11610 SW HAZELWOOD LOOP-1 r �
� I
i
,I
IL
•
{
JIM "t
, Y,� JJ�•( V
t r e7f��Kt� r�M t�'� 1 �>,q 1d •�,
t� d'� ,r�� Std 4 t ;: �r(���• t 1 s
• 6k+A'"t���(�!�t ��{j, � - ,. art1� � t� � t�
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Fooling Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling Plumb. '� �, y
"p
PosVBeam Mach. Shea:iSheath Framing -Mech. 3,�4 4,41Pr,
„u Plbg.Und/Flr/Slab PlbC. Top Out Insulation
c
r N a r
Post/Beam Struct. 11, Mecr 1. Ro gh-in Gyp. Bd. -Bldg. j� �1x { ,
s 'la San. Sewer +e Appr/Sdwlk Reins. '
co
Other:
of
,
Date: /T2 T/9yA.M�_ ,M. Entry:
r �(o �Q
Address:
Tenant: Ste:_.__._..__ MST:
BUP: t a '•
� 'gC ,.1Wy 4f P� 4
Con/Own: MEC:
_ _ qL�� d
_ yy Caa ww�fpKjn �Cs, i.
7Y GuN?� AS PLM:
U '7 D ELC: i", V tt
+ THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: i '�� �'' �'�''� * +' "1 ��^
ah
88��73• 1�*�
..I
I
a<�c:
z
n' {
Inspector: Date:
MOVED DISAPPROVED/CALL FOR REINSP, CF CO
1
ow
i f 7}
••.
�•t � 6�� fit'a t��i�f9r
1Y
qa '``' " -,fir v :.y, yc ra�rna� t� re.w rrry �?
A
: F
CITY OF TIGARD .•
DEVELOPMENT SERVICES PLUMBING PERMIT 3
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : PLM96--O321
DATE_'. ISSUED: 1O/22/96
PARCEL.: 1 S 13413D-05000 Yr
�iITE ADDRESS'. . . : 1. 1610 SW HAZELWOOD I-P �
SUED I V I S I ON. . . . : FNGLEWOOD NO. 2 ZONING. R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . 1.38 l
CLASS OF WORK. . :AL"F' GARBAGE: DISPOSALS. Q1 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREV NTR S,. . : 0
OCCUPnNCY GRP. . : R3 FL-OOR DRAINS. . . . . . : I:A TWIPS. . . . . . . . . . . . . . : 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . . 1 CA('CH BASING. . . . . . : : 0
LAUNDRY TRAYS. . . . . : 0 SFFRAIN DRATNS. . . . . : 0
SINKS. . . . . . . . . . . 0 URINAL_5. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . . .. iii OTHER FIXTURES 0 '4r,;
TUB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . 0
WATER CLOSETS. . : 0 WATER LINE (ft ) - - -
D I SHWASH'—`RS. . . .
ft ) - - .DISHWASH'-RS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remirks : F2eplacing Water, F'2ater'
FEES ---_-___-___---_
Owner•»-�---__—_--------_----___`'___._.____..__________{,__�__—amo�.ict _ b date_ rec� ii-c
•.JEFf• SFDF-_Y YES Y F
17.
11610 SW HAZELWOOD LOOP FRMT $ 25. O0 JDA 1O/22/96 96-285496 ,
TIC 1" 1. 25 JDA 10/22/96 96-285496 " .
TIGARD OR 97223 C `
Perone i#: ,;?:`'
f:ontrac�tor•; � }
PORTLAND PLUMBING
6335 SE BROWNLEE ROAD
MILWAUKIE OR 97267
Phone #: $ 26. 25 TOTAL..
Reg #. . : 62647
__....._.._--- ._. RE M I RED INSPECTIONS
This peroit is issued subject to the regulations contained in the Misc.. Tmipet_tinn
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Ini;pertion
dpplr.cable laws. All work will be done in accordance with
approved plans. This peroit will expire if work is not started
,ithin 18@ days of issuance, or if rork is suspended for Bare
:ha, 180 days.
