15185 SW 79TH AVENUE WIN
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CITE' OF TIGARD c # F'. . . . .
FER1�117' #. . . . . . . ME:C96-•088
DATE ISSUED: 08/20/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 67223.8199 (503)839-4171 PARCEL: GS 1 1`CA-04400
iv liU DRLSI,:. . . . . 15185 SW /') I-ll NVE
SURD IVISION. . . . : DURHAM ACRES ZONING: R 4. 5
BLOCI•:. . . . . . . . . . . LOI.. . . . . . . . . . . . . . .b
CLASS OF WORK. . :ALT FLOOR FURN. . . . : 0 EVAi COOLERS: 0
TYi*'E OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
UCC t)PAIVCY GRP. . : RS VENTS W/O A{='1='I_: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 17.1 POILERS/COMPRESSORS HOODS. . . . . . . . 0
!
FUEL TYPES_.______________ 0--3 1AP. . . . : 1 DOMES. I IVC I N: 0
: /GAS/ / / 3-15 HP. . . _ 0 COMML. INCIN: 0
MAX INPUT. 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FI REE DAMPEF ?, . :30--50 HP. . . , s 0 WOODSTOVES. . : 0
GAS PRESSURE. . . 0+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF' UNITS----------- AIR HANDLING UN I TS OTHER UNITS. : 0
FURIV ( 100K BTU: 1. (_ 100011) cf n : 0 GAS OUTLETS. - 1
FURN ; =100K PIU. 0 > 10100 cfm : 0
Remar-ks : Add frrrnacc and a/c
Owner-:
KEITH BgRiJUM type amol.rnt b/ date 1)F _ pt
15185 SW _,'r_-H PRMT $ 25. 00 JDA 08/20/96 96 263114
;PCT $ 1. 25 ,JDA 08/20/96 96--2:1831 14
T I GARD OR 9 7LCC_4
Phone #: 639-27L4
UUNTRACTOR 1\107 ON FILE
Phcne : $ 26. 25 TOTAL
Req #. . .
R'.EQU I REL I NSPE[:T I ONS -----
This permit is issued subject to the regul,tions contained in the i+lec:ha:-rical Insp
Tigard Municipal Code, Sta►e of Ore. Specr,aky Codes anu all other Mise. Inspection
applicable laws. All 4ork will `^ done in ac,:ordance with Final Inspection
approved plans. T,is permit will exp,.•@ if worth is not started
withi 1 180 days o. ssuance, or if work .- suspended for more
than 180 days.
N ( ermittee Signatr_rr e : �� �n-•-•..,.—
-- I r
v Cal l for inspect ion 639-4175 1
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspecti,)n Line: 639-4175 Business Phone: 639-4171
Footing Hain Drain Cover/Service
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing
Plbg.Und/Flr/Slab Plbg.Top Out Insulation Osct�w.
Post/Beam Struct. Mech. Rou h- Gyp. Pd. -Bldg.
San. Sewer it Appr/Sdwik Reins.
Other: –-
Date. _ 6 A.M. Entry: —J
Addie^•s:
-- `
Tenant: te:_� MST: _
� �•� a PUP:
Con/Own: _ MEC
PLM:
ELC: _THE FOLLOWING CORRECTIONS ARE RFOUIRED: ELR: _
Inspector" __ --- _ Date: ��
PROVED __DISAPPROVED/CAL! FOr1 9F.INSP. CF CO
Plan Check#
CITY OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P E._
(503) 639-4171, x304 Date to DST
Print or Type Permit#
Incomplete or illegible applications will not be accepted Called
Name of DevebornenVProleci Desc nption -7PRICE
Table 1A Mechanical Core OlY AMT
job Street-Address-- Suite# A) Permit Fee -0- -0- 10.00
Address 1 ,i) .L'� C Lii2 ..
Bldg# citylstate Zip B) SupplerrAntal Permit 3.00
Name(or name of busine s) 1.) Furnace to 100,000 BTU It 6.00
Owner �� 'c� incl.ducts&vents
enlinn Address 2.) Furnace 100,000 B"rU+ 7.50
incl.duds 8 vents
C. 16ia'e Zlp Phone 3.) Floor Furnace `V 6.00
1' .4 '17-ti' ind.vent
Name 1 name of bualneu) 4.) Suspended he?ter,wall heater 6.00
or floor mounted heater _
Occupant Mailing Andress 5.) Vent not incl.in
3.00
appliance perm'
City/State zip Phone 6.) Boiler or comp,heat pump,air Gond. 6.00
_ to 3 HP;absorp unit tr lUOK BTU
Name 0 w ti« 7.) Boiler or comp,heat pump,air Gond. 11.00
3-15 FIR absorp unit to 500K BTU
COntrartOr Maiw pdq is f + , f B) Boiler or comp,heat pump,air cond. 15.00
�� 15-30 HP',ab^.orp unit 5-1 mil BTU_
Attach copy of C-415tate Zip Phone ` �s 9) Boiler or comp,heat pump,air cond 22.50
Current Licenses " � } )? 3 1 30-50 HP;absorp unit 1-1.75 mil 9TU
C,,epn Const Cont Bard Lic# Exp Date 10.) Boiler or comp,heat pumo,air cond. 37.5p
>50 HP;absorp Lnit 1.75 mil BTU
CDT Business Tax or Metro# FXp.Date 11.) Air handling unit to 4.50
_ 10,000 CFM _
Afchitect Name 12) Air handling unit 7.50
10,000 CTM+
Or Marling Adareas' i 13.) Non portable 4,50
evaporate cooler
Engineer CitycState --- p Phone 14) Vent fan connected 3.00
to a single duct
Describe work New O Addition O Alteration 0 Repair O 15.) Ventilation system not 4.50
to be done Residential 0 Non-residential O included in appliance permit
Additional Description of work 16) Hood served by
mechanical exhaust 4.50
tc 17) Domestic incinerators 7.50
Existing use of 18) Commercial or industrial 30.00
building or property_ r�� /' f pe incinerator
19) Clothes dryers,etc 450
Proposed use of 7 20) Other units 4.50
building or property
Type of fuel-oil O natural gas 0' LPG O electric O 21) Gas piping one to four outlets 2,00 �
,77 1'iereby acknowledge that I have read this application,that the 221 More than 4-per outlet (each) 50
information givens correct.that I am the owner or authoued agent of
W tie owrer,that plans submitted are in compliance with Oregon State J
� P P 9 QTY.SUBTOTAL � I
laws _
Signature of Owner/Agent Dale 'SUBTOTAL
1' , 00
5%SURCHARGE
Contact Person Name Phone PLAN REVIEW 25%OF SUBTOTAL
14A
TOTAL
i 1dst%mechpmt duc Mlnlmum t ermit fee is$25+5%surcharge
Rev 7196
Pcrmit #: MCC�6
Aciclrctis:
I�,sucd by: _ _(=C is ��` Date:
Statement: Information Notice to 111'roperty Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building ermit can be issued. This statement is required
for residential building, electrics mechanics , and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement, This statement will befilled with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313:
X ® 1. t own, reside in, or will reside in the completed structure.
X 2. I understand that I must register as a construction contractor if the st;ueture is sold or offered for sale
before or upon completion.
❑ 3A. Nly general conte actor is —
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
It'll hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
"' registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
J
:° I hereby certify that the above information is correct and that I have read and do understmid t he I nfm at ion
LLNotice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)