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INSPErTION NOTICE
City of Tigard Building Departmen+.
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
1 Type of Inspection —� '
Date Requested____C � _ - Time A.M. P.M.
Address Permit #
I/�^
Owner — — u Z U""`_ Lot #If-
BuilderThe following Building Code deficiencies are required to he corrected.
Presented to __ -___ _ (' App,oved
Inspector — , —_ ---_�_ �__� Disapproved
Date -- J' z / --
CALL FOR REINSPECTION
0 YES FA NO
s wr � t■r
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Receipt #�1-9a
CITY OF TIGARD MECHANICAL PERMIT
Permit #
.:�
Description —
Table 3A Mechanical Code _ QTY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Bax 23397 ---
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents 6.00
2) Furnace 100,000 BTU 7.50
Incl.ducts&vents ,
Name of Development 3) Floor Furnace 6.00
^ incl.vent —
Job Address 4) Suspended heater,wail heater 6.00
Address -` I':i or floor mounted heater _
Tax lot Map No. 5) Vent not incl.in 3.00
Lot Block Subdivision appliance permit
—�~ Name(or name of business) Repair of heating,refr lg.,8) cooling,absorption unit 6.00
Mailing Address phone 7) Boiler or comp to 3 HP 6.00
Owner 0 s
I^ r :* i absorp.unit to 100,000 BTI)
City/State Zip 8) Boiler or comp to 3 HP-15 HP 11.00
T, 4 , J absorp.unit to 500,000 BTU
Name — Boiler or comp 15-30 HP
9) absorp.unit 1/2-1 million 15.00
Melling Address phone 10) Boiler or comp to 30-50 HP 22.50
T6 // absorp.unit 1-1.75 million
Contractor City/State Zip 11) Boiler or comp to 50 HP 31,FJ
c- c
17 Rr • absorp.unit 1,750,000 BTU
State Registrntlon No. qty Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM
I hereby acknowledge that I have road this application that the information given Is 13) Air handling unit 7.50
000 CFM +
correct,that I am the owner or authorized agent of thu owner,that plane submitted are in 10, ----
compliance with State laws,that I am registered with the State Builders'Board,that theNoi I portable
number given is correct.(If exempt from Slate registration please give reason below). 14.1 evaporate cooler 4.50
) Vent fan connected
to a single duct 3.00
- Ventilation system not
18)) Included in appliance permit 4.50
17 Hood served by — 4,50
mechanical exhaust _
Signature(owner or agent) Date ) Domestic type 7.50
Describe work [I addition El alteration repast El 18 incinerator
to be done residential FJ non-residentia ❑ __-- 19) Commercial or industrial 30.00
Existing use of type incinerator
buildingor properly _ _ 70) Oehlersolar,clothes ove,water
t sr,etc. 4.50
,
Proposed use of -- ---
building or property _ _--.—.—. 21) Gas piping one to four outlets 2.00
Type of fuel- oil O natural gas I' LPG I_I electric i 1 --.
22) More than 4-per outlet
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK O!-t CON --- — — ---
r S'1 RUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONS'rRUC PION 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 _