Tsslaed BY : _
M
Call for inspection — 639-4175
s.
l
� �• 'T .� ail L ;L 1:'
.Ir
':, Ltd ' `�}.1't� '�t�L�I .;. ..�_.».rY..+.....m•...�«»sr�ars�_+'uae:..r. _ '���
�_aW„-.,_ r..,•.. AAAA_.....-.. _. ,...�-.,.�,.e_—., :.....,.,..w.- +:
Y I{
1
•ITY OF TIGARD Plumbing Application Recd By '� _
00
.3125-SW HALL BLVD. Commercial and Residential oats Recd
;]GARD, OR 97223 Date to P E•
503) 639-4171 Date to DST
Permit.
Print or Type Related SWR r
Incomplete or illegible applications will not be accepted Called
Name of Develop ect FIXTURES (individual)
I I __ j QTY PRICE AMT
Sink
Job __ -
9.00 A
Address Street Addiess $U1fe Lavatory_ �- Ton
Fk1,.�.et wm.-t. _
Tub or I-ub/shower Comb. 9.00
tlM9 Cityrslate Zip Shower Only 9.00
�. TI �1 w. 77 Water Closet - 9.00
Name
J F.n
9.00
OWntlr MaiNng Address -T Su is sal
9.00
ne 9.00
CAY�a'• Zip Phone 2' 9.00
4 Psarrr 3 9.00
_ _ 4 9.00
Occupant INer�rtp Adwrass Suite Water Heater
I 9.00 Qr
Laundry Room Tray 9.00
CilvlStMe Zip _- Phono Unnal --
9. 0 Name Other Fixtures(Speafy) 9.000
)• Mei- a At,_A 000
I Contractor Manure AddreSuite - 9.00
Ar V4e
CityrSlate Zip Phone 9.00
A
JR 4`7 / —
( �:�� V�.�•-?4''�� 9.00
'Jeogon Const.Cont.Board Lits Ex.p.U816 9,00
Aloo*Copy+writ 'r �i 2 j ` _- 0r,_ - - - i
9.00
I I Lic t Exp.,�Oat, Sewer-1st 100'
1•teeiMee ��� L__ Sewer-each additional 100' 30.00 _
COT Business Tax or fineuo t 25.00
q Exp.Date Water Service-1st 100'
la
10 00
Name - Water Sernce-each additional 200' 25.00
ArcFrlteCt Storm b Ram Dnir- 1st 100' 30 00
0 Mailing Address - - Storm d Rain Darn-each addibonal 1
1 .,i. a 00' 25.00 I
_
Mobile Home Spars 25.00
L�tyiErwin� 5lats tip Phone —Back How Nrevenuon Dewice or Ant!-
Pollution Cewce 25.00
)Ncnbe Waft Vow O Addition O Alteration O Rroair O Residential 8ackfiow Prevention Device' 15.00
']tooidd done. Residential O Von resrbential O
+JdrHonsl descnption of work 900
Any Trap or Waste Not Connected to a Fixlur.3 _ '-
Catch Basin 900 �
c Insp.of Exrsung Plumbing i "0 00
I
1 — - perahr i
d Isarg use of Specialty Requested Inspections 40.00 !
•-aiding or won"--- _ oerrhr
- Rain Cram,singe family dwelfirg 3000
"WSW use of Grease Traps --
Niudl or 9.00
ng pmp3ny__.
