12085 SW 116TH AVENUE ADDRESS:
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Pf-UMBINIJ PERMI I
P,ERM I V #. . . . . . . P-LIY196-0025
• CITY OF TIGARD DATE ISSUFD: VIZ/07/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 2S103BA-001,29
-;113123V
,#.Tigard,Or"on 9722398199 (503)639-4171
UBD I V I SI ON. LL-*-RUN HE I GHTS NU. ZONING: R-4. 5
BLOCK. . . LOT. . . . . . . . . . . . . . 4-- 2-D
CLASS OF WORK. . :ALT OPiRBAG)CE DISPOSALS. : Q1 MOBILE HOME SPACES. 121
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW f-,REVNTRS. . 0
OCCUP,ANrY GRP,. . :R3 FLOOR DRAINS. . . . . . 0 TRAPS. . . . . . . . . . . . . . Q1
STORIEz . . . . . . . : 0 wnTER HEwETS. . . . . .. I CATCH BASINS. . . . . . . : 0
F!XTU RES----,-- --- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
S I NKS. ' ' " ' " " : 0 URINALS. . . . . .. . . . . . : 0 GREASE TRAP'S. . . . . . . . 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
TUB/1SHOWERS. . . . : 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. . : 0 WATER LINE (-Ft ) . . . : 01
DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0
Remai-1-<s : Installing water- heater,
Owner: FEES
DEI-0-0 DUTTON type an,ai-tnt by date r-ecpt
12085 SW 116TFI AVE r:,RMT $ 25. 00 B 02/717/96 96-275718
5r,CT $ 1. C r D Oj.'/07/9G 96--275718
rIGARD OR 97223
Plhane #:
bunt r-actot,: ---___---------____---.___------
CONTRA-TOR NOT ON FILE.
-----------------
Ptione . 0 26. 25 TOTAL
Rey
REOUIRED INSPIECTIONS
This permit is issied s-Aject to the regulations contained in the Miss. Inspection
Tigard Municipal Code, State of Ire. Specialty Cooes and all other Final ITISJ)eCtiori
applicable laws. All work will be Bene in accordance with
approved plans. This permit will expire if work is not started
Nitnin 160 oays of issuance, or if work is suspended for more
than 180 days.
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f"et-mittee A"Ot jotlg
&-10d By .
Call for, inspection 639-4175
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City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. #
13125 SW Hall Blvd. Permit # PZM �% z
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
N-.9 0-ftoin m Now Sing a Family Residences Only
CR
"�� 0 1 BATH HOUSE 5140.00 0 2 BATH HOUSE$195.00
Jib " 4 - �u i /� � 0 3 BATH HOUSE$225.1.0
Address ar.�." b Fee includes all plumbing foctures in the dwelling and the first 100 feet
-7'1�'�� J�>-z.. of water service, s,-itary sewer and storm sewer. See fees below.
FIXTURES QTY PRICE AMT
S Sink 9.00
VAn Ad*- Lavatofy 9.00
Owner n :> l 67yo 3570 Tub or Tub/Shower Comb. 9.00
Shower Only 9.00
Water Closet 9.00
" "•c.�^•«°�°�r Dishwasher 9.00
)4'GtJ ' vYj Dg77b� Garbage Disposal 9.00
Occupant M""Ad*„ Ph- Washing Machine 9.00
Floor Drain 9.00
• A Water Heater 9.00
Laundry Room Tray 9.00
"■^• Urinal 9.00
Other Fixture!. (Specify) 9.00
N.aw A4*- P%m 9.00
COntl3ttOf
9.00
e" Sm. m 9.00
Sewer 1st 100' 30.00
st.ft p.V.-N. civ&..r••"" Sewer-ea. Adr,t 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm .;Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below 1 Mobile Home Space 25.00
Back Flow Prevention
f c� Device or Anti-Pollution Device 9.00
• •••�s o.+r ' �• Any Trap or Waste Not
ConneLled to a Fixture 9.00
Describe work new O addition Q alteration 10 repair Q Catch Basin 9.00
'o be done residential N) non-residential Q Insp. of Exisi. Plumbing 4).00[hr
',pecially Requested Inspections 40.00/hr
Existing use of y��
orproperty14.-=3� ��ti �� Rain Drain, single /amity dwelling 30.00
