12240 SW 116TH AVENUE-1 12240 5W 116TH AVENEU
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CITY OF TIGARD MECHANICAL PERMIT Receipt#
13125 SW F1ALL BLVD. l�;1 Permit #/Jj� 9n '-6e)1f!
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P. O. BOX 23397 j '[) 3t� Description -
T I GARD, OR 97223 Table 3A Mechanical Code CITY PRICE AMT
(503)639-4175 1) Permit Fee -0- -0- 10.00
Name of Development •>t+�Z��t 2) Supplemental Permit 3.00
tLZ �1C� �S.�, 1` I
Job address I 11 Furnace to 100,000 BTU 6,00
Address incl,ducts 8 vents
Tax Lot May;tw. 2) Furnace 100,000 BTU + 7.50
Lot Block Subdivision incl.ducts&vents
Name(or name of busirx±ss) .Uv_W�V7.i7t 3) Floor Furnace 00
122t1C� S.••� ales incl.vent _
b2c--2v;?,
.&MVAddress PhoneSuspended heater,wall heater
Owner itr 7 x.-22 ) 4) or floor mounted heater
Ci ty/State zip 5 6.00
ti���~ ! ) Vent not incl,in
� 3.00 OL
appliance permit
Name(or name of business) 6) Repair of heating,ref r ig., 6.00
cooling,absorption unit
Mailing Address Phone 7) Boiler or comp to 3 HP 6.00
Occupant absorp.unit to 100,000 BTU
city/State Zip 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU _
1 irt+n� Name Z�?`1( 9) absorp.unit'Boilerof.:omp-1 million 15.30 HP 15.00
ti 5 13 �u tulailing Address tJ 1 !N r`,.i 10) Boiler or comp to 30-50 HP 22.50
M t)�e � CR 11_� _ absorp.unit l -1.75 million _
Contractor City/State - Eip - 11) Boiler or comp to 50 HP 31.50
- 2 /o _ft
absorp.unit 1,750,000 BTU
State Registration No. __ - _� [ity Aus.Tax No. 12) Air handling unit to 4.50
10,000 CFM --
I hereby acknov dge that I have read this application that the information given is t 3) Air handling unit
10,000 CFM + 7.50
cared,that I am the owner or authorized agent of the owner,that plans submitted are in — --
compliance with Slate laws,that 1 am registered with the State Builders'Board,that Ow 1 ) Non portable 4.50
number given Is correct.(If exempt from State registration please give reason below), evaporate cooler
4 �l e w y� 15) Vent fan connected 3.00
to a single duct
1 fi Ventilation system not 4.50
included in appliance permit
17) Hood served by 4.50
mechanical exhaust
Signature(owner or agent) Date 18) Domestic type 7.50 -
Describe work ❑ addition ❑ alterr,tion ❑ repair incinerator
to be done residential ❑ - non-reAdenlial ❑ 19) Commercial or industrial 30.00
Existing use of _ type incinerator —
tluilding or properly` •-`�1 L `.vr x.1.1 r1_0i L 1_l t L 20) Otherheatei.solar,clothes,water,etc. 4_ 4.50 C
Proposed use of �' -
builc'ingorproperty )r��Y\,- ----..__.____-_ -.
21) Gas piping one to four outlets 2.00
Type of fuel- oil ❑ natural gas ❑ LPG ❑ electric C1
22) More than 4-per outlet
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7141S PERMIT BECOMES NULL AND VOID IF WORK OR .,C)N- -NOTICE SUB-TOTAL- 1
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S%SURCHARGE 7 j
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
AE%NDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER
WLRK IS COMMENCED. TOTAL
Special Conditions
Date issued by __
IMAM
INSPECTION NOTICE aUy
W.Nc 7 City of Tigard Building Depwiioent + �0
54FcT 6-xp -1z-5 P.O. Box 23397 +
Y Tigard, Oregon 97223
2$y _ d 9 Phone: 639-4175
InA1Z2Y 040
Type of Inspection
Date Requested �� ' �� Time• A.M.—P.M.
Address ��� �l�- � ' Perm, #!U tb II
Owner_ 91 ��1 Ic _ _ _ Lot #
Builder .