QUANTITY TOTAL
Are you capping. moving or replacing any fixturos? Yes p No❑ 111101TWInc or riser diagram a requred if quanay Total is >9 l
(H yes see back of form) _ *SUBTOTAL
hr.✓•acknowledge that I ha-,e read this applicc,on.that the informaton `
inen a correct.!hat I am the Gwner or authortzeo agent of the owner.and 5% SURCHARGE
',at olans submrtted are in compliance with Oregon State Laws _
dignatun of Owner/Agent Data PLAN REVIEW 25.1.OF SUBTOTAL --
�saured only Ll nxe 7ty total�>1
TOTAL
intact Person Nam• Phone
Minimum permit fee is S25• 5%surcharge.except Residential Backflow
Prevention Cevice,which s 515+5%..::•Charge
i:tdstslplmaop.doc&98 I
I
s
t
S,
PLEASE QQMPLUE Ad_APPROP_R1ATE TQ-PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub/Shower Combir;aJon
Shower Only
Water Closet _
Dishwasher �—
Garbage Disposal
Washing Machine _
Floor Drain 2"
_ 4" _
Water Heater _
Laundry Room Tray__
Urinal _
-Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
i
A916
1 I
.w
6
'vv is
` i
A
C:11 Y OF, 1 1 GARD — PE,C'1:IIT Cot- PAYME.N'I RECE E I V1 NI:s. a��F•—cifSwr+;'/t'
CHECK AMlUN F s FA9. ar'
NAME^ 1='Gn rl.-aND METRC) AT RE CAl-.'.'iH AM!JUN r ski. ov,
ADDRLS ; a 1001 O aW I EAVE.kICIN HL.S01- NWY PAY14-Al DAIS
r:;l.:l�l.7iV.C:3Xt.IhJ
F3►_•:.AVt~RT0N, OR 9700t w
PURPOsk UE PAYME.NI AMU' NI PrIlD P0PPUgF- Ifi- PAYM--NI FMIJUNI 0010
_ M �:ttAhl l l W4. - •...._.._,.. .� ._ &!J. Oki PL.UMB I NU 11-M
ELECrRICA1._ ` ERMt r 31.1. OVA St. BUILD PIER 4. P`i
I
t"'`UR 11610 SW NAZELWOUD LOCIP
' f TOTAL. NMrJL)NI PAIL? _) Elb
7
CITY OF TIGARD
D�^ ELECTRICAL PERMIT
�cVE�.QIPII�EIVT SERVICES
--0672
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #r D: 10/2 2/9
DATE ISSUED: 10/22/96
PARCEL: 1 S 1'74PD--05000
SITE ADDRF_SS. . . : 11610 SW HA7_EELWOOD I._P
I
SUBDIVISION. . . . : ENCaLEWOOD NO. 2 ZONING: R-4. 5 �
E11_.0CF;. . , LOT. . . . .. . . . . . . . . : 138
Pr^o,jectDe,cription ; Adding branch circuit
-RES I i.)ENT I AL. UNIT--• - -- TE MPI SRVC/FEEDERS------- __.__._M I SCELLANEOUS-.--_-_
1000 SF OR LESS. . . . : 0 0 - X1'00 amp. . . . . ., „ 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L_ 5OOSF'. . . : 0 01 400 amp. . . . .. . . : 0 SIGN/OUT LINE LT.3. . : 0
I.-IMITED ENE_RGY. . . . . . 17..1 401 - 600 amp. . . . . . . . 0 9TGNAL/r'ANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 6O1•1•amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
t -._._._--SERVTCE/FEEpFR._.._..._.-. _....-BF2(aNC:H CIRCUITS_...__-._.. ._.-._ADD' L INSPECT TONS-----
I
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPErTION. . . . . : 0
; 201 400 amp. . . . . . : 0 I st W/O SRVC OR FDR. : 1 PFR HOUR„ . . . . . . . . . . . 0 1
401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 1.000 amp. . . . . : 0 _..____._..-__.____.._.---_.__..PI_.AN REVIEW SEC'1"ION--_.____.___-____._._..
1000+- amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only . . . . : 0 SVC/FDR > 225 AMPS. . : CLASS ARER/SP'EC OCC. :
C.;wner,: ______.____..__..__._..._._____.___._.__.._..__.__._. --___-------___-_-•- FEES
,JEFF SEDEY type amol.rnt by date recpt
11.610 SW HA7_ELWOr!0 LOOP PRMT $ 35. 00 TDA 10122:196 96--2854.96
15PCT $ 1. 75 JDA 10/22/96 `36 2''85496
TIGARD OR 971ti=3
Phone #:
PORTLAND METRO AI:RE $ 36. 75 TOTAL
10010 SW BEAVERTON--HILLSDAL-E HWY
REu111 I REL' INSPECTIONS
-_._._._.....
BEEAVE.RTON GR 97005 Wall Cover Fl Fact' 1. Final
Phone #: Elect' 1 Service
Reg #. . : 61219
This permit is issueu subject to the regulations contained in the
Tigard Municipal Code, State of Dr•e. Specialty Odes and all other Perm i t t e S i gnat Lire
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 198 days of issuance, or if work is suspended for more _ 7
than 188 days. I s s 1.r F� y _
_.._....._._.._,._....._..._._---•-•--.•--•--......_.._ ....__ . oJNER TNSTALLATION
The in•.tallation is being made on property I crwn which is not intended for
sale, lease, or, rent.
