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MECI IAN I CAL-
( ITY OF T I GARD PERMI'T
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT 0. . . . . . . . MECI-)4--01 b
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 DATE ISSUED: OG/CO/04
P0R(7,FJ_!
..,Tr,- nr)DRESS. . ' 4175 r3W 11PTH AVE
'11.213ADIVISTON. . . . C,-)LES Ab"ZS ZONING R-4. 5
2! OcK. . . .. . . LOT. 4
Or WORK. . :A!...T FLOOR TURN. . . . : EVnP COOLERS:
YC', OF USt. . . . :SF UNIT HEATERS. . ; VENT FANS. . . .
r)Cf'l JQQNCY GRP. . -R VENTS W/O APP1_- VLNT SYSTEMS:
,;,roRTE9. . . . . . - . 1 SOIL.ERS/COMPRFSSORS. HOODS. . . . . . . :
'71jEL TYPES---- 0-3 Hr. . . . DOME S.. INCTN-.
3-15 HP. . . . COMML. INCIN:
MAX INPUT; 11TU 1 0 1-1p. • RErIAIR UNITS:
"IRE DAMPERS% . : 30 50 HP. . . . WOODSTOVEE). . :
r.,RESSURE. 30.(.. 11P. . . . 0_0 DRYERS_-
OF qip mNDL_ING UNITS OTHER UNITS. : l
":-I)P N ! 100K BTUs I <= 10000 r f m : P T S. .2,
(.11RN �=1.1211121K BTUs > 100@0 rfm:
Remar-ks - ELECTRTC 'r(I rQc'. CONVFRSTON
FEES
7_1111,' nENAGNT type ainot.int by date r-ecpt
PRMT I, C5. 00 GW 06/20/014
2 'W10G/C0/ )4
. 17S SW 5PCT $ 1. 25 S
OR 972,-14
Carit-.-Ac-t at-:
0 1. 0 HFnTING/r0C3i_TNG
01. 0. BOX 1P66
1'-QNnV OR 97055
pl—.1TIC #: $ 26. 25 TOTAL_
Rag *_ .- 87071 REOUIRED INSPECTIONS
rib perut it issued subject to the eegulat.',ns contained in the Gas Liiie Insp
Ti,:,rl Plt"irivl !'-4- '—p of Ore. Specialty Codes and ail other MprhwitcAl Irgp
applicable labs. All work N111 be done in accordance with Firia l InrpertAion
app.-cyvd plans. "Ns permit will expire if work is not started
`.'-i , 189 days of issuance, or if work is vispended for more
'no days.
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rp.i I f n- in-,p. prt i ol 639-41715
----------------
/./ iNSP$CTION N(YI ICE
Cl.ty of Tigard Building Departnient
13125 SR Hall Blvd. T1.9ard, Oregon 97223
Inspecti/u�n Line (Rec-O-Phone): 639-4175 Business Phone: 639-4,171
Inspection: /�C ' Lys 5 C.. Cvl /.c�ct-,�i1 h PC.[-P-t�
Footing Plbg. Underelab Meech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requeated:_ l� 1 _ Timet _AM ___PM
Addr... �I � 1 /tel.�r t=��c �y- ✓/ /
Permit 1:
Builder:
Tilt FOLLOWING CORRECTIONS ARE REQUIRED:
30 ; - v 00s,5/.b Le
-'.i c 0- a-C It'e.KJ/L 11 CL"�
15 91
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inspectorsDate: l
APP1lOVED DISAPPROVED APPROVED SURJECT TO ABOVE
-_Cal: For Retnep.
INSPECTION NOTICE 1
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
nspection Line (Rec-O-Phone): 639-4175 Buaineas Phone- 639-4171
nepection:_ -��c c/ )a 17 1 CQ_c --- -----
Footing Plbg. Undorelab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sower Framing -Bldg.
Poet/Beam Merh. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line q / Gyp. 8d. -Hoch.
Date Requel /��
s(ted t CP - / �7 TH�imet AM/'�___PM
/
Addreast / / I Pecmt � V#t /
l� T /
Builders ' /1 C /7 } ccz_ _—Qq -- 27 $' —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector. !" Datae._(±�-L?�-�—�-
APPIlO 2? __ DISAPPROVED 1"PROVRD sURd'RCT To ABOVR
Call For Reinsp.
I T G1-1R1.) P t I j 'I ICI ()F- I fil AJ 111 1 NO. 9
1 1, IMF
0. BOX 1;'f,6 PAYMEN I DH I I
F,ANDY, OR SIM D I V P-if i.I IN
9 70,505-
11 Vllymf H I 14WHINT Pfill.) PLIWOBF OF t-,lAYMV-NI I-IMMINI 1=,A 11)
pui. 00 91'. HI. DA) WR
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1(lit-11. ()PPILINI PAID
City. of.Tiga;d MECHANICAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION Pera-lit # _
Tigard, OR 97223
(503) 639-4171
meDescription
Tabl•a 3A Mechanical Code QTY PRICE AMT
e .`
Job y �S /r //� 1) Permit Fee -0- -0- 10.00
Address ---
2) Supplemental Permit 3.00
-�oname of Nmw"j Furnace to 100,000 BTU
incl. ducts &vents 6.00 i
Furnace 100,000 STU + i
Owner ��' � -� 2) incl. ducts &vents `7.50
56-r-Furnance
3) incl. vent 6.00
--S-uspe-5-5U heater, wall heater
4) or floor mounted herter 6.00
OCCU ant y ent not inc rn i
P i(�-1
5) appliance permit 300
zv - }repair of hieating,re ri7 ig.--
6) cooling, absorptior unit 6.00
Boiler or comp, heFt pump, air con
7) to 3 HP; absorp unit to 100K BTU 6.00
over or comp, heat pump, a,r con
Contr,3ctor i7�S�S 8) 3-15 HP; absorp unit to 500K BTU 11 00
_ ° offer or comp, eat pump, air co-n----.
C 9) 15-30 HP; absorp unit .5 1 mil BTU 15.00
'"" . R.T.. of er or comp, eat pump, air con
�7C 10) 30-50 HP. absorp unit 1-1.75 mil BTU 22.50
erTF Pby a-snow e ge that I have read this application, that t eof etar or comp, eft pump, ai con .
information given is correct, that I am the owner or authorized 11) >50 HP, absorp unit 1.75 mil BTU 37.50
rgent of the owner, that plans submitted are in compliance with a an ing unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4,50 I
Board, that the number given is correct (If exempt from State Air handling unit
registration, please give reason below.) 13) 10,000 CTM +
_ 7.50
Pon portable
14) evapora' cooler 4+50
Vent fan connected -
_ 15) to a single duct 3.00
en i a ion s/s ern not --
16) included in appliance pe,mit 4.50
,... ««.,
Hood serve -by
17) mechanical exhaust 4.50
Describe work new additionj aeration 0 repair ommercia or In r stria —
to be done residential t8 non-residential O 18) type incinerator 30.00
�
xis mg use o i/ - other i.e, wo s ove, wa ei —
building or property s� /• 19) heater, solar clothes diye-rrs; etc. 4.50
ER Proposed use of 20) Gas piping one to four outlets 2.00
N building or property
O 21) More than 4-per outlet
.. Type of fuel -oil 0 natural gas LPG Q electric - -
J
C. NO]
TICE
Minimum Fee 52:1.00 SUBTOTAL
-� PERMITS BECOME VOID IF WORK OR CONSTRUCTION -- -
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED
-- - -
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WX)RK IS COMMENCED.
TOTAL
Special Conditions L----� -
Date issued by—
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