The following Building -
f C deficiencies are�to be corrected:
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Presented to _ _ — _ Approved
Inspector `' Disapproved
Date 7
CALL FOR REINSPECTION
Cl YEs F�] NO
CITYOFTIFARD
WYOF
TWA
COMMUNITY DEVELOPMENT DEPARTMENT 17
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13125 SW HWI Blvd. P.O.Box 23397,Tigard,Oregon 97223(503)839.4175 ]�RMITO
PEWI-T- +:.....:s-idEC90=00 3
639-4171 PRIM. PERMIT #.: MEC90-0011
DATE ISSUED: 01/26/90
IT$ ADDRESS. .. : 12240 SW 116TH AV PARCEL: 2S10313A-00119
UBDIVISION.. . . : LERON HEIGHTS 'ZONING: A.-4.5
LOCK...... . .. . . LOT. . .. . . . . . . . . :20
S OF WORK. . :ALT FLOUR FURN EVAP COOLERS:
PE OF USE. ... :SF UNIT HEATERS. . : VENT FANS... :
PANCY GRP. . :R3 VENTS W/O APPL-1 VENT SYSTEMS:
OTORIES.. .... . . . BOZi,ERS/COMPREoSORS HOODS. . . . . . . :
L TYPES------------ 0-3 HP. . . .: DOMES. INCIN:
fAS
OD/ / / 3-15 HP. . . . : COMML. INCIN:
INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
E DAMPERS?. . : 30-50 H11. . . . : WOODSTOVES.. :
PRESSURE.. . : 50+ HP. . . . : CLO DRYERS. . :
OF UNITS----------- AIR HANDLING UNITS :YfHER UNIi3. :
N < 100K BTU: <= 10000 cfm: GAS OUTLETS. :
N >-100K BTU: > 10000 cfm:
�emarkn: New ChLmney
�Ener: ----------------------------------- ----------------- FEES --•------------
NWARDEN type amount by date recpt
¢.2240 SW 116TH AVE PRMT $ 15.00
5PCT $ 0.75
�TGARD OR 97223 PAYM $ 15.75 JLH 01/26/90 A
hone #:
ontractor: -----------------------------
ORRISON CHIMNEY SAFETY EXPERTS
I
833 N. PENINSULAR
RTLAND OR 97217 --------------------------•----------
hone 1: 289•-0852 $ 15.75 TOTAL
eg #. . : 55198
------- REQUIRED INSPECTIONS -------
�his permit is issued subject to the regulations contained in the Gas Line Insp
Igard Municipal Code, State of Ore. Specialty Codes and all other Post/Beam Insp
applicable laws. All work will be done in accordance with Mechanical Insp
pproved plats. This permit will expire if work is not started
ithin 180 days of iss..ance, or if work is suspended for more
han 180 days.
- i
Permittee Signature: FI.�'�►+
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Issued By: — - _ -- —
Call for inspection - 639-4175
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Department 24 Hours Prw nap
EXCAVATION OR FI L '., 0 PLU
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REINFORCING STFFL 0 Wi»
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FI AMINC s. .�•a I:3 FINAL
�t so Conspicuoucly Fbgo#ti, Facing the Street Until Completion
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BUILDING PERMIT APPLICATION TIGARD DATE-- - 1s 3483
THE UNDERSIGNED HEREBY APPLIES FOR A. PERMIT FOE, I HE WORK HEREIN INDICATED BUILDER PHONE siLt�s;lT.l__
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE �U
LOT N0._
OWNER I'lichardP� den JUBADDRESS 122t�i} q�d LIGE} /�9g� _ ARCHITECT ZZ 119, 2S1-3BA
ENGINEER
BUILDER Art Wheeler Const. C-0- ADDRESS 4355 N.E. Division-CreahadlESIGNER -Lindal Iioms
STRUCfVRE El NEW ❑ REMODEL. ET*DDiTION� U REPAIR ❑ RENEWAL�(1 FIRE DAMAGE ❑ DEMOLITION
KICRESIDENCE ❑ COMM CI EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT Cl GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY __LAND USE ZONE R-7 BLDG.TYPE _ FIRE ZONE--=-PLAN CHECK BYt)Mi
_._�..__MEAT
ronstrmt family room addition tm existin_g_single family Owelling.
corrviction :sheet attaelll id, —
SEWERPERMITM UM
_OCC.LOAD FLOOR LOAD 40 _ HEIGHT 12 NO.STORIES 1 AREA 318 NO.BEDROOMS -0 VALUE 11,00
BUILDING DEPARTMENT SETBACKS FRONT W REAR 7g LEFTSIDE RIGHTSIDE .,,..