building -[�.- -----
Residential backflow prevention
d devices 15.00
Proposed use of
Ln buuding or property
'(Except residential backRow
r prevention devices)
J
NOTICE *Minimum Fee $25.00 SUBTOTAL
PERMITS SCOCME VOID IF WORK OR CONSTRUCTION
"J 5% SURCHARGE
--� AUTHORIZED I;; NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL G(/ Z S
Specicl Conditions _
i- Y Date issued _. by
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in AXr/Sdw1k
Foundation Plbg. Underslab ech. Rough i / ' Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:_
Post/Beam Mach. San. Sewer Gas L no -Bldg. `
Plbg. Underfloor Rain Drain FramingPlum
Alarm Water Line Insulation (—Mecham /
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date ilcque ted:_ �'` p� — �1 Time: AM PM
ddress: .• .� CAG .� ,> ��� �
:4-THBuild r L.' 5`ID �S 7 Permit #:4-
THE
E FOLLOWING CORRECTIONS ARE REQUIRED: / t FC- vC, 3 3
H
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Inspector: �'' Data:
09! PROVED DISAPPROVED _APPROVED SUR JE T TO ABOVE
I"? _Call For Reinsp.
CITY OF TIGARD
MECHANICAL.
F'CRMIT
COMMUNITY DEVELOPMENT DEPARTMENT FIERMIT #. . . . . . . : MEC96--003-
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)839-4171 DATE I`''UCD. 0`/0 7/96
PARCEL: 2S i 0SBA-00109
_ITL r i ,.;_ �ta� ."W lib-1' 1i (iJL
:AJBDIV191ON. . . . : LERON HE1GHYS NO. 0 TONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :43
CLASS OF WORK. . :ALT FLOOR F"URN. . . . : 0 EVAP COOLERS: 0
TYPE OF" USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRp. . : R3 VENTS W/O APIFIL.: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BC?ILERS/COMFIRESSORS HOODS. . . . . . . : 0
I"ULi_ TYFICS __...._.._____ ._..._.-- 0- HIJ. . . . : 0 DOMES. INCIN: 0
: /GAS/ / / 3-15 HFI. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 STU 15--30 1-1p. . . . 0 RU AIR UN vrS: 0
FIRE: DAMF'E:RS?. . a 30..50 IiFI. . , . a 0 W'JODSTGVES. . : it)
(:-jA: P,f�GGSURE. . . : 50+- lip. . . ., : Q1 CLO DRYERS. . : 0
NO. Of: UNITS---------.- -- - AIR HANDLING UNITS OTHER UNITS. : 1
1-URN ( 100K BTU: 0 ( 10000 c_f m : 0 GAS OUTLETS. : 1
F'URN > =100K BTU: 0 ? 10000 cfm : 0
P(3inar^ks : qL:,s pi.1_ing and watcai, he Ater,
Owner-: --- __..______.___._...__........._..........._..____._._...____ _.________ _.___._ ___ FEES
UL--'LOS DUTTON type aamol.mt by date r^ecpt
12085 SW 116TH AVE PRMT $ 25. 012, D 02/07/96 96--075716
r
SF'CT $ 1. E",5 B 00/07/96 'y6--475'"71;
TIGARD OR 972::2::;
':'hone #:
C.ontractor:
CONTRA(_TOR NOT ON FILE
LE
Phone #: $ 2 6. 25 TOTAL
Reg #. . ..
REQUIRED INSV,ECTIONS
Thi: pernit is issued subject to the reg nations container in the L7c+s Line Ins p
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical In;p
applicable laws. All work will be done in accordance with Final I1r s pest 1 on
approved plans. This pereit will expire if work is not started
Kithin 180 days of issuance, or if work is suspended for sore
thwn 1180 days.
Call fct' inspection - 639-4175
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Permit#: e l'Y�33�PL PA qk
Address: J Zl�h5 `fit l� �'` /-y`s' _
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Issued by: Date:
Statement: Information Notice to Property Own3rs
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), r 2quires residentia'constriction permit appli-
cants who are not registered with the Construction Contractors Board to .sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701 010(7),
need not submit this statement. This statement will be f led with the permit.