OWNER' S SIGNATURE: _ - - _ _ DATE:
___._..--_•---_._______..._.__..._----.._..--COi,!TRACT 0R .NSTALL-A'TTON
SIGNATURE OF SUPR. ELEC' N: DOTE:
L J CENSE: NO:
Call t -it- inspect iun - 61-1194175
� AA 1lI r ri rl
V`r vr.
I
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Recd By
Date Rec'd
TIGARD OR 97223 Date to P.E.
Phone(503)639-4171, x304 Dnte to DST
Print or Type
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit d (2 ,
Fax(503)684-7297 Called_
1. Job Address: I 4. Complete Fee Schedule Below:
Name of Development---_ ____ Number of Inspections per permit allowed -
Name(or lame of business) `TP,� e L-I5 _ Service Included: Items Cost Sum
Address 1 I C� S'W RA.7 e j One 4a. Residential-per unit
t-- 1000 sq.ft.or less _ $110-06 _- 4
City/State/Zip F IQ ` < q 7;7 2,3 _ _ Each additional 500 sq ft.or !,
Commercial ❑ Residential portion thereof $25.00 1
Limited Energy $25.00
Each Manufd Home or Modular
UH-)fling Service or Feeder $68.00 _ 2
2a. Contractor installation only:
(�ttach copy of all current,lice s Irs Services or Feeders
Electrical r;ontract,)r � �_t 1 r��L� r'_ Installation, oraltless
or relocation
Address o c 5 16 �Nl/ .�P ae 200 amps or 400 $80.00 2
__ 201 amps to 400 amps _ $80.00 �_�_ 2
cityi�V Stat'Ye1_��_Zip d�' __. 401 amps to 600 amps - $120.00 __ 2
7
Phone No. r5 2,<- ' _ . 601 amps to 1000 amps $180.00 2
lob NQ`_ Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. J7- b 7��Exp.Date Ost.= _
OR State CCB Reg. No. 6_:12 1"i--Exp.Dat,- rt•-. 1 1_1_ 4c.Temporary Services or Feeders
COT Business Tax cr Metro No.--L ' ' _Exp.Date.-c�,^_fi. 9`7 Installation,alteration,or relocation
200 amps or less $50.00 _
Signature of Supr. Elec'n r 201 amps l0 400 amps $75.00 2
��- - 401 amps to 500 amps $100.00 2
Over 600 an ps to 1000 volts, '
License No-, Exp.Date` see"b"above.
Phone No.___ 6 7-t': - 7& 1 `X
- - 4d.Branch fir�ults
No",alteration or extension per panel
2b. For owner installations: a)1 no lee for branch circuits with
J
purchase of service or
Print Owner's NameA-_ feeder fee.
Address J Each branch circuit -_ $5.00
h)The fee for branch circuits
City State Zip without purchase of
Phone No. _ _ _ _ _ service or feeder fee. V �.
First branch circuit $35.00 _ - ?
The installation is being, made on property I own which is not Each additional branch circuit_ $5.00 __ 2
intended for sale, lease or rent. 4e.Miscellaneous
(Service or feodel not included)
Owner's Signature _-_ .__ Each Nur;o or;,-igation circle $40.00 _ 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):' Signal circuits)or a limited energy
panel,alteration or extension $40.00 7
-__--
Please check appropriate itern and enter fee In section 5B. Minor Labels(10) $100.00
4 or more residential units in one structure 4f.Each additional Inspection over
-__-Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection _ $35.00
_Classified area or structure containing special occupancy For hour - - $-,5.00
as described in N.E.C.Chapter 5 In Plant $55.00
*Submit 2 sets of plans with application where any of the above apply. 5. Fees: OQ
Not required for temporary construe,on r,c•vices. 5e.Enter total of above fees $ ��/✓✓✓ -
5%Surcharge(.05 X total fees) $
NOTICE Subtotal $ `
5h.Enter 25%of line 5a for �i 7 J
PERMITS BECOME VOID IF�VORK OR CONSTRUCTION AUTHORIZED IS Plan Review it reauiLiud(Sec.3) $ -NOT COMMENCED WITHIR 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ---
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ 1 rust Account q $
Total balance Due
I%DSTSELC86 APP net W96
,I u.,
1' 1
A
i
t
1
i
�I ft
1E1 �
F I
C:17Y OF 1 ,(4ARD _ kL-C! rt'l fit I'()YMkN1 kEL'trlll iJCI. 6�� �k►;� 1^+w, f
CHECK HMUUN f
NAME r PORTLAND ME TRU (4'I RE' 0*3H AMU1JN I R �►. ?� �
Fit>gFZE. ;Ei s ]�►r�! iW I►rw,G1VE:�+1GlN NL. UL HWY PF1YW!l.NI 1lATL r 11[►r", ;� ;,
f',Uoi:>IVISION e
C BEAVERTON, UP '3 lOQ'i- ►.