Permit _ THIS PERM11 IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE EUILDING CODE, ZONING
REGULATIONS AND ALL APPLICA31LE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 28000 WO111K WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
—�,WITH ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
S Ib-total_ 34 sOU RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS 10 HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 4 «.24
SDC-
Total 36.24
—— PDC# APPLICANT OR AGENT'
By
Receipt No. -
Approved ADDRESS PHONE
i
"DUN
r
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor _
Permit No.
- Rough-in
S_j/ � � ^-�—� —----------- --- Fixture ---
Final
HEATING
Contractor
--T Permit No.
Gas or Oil
R ough'i n
Final
---------._.—�--__-- — SEWER -------
- -----_----�------ -------- --- ----- Final
----- -- —....--_—._..--�__— DRIVEWAY — -- ----
—_—_— Final
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY final
CERTIFICATE OCCUPANCY
ILendsceping
�I Zoning Final
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Address Permit No. /—:j IT
Permit charge ;s
Owner /�.�.�/ `�. ,,,,��L) Connection fee
0 - _ Paid key.__- ---
Type of Building �• _ Date connected
Service Rate Inspection fee /G
Contractor _ Paid by —Date1l __
Size of connection 1 ___ _ Assessments _ Paid
k
l
Addres b Y t4 Al/F Permit No.
Permit charge a
Owners O PE plp M t R. Connection fee
Paid by+iw m rz•,k
— I
i
Type of Building-'aa Date connected / 7 - 74)
_ f
Service Rate � Inspection fee_ ' of-?
tt
1
Contractor ,IyNC,? Paid by _ Gate_Z
I
Size of connection_ '' Assessme,, Paid
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BUILDING PERMIT APPLICATION TIGARD DATE 1VOy �3 js�0
THE UNDERSIGNED HERr-BYAPPLIES FOR A PERMIT FOR TfiEWORK HEREIN INDICATED BUILDER''HONE,✓!- >t/
CSR AS SHOWN AND APPROVED IN THE ACCONIPANYING PL 'NSA D SPECIFICATIONS. OWNER PHONE 0 v'Z�0�rj5,
�� n /� ILV 1 LOT ClO.jp-Le*+-!+L��je_ ,=
ER IN%I, M4 PPe"dJ""S ADDRESS IZ240 S \V --1tVe• �. TL 11q. 2.91 • "3 19 ,
ARCHITECT
L.DEAADDRESS(
SIGNER ENGINEER L
BUIN npd/ /f -`
1M�1Cb��. �.t� ADDRESSZI�EJI�eIVI,f IQ111.�'*�f�AJ DE . �f /gyp
STRUCTURE C NEW _0_REMOD_EL _ A_DDITION _] REPAIR 0 RE_NrWAL _❑ FiREDAMHGE 0 DEMOLITION
RESIOENCE 0 C0N1M (]EDUCATIONAL C GOVT 0 R[LIGiOUS_+C1 PA i 10 C CARPORT C GARAGE C STOq GE 0 SLAPC FENCE
C-LCUFANCY V LAND USE ZONE BLDG TYPE �[ FIRE ZONE PLAN CHECK BYHEAT
SEWER PERMIT#
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA 3/g NO.BEDROOMS �O' VALUE/ 000
BUILDING DEPARTMENT _ SET BACKS FRONT REAR 7}r LEFT SIDE RIGHT SIDE
Permit li Go THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN TH_ BUiLDiNIC CGDE,ZOWN-
!AIanCheck w
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THI
�ZQ- - WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AIJD IN CuMPLIAIJC:
WITH A:► APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF TH'S PERMIT DOES NOT WAIV:
Sub-total ,410 RESTRICT.VE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURP,ENT CITY EUSItiES:
I z q LICENSE.SEPARATE PER;MiTS REQUIRED FOR SEWER,PLUMBING AND HEATING.
tate Tax •
Total _TG . z SDC- ow,ko p►, e•� _
PDC# APPLICANT OR AGENT -"
By � 99
.-- -
Receipt Na. _ _ y h� 2 43 L9
Approved ,�— —� ADDRESS�� 'HONE
SDC
DDG - S
SCWER CONNECTTON S
SEWER INSPECTIQN S _ ''-, �//r`}c�D,. og�a�, aC, 3 79'
-
SEWER SURCHARGE
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