12500-12502 SW 127TH AVENUE 12500-02 SW 127TH AVENUE
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CITY OF T'FA RD PEI RUT NO. ME (391.31U19
07YOFTWAIND
COMMUNITY DEVELOPMENT DEPARTriIENT DA11' 3:SSUl;:*D: 7/1-11/89
13125 S.W.Hall Blvd. P.O.Box 23397,Tigard,Oregon 97223.(503)6394175 PP 11`1- PM 1'.NO. 891.389
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JOIR 1.2500 SW ir.?77+4 AVE- :5-6Z S{6
1A MAP/I...0 SUB: Sl:-:*E:-* SEUTION BK
i AND (JSI::..
L.OT E.)]:Zr-,: :
:1, NO: NU:
WORK (::I...ASS : PE'PA 1 P 1::*I.)1:4N(.)(:F-.* <100K MR HANDLR (10
(.)SE 7'yPl;---. : 2. FAM11 y 1`:*llPNA- CrE' 10OK4- ATP HANDL-4-4 10K
CONS'T . I*Yl:)I--.:: VN F1._ODF-4 F URNAC.E.. FEVAP .COOI EP
OCCUP.(.',PP . 1.11:-,:A T,E,[1 VI :N7' FAN
V E'N I' VEEN'T . L-'iY3'T*P::M
HOOD
NO . u'roj:43:1ES : 1NUI.Nl:::14A'Y'DR(DOM
DWELL.kJN:C'T*!; : 10
J:NC':l:Nr--;A- A'R:)l-'1(CUM
'T'YPE: WOOD r4I;:l:*-A1.R UNT'I'S
MAX . INPUT RLP/C01,11-1 50-H.-K) 01+10:4 10
F 1PE IMPPS7 GAS PJ:l---,.l:N(*.; OU11 E'1*5
HIGH Prd SS'?
LOW PRE:557
PF:mAlIKS :
0-iiiiineyu; -rcir, J.() w-ji) !:itl:IVv.-?%
V-2580 1.2582 128tli
W PLAN Pli.lIvITEM
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I FIX'TUPE'S ll;Z4'15 0 0
S'T'A'T'E: 1A 1k2. 7.1-5
OTHE"P
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N Oregon Chimney Repair & Cleaning
T 1318 SE Rhone
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A Portland, OR 97?02
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o 231-7704
IR
17F-*-'('F.;Jl::'1* NO .
This permit is issued subject to the regulations contained in I itle 14 .......
of the TMC. State of Oregon Specialty Codes,zoning reputations ISI: 11SISP1'EC11ON!,
and all other applicable codes and ordinances, and it is hereby F*1:PF P L A Ll E'.
agreed that the work will be done in accordance with the plans and ME:(:CHANLA., . SYS'TE.M
specifications and In compliance with all applicable codes and N/;I...
ordinances The issuance of this permit does not wove restrictive
covenants. Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and
void if work is not started wWin 180 days,or if work Is suspended or
abandoned for a perir.)d of 180 days any ti ne after work has
commenced It shall b:the responsibility of IN nermittee to assure
all required Inspections are requested and approved
Permittee Signature
13sued By CAI..I... F*(:11.) T N S 1.*)C:-.:CT TON 639- 4175
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
City of Tigard
13125 S.W. Hall Blvd. MECHANICAL PERMIT nocelpt* _ -
P.O. Box 23397 Permit +r >
Tigard, OR 97223 Description
639-41;5
T!bie 3A Mechanical Code QTY PRICE AMT
---------- T -
1) Permit Fee — -U_ -0- 10.00
Name or DevOlopment 2) Supplemental Permit 3.00
1,2662 " ? v Furnace to 100:040 BTU --
. b c / 5 Z �tv l��'« 1) r nc,.duds&vor r , 6.00
Address —. _- .- -- --
TaxLot Map , Furnace 1UO,000BTU +
N0 Z1 ind.ducts&vents 7`i1'
Lit Block Sub*01mbn ---- --- --
Name(o(name o(businow) 3) Floor Furnace 600
incl.vent
laming Address pho^ -- Suspended heater,wall heater
Owner " 4) or floor mounted heater 6.00
City/State
Vent not incl.
G7 5 in 3.00
_appliance permit
Repair of heating,refrig., -—
rune 8) cooling,absorption unit _ 6.00
tq ire.—s
Phone Bailer or comp to 3 HP —
absorp.unit to 100,000 BTU 6.00
Occupant city/'Stale 2jP 8) Boilcrorcompto3tiP-15 HP 11.00
_ absorp.unit to 500,000 BTU
Name! gBoilerorcomp 15-30 HP -- — 15.00
) absorp.unit 112-1 million
Ady,e,s t0) Boiler or mnip to 30-50 HP 50
i 3/k- ��_ /C CLCJ tib . absorp.unit 1 -1.75 million -- —
Contractor CAYIStale ap 11) Boiler or comp to 50 HP 31.,0
/ _ absorp.unit 1,750,000 BTU
s�t�o Libor W. Coy out. r;n 12) Air handling unit to --- - --- —
4.50
10.000 CFM
I hmetr,acknowledge But I have read tNs appiicariOn that ase wrormawx,g"n is 13) Air handling unit 7.50
oorrec,Olaf I am the owner aaut ionzed agent of five owner-Bar plans submitted r."i in —10,000 CFM a —
ovMO arca with sate laws,that 1 am registered with are stare[krlklers'Board,G n.amNon portable
n trnrwr given is oxred.(B oxen-1 from State rogsvahon phase lo
give reason bew) 14. ) evaporate cooler 4.50
1 ) Vent fan connected
to a single duct 3.00
) Vertilation system not
16 includthi in appliance permit 4.50
17) Hood served by
mechanical exhaust 4.50
stnaa. Domestic type
Describe work Eladdition U alteration U repair U 19) incinerator 7.50
to be done residential ❑ non-residential ❑ 1 g) Commercial or industrial
Existing use of Y type incinerator 30.00
-
building or properly --------._�- - '0) heater.
i.e.,�voQy�_o�sl "ter
heater,solar,clothes dryers,etc. ( 4.50
Proposed use of /6
— —.
'.wilding or propr:rty_— 21) Gas piping one to four outlets 2.00
Type of fuel- oil (] natural gas ❑ LPG ❑ elo trot I I �—--- -
-- 22) More than 4-per outlet
NOTICE SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -- —
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 100 _ 5% SIIRCHARGE
DAr"S, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PIAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIMF AFTF(I - -
WOFK IS COMMENCED. TOTAL
Special Conditions
I S�M �r 3 �� y � �� l
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT NU 1458 DAT2 fr
PERMIT IS GIVLN TO
a
OF
TO CONNECT A —G"__
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTII.CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID , g,; .., TIGARD SANITARY DISTRICT
BY f
CONNECTION INSPECTED AND+APPROVED
Date --Superlutendent
i
Ad,i re1�,� �� .� _.> >��cn Permit
Permi t charge_,_.__.. .- -
C._ __---- ---
Connection fee .p..._._...._-.
7�o_� _
0 w t i
Paid
Type of building �x Date connected Z—7,73..1.^ - .-
Service rate
Inspection fee_.__. 5�'00 ._.v. _..-.
._.Date _
Contractor �ll nnk Tnvnci _ _ Paid by "'---.--,--
Size of connection d"
Assessment Paid
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