chrg(SSDC) PHONES ; ,�t� j 10-230-505 TRFD (95x) _ - 10-435 TRFD (5X) _ ARCH/ENGINEER 10-230-506 Washington County Fire /1 (95x) _ NAME: � - }�ECti�[ t/1 . a0-435 Washington County Fir e I1 (52)0. ADDRP.SSt 10-220 Apart/Wedgewood _ TOTAI, PHONE: . : t PREPAID REC BALANCE DUE APPLLC".HT SIGNATURE--�-�- \ Received BY: Date Received: � t ■ t /CIT'*V' 0F TIGARD MECHANICAL PERMIT Receipt dl Permit N IV.2 "� 3 __ Description Table 3A Mechanical Code OTII P MCE 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 Furnace to 100,000 BTU 1) incl.ducts&vents 6.00 Furnace 100,000 BTU 4 2) incl.ducts 8 vents 7.50 Name of etopment Floor Furnace _ �L_ 3) incl.vent _ 6.00 Job grass nye�yi4) Suspended heater,wall heater 6.00 Address _ f or floor mounted heater Tai Lot ap No 5) Vent not incl.in appliance permit 3 .00 Lot Block Subdivision _ Name(ni name of b„sineas) 6) Repair of heating,ref Ig., 600 cooling,absorption unit 16.00 Mailing Andreas — Phone - --- Boiler or comp to 3 HP Owner 7) absorp.unit to 100,000 BTU 6'00 city/State _— -- zip -- Boiler or comp to 3 HP-15 HP �- 8) absorp.unit to 500,000 BTU 11.QO Name 9) Boilor or comp 15-:t0 HP _absorp.unit 1/v-1 million 15.00 Malting Address -- -vtarr 10) Boiler or comp to 30-50 HP 22.50 absorp.unit 1 •1.75 million Contractor cey'sale --- - zip 11) Boiler or comp to 50 HIP 31.50 abst,rp.unit 1,750,000 BTU State Registration No -- — City Bus rex No 12) Ali handling unit to 4.50 10,000 CFM 1 hereby acknowledge that I have rear: thea applrration that the iMomation given is 13) Air handling unit 7.50 + carred,that I am e owner or xxi auttzerf agent of the owner,that dans submittedsubmittedt0,000CFM are in - compliance with State laws,that I am registered with the State Buildws Board,that the Non portable raxttber given is correct (H exempt from State registration pfease give reason helow) t 4) evaporate cooler 4'50 Vent fen connecled ---—�- t 5 to a singie duct 3.00 --__ Ventilation system not _ 19) Included in appliance pet mit 4.50 17) Hood served by 4.50 mechanical exhaust sww`xe(owner or agent) - ----- Dole Domestic type Describe work ❑ addition [Ialteration S repair El 18) Incinerator —� 7.50 to be done - residential [I non-residential a 19 Commercial or industrial _W 30-00 Existing use of ) incinerator building or properly i Other i e ,woodstove,watef 20) heater,solar,clothes dryers,etc. 4.50Proposed use o1 ------.- _--. building or properly.-- 21) Gas piping one to four outlets 2.00 Type of fuel oil F] natural gas I I LPGs I 1 electiic 22) More than 4-per outlet "QT1-C9 SUWTOTAL THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON - STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S% 41%SURCHARGE r DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUWTOTAL f.00 ABANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER ---- -- — WORK IS COMMENCED TOTAL Spddal Conditions .----- I)ata issued --- . ---- by - ----- - _. . - --- .