Fill in the -,ppropriate blanks and initial boxes I and 2, and either box 3A or 313:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structu.e is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor rcgis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
313. I will be my own general contractor.
V
If I hire subcontractors, I will hire only subcontractors registered with the Constniction Contractors
Board. If I change my mind anti 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.
I hereby certify that the above information is correct and that I have read and do u:1derstand the In►ormation
Notice to Property Owners about Construction Responsibilities on the reverse sidt of this fount.
(Signature of permit applicant) (Date)
(White copy to issuing agency pet?nit file,
pink ropy to applicant)
City of Tjgard MECHAN!CAL PERMIT Planck/Rec. # _
13125 SW {dal' Blvd. APPLICATION Permit # MCC � ot?;3
Tigard, OR 97223
(503) 639-4171
^�• Description
Table 3A Mechanica! Code QTY PRICE AMT
Job G7 C41) Permit Fee 0 0 10.00
Address •• -
-T" ,V,q 2) Supplemental Permit 3.00
•m• ^ ^•m•^ •^ Furnace to 100,000
2e,-rlV'4, 1) incl. ducts &vents 6.00
o ••• urnace -j+
Owner f �:� acs- ll 2) incl. ducts &vents 7.50
•• o Floor urnance
TE' ; Z3 3) incl. vent 6.00
•m• « • •^�• uspen eater55 eati�F er
�c Gam, 11 Z �' _ 4) or floor mounted heatEr 6.00
o «• �^^•
OCCUDBnt Vent not incl. in
Q� � �`fi JSz' 5) appliance permit _ 3.00
Repair of heating, re ng.
/ 6) cooling, absorption unit 6.00
m• Boiler or.omp, ear pump, ar cond.
c _/ 7) to 3 HP; absorp unit to 100K BTU 6.00
• — Boiler or comp, heat pump, air cond.
Contractor _ 8) 3-15 HP; ibsorp unit to 500K BTU 11.00
•'• Boiler or comp, heat pump, air con .
9) 15-10 HP; absorp unit .5-1 mil B i U 15.00
•��+�". " •• oiQr or comp, he5t pump, air coni
10) 30-50 HP; absorp unit 1-1.75 mil BTU 22.50
hereby ac now a ge that I have -ehd this aop icati� o—' n,that the Boiler or comp, eat pump, air cond.
informatio r given is correct. that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with it handling unit to
State laws. that I am registered with the Construction Contractor's 17.) 10,000 CFM 4.50
Board, that the number given i= correct. (If exempt from Slate Air handling unit
registration, please give reason below,) 13) 10 000 CTM + 7 50
on portable
., 14) evaporate cooler 4.50
o en�an connectea
fy ,c�•x�i-, vr�z��, �U _ 15) to a single duct 3.00
–¢= entr aeon system not
16) included in appliarae permit 4.50
Hood serve y
17) mechanical exhaust i 4-_-0
Describe%6r: new U a ikon "aeration repair omn :rcia or i, ustna to be dnnP residential Q non-resida dial O 18) type incinerator I 3000
Existing use of Other i.e, woo stove.water
budding or property p4en-:L7 er,-y &E" 19) heater. solar, clothes dryers, etc ( 1.50
Proposed use of 20) Gas piping one to four .,utlets 2 00
budding or property
21) More than 4-per outlr.t (each) 2.00
✓� Type of fuel -oil Q natural gasA LPO (_1 electric � )
NOTICE
J Minimum Fee $25.00 SUBTOTAL
PERMII S BECOME VOID IF WORK OR CCNSTRUCTION
c7 AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 511. SURCHARGE 2�
J IF CONSTRUCTION OR WORK IS SUSPENDED OR —
ABANDONED FOR A PERICu OF 180 DAYS AT ANY TIME PLAN REVIEW. 25% OF SUBTOTAL
AFTER WORK IS COMMENCEC
TOTAL
Special Conditions _
Date issued by
�',1001M0973�MECHPI.,I