r
PURPM., C!f- Ve4YMLNI AME)UNI PAIro NLJRP0Sf:. ()I- i.AYMLJTJ WLIUNI 1 !410
M�J.14ANIC AL FAQ 9265. 00 FAL.►.1MSING~NLRM
EI_ECTRICNL I,)ERMIT 35.0el Sr, BUILD PER
b
t
d0
FOR Llfsllh SW HAZE1.1.401:)1)
r
ilk
1
i
r
CIT 01 TIGARD MECHANICAL
DEVELOPMENT SERVICES PERMIT
PERMIT #. . . . . . . : MEC96-0363
13125 SW HR11 Blvd.,Tigard,OR 97223 (503)639.4171 ..+,
DATE ISSUED: 10/12-2/96 Fi
F'AF1C11..; 15134ED-05000
SITE ADDRE.;.')G. . . : 1 16 i O SW HAZEL_.WOOD LF
SUBDIVISION. . . . : ENGLL:WOOD NO. ;:' ZONING: R-4. 5 •
BLOCK. . . . . « . « . LOT. . . . . . . . . . . . . : 138
CLASS OF W', FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF U' „ « . . :SF UNIT HEATERS. . : 0 VENT F ONS. . . : 0 •
OCCUI'AnIC'r JRP. . :R::'. TIENT S W/O ADPL. 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 13L;1L.FRS/COMPRESSORS HOODS. . . . . . . : 0
FUEL TYPES---_.__._._.__ _..........._. ���--1; HP. . . . : 0 DOMES. I IVC I N: 0
: /GAS/ / / 3-15 HP. . . . : 0 COMMI._. INCIN: 0. a�
MAX I NPU-i : 0 BTU 13-30 HP. . . . : 0 REPAIR UNITS: 0
F1 RE DAMPERS?. . 30-r0 HP. . . . 0 WOODSTOVES. . . 0
GAS PRESSURE. . . : 50-+ HI '. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS- • _..._ AIR HAN LING UN T TS OTHER UNITS. : 0
F1J1Rr4 ( 1001! BTU: 1 (= 101100 r_f m : 0 GAS OUTLETS. : 1
FURN ) =100K BTU: 0 ) 14.'000 cfm : kr I '
Pemar^ks : Replacing Fi_rr-nate
Owner-- -•.__.___..____.._____._____...-__-_._ ___._.____ _______ ____.___._ FEES
JIFF SEDEY type arlol_rnt Ley date re._pt;
11610 SW HAZELWOOD LOOP PRMT $ 25. 00 JDA 10/22/96 96-285496
5PC'" 1. 25 JDA 10/22/96 96'-c'BtP496
L
TIGARD OR '37223 '
Phone #:
Contr,acto
PORTLAND METRO--AIRE
10010 SW BEAVERTON HILI__SDALE HWY
BEAVERTON OR 97005
Phone #: 626-7818 $ 26. 25 TOTAL_
Req #. . : 61219
-- - - -- REG?U I r_0 INSPECTIONS
This permit is issued subject to the ,regulations contained in the Gas Line Int.p
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misr_. Inspection
applicable laws. All work will be done in accordance with Firral Inspection M _
' approved plans. This permit will expire if work is not started
within 180 days of issuance, or if wort is suspended for more
than 180 days.
r Permittee Si.gnat ,e ;
I s s r-red B v : _____ _�_____-- --•-- _ _ v
Call for, inspection - E39-4175
t
7 .
- -
i.y
Ik c
A e
Plan Check# • - � i
CITY OF TIG"'RD Mechanical Permit Appiir-ation Recd By _ 1
13125 SW HALL SLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date tri P E.
(503) G35-4171, x304 Date to DST
Print c Type Permlt# L'l
_ Incomplete or illetlible appiications will not be accepted Called -
I Name of 0evelopmentiProla-t _ 1 Description
Table 1A Meuianical Code CITY PRICE AMT
Job treetAddresa
pudeA A) Permit Fee n- -0- 10A0
Address l G r� v✓
BIa9s C tyrstate Zip B) Supplemental Permit 3A0
_� r�•.`rc1 rl.-)x,23
Name for name of business) 1.) Furnace to 100,000 BTU 6.00
Owner ,) !'n T.p 0•n incl.ducts&vents t
Mailing Address } 2.) Furnace 100,000 BTU+ h I 7.50
incl.ducts&vents
Cdyrstate 7. Phone 3.) Flocr Furnace 6.00
incl.vent
Name for name of business) 4) Suspended heater wall heater 6.00
_or Floor mounted heater
Occupant Marling Address- U0
5.) Vent r..:incl.in
-
3.
appliance permit
Cry'state zip Phone 6.) Boller or comp,heat pump,air Gond. 6.0(
to 3 HP,absorp unit to 1,001KBTU
Nlame J� 7.) Boller or comp,heat pump,air rond. 11.00
3-15 HP;absorp unit to 500K RTU
Contractor Mailing Address
- 8.) Boller or comp,heat pump,air cond. 15.00 )
lr�C'1t� ��U f��l _� 't 15-30 HP absorp unit 51mil 3TU
Attach copy of ci rstate zio Phono _ 9.) Boller or comp,heat pump,air Gond. 22.50
Current LicensesX44 1� �'x�.`. 5 .(y- (,'' I 30-50 HP;absorp unit 1-1.75 mil BTU
Oregon Const.cant.Board sic r Exp.Date 1U.) Boi er or camp,heat pump,air Gond. 37.50
6 ' -�� I I J i` >50 Ht',aAorp unit 1.75 mil BTU _
COT
Business max or Mew a - Exp.Date 11.) Air handling unit to 4.50
10,000 CFM
Architect Name 12) Air handling unit _ 7,50
_ 10,000 CTM+
wr
or Mar Address 13.) Non portable 450
evaporate cooler
Engineer Cityr5late - =ZipPhone 14) Vent fan connected 3.00
_ to a single duct
De.cnbe worts New O Addition O AlterationO Repair O 15.) Ventilation system not 4.50
to be done Residential0Non-residential O included in appliance perm;t
Additional Description of work 16) Hood served by mechanical exhaust 4.50
_ 17) r )mestic incinerators 7.50
Existing use of 18) Commercial or Industria" 30.00
budding or property_ _ ncinerator
19) Repair units 450
Proposed use of 20) Woodstove^ 4.50
building or property _
21) Clothes dryer,etc. _ 4.50
Type of fuel-oil O natural gas LPG O electric O 22) Other units 4.50
t _ _
I hereby acknowledge that I have read this application,that the 23) Gas piping one to four outlets
i information riven is correct,that I am the owner or authorized agent of ( 2.00
i the owner,thai plans submitted are in compliance wrth Oiegon Stats; 24) More than 4-per outlet (each) 50
laves. l 1`Y
/c7-��-
Signature of Owner! gent pew
QTY.SUBTO rAL
'SUBTOTAL ,�P
Contact Person Name Phone 5716 SURCHARGE
r �
PLAN REVIEW 251,r6 OF SUBTOTAL
TOTAI.
-- S
i:WstVtie-hpmt.doc (rev 7/96) � 'Minimum permit feels 525+5916 surcharge
I
•
•
crrY w- 'I1CitAka) wctI�'7 'A 144 VVILI!I ki:.t.:h.II f NLI. j-jC� j'L4':,4"1`� M
CHECK 0I10UN I A fig. r.15
tdt�M1: a NIijR(1-PNU 1+11_ i'RU N I M:' t ASH IAMIJUN 1" 0. 00 y
A1 DRks a 1007tH '.,W klE.t'IVh.k1 CIN ITL(-;i)i- HWY PAYMI N I W41 L r. 10/c:21i9E.
�UI3WvlSfuN
A4AVLRT0N, OR
PURPOE . UF {•AYMF:.W I raMJLIN t PA 11) pUkjpEjbE: OF POYMi-Al NMUUNI PAIL)
Ml-:C:I�ANII^:AC�.F��...,_,.._......
ELEU f MAI... P 'RMI'T 3;`,. 00 sr. BUILD PVR �+•
{
{
{ IUP � 0 SSW HAZIELWOUD L.013P
I
i .