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INSPECTION NOTICE
3ity of Tigard Buildino Department
P.O. Box ?3397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection ?
�� - Ly .. �Pm-
Date
Requested Time A.M./7� A
C`11 Permit # ��
Address —�-..tom-� -�/) �r ►�
Lot #
Owner
Builder ..
The following Building Code deficiencies are required to be corrected:
1
Presented to } t Approved
El
Inspector "� f Disapproved
Date __
- �-� ' -
CALL FOR REIMPF,CTION
❑ YES ❑ NO
(ITY I IGARD PLUMBING 13a25 94 H%U al%KJ.
A444KAnts RWM hOW Ortoom IteoMrsolion to conducl a plumlAngUWd CR WW
PERMIT &N-4175
Nanta of DWvi*kpiWA
Addw,% Plumbing Permit Nn,�I�,
OAS 014-214510 OUAN. PACE AMY
Job Tax Lae mw No.
Addrvss
FIXTURES
Lot Okx* SubdrA*kw
Sir* 7.s0
or 4091u Levakwy 7.50
Tub or TWShowe(Go" 1 so
Showw Ordy 150
Owner
city/plAto W&Iw C40W 710
Dishwasher 7 so
Phone Garbage ENswul 7 50
Washft Machine 7-50
Fkxx Drain 7 50
Phone Water Healer 750 0
OccupantZip Lan_ Room Room Tray 7 so
Urinal 750
00w Fixtures(Specfy) YLSO
750
I'so
A- ?
MISCEEANiOUS
CAY INA Tax NO seww lip 1w 3000
4 15�/'0 1 ----- - -T
wo Pkwt*,Ws Mo No Sevier-Oa!! 0 100 is 00
wafer soft**10 100 2000
I lmeby#A* OW I hwe mwd SW go ft 1 local a on WOW Son4de e&Ad*l.,UD' --1&00
Olveri is Go, twostim soi ! &Ann&Pan DnWn I M100' 3000
h@m&9%f*pMlft Dintgoal --T— -
OwfftV we*vA be dipwil in ft=tdwm vA&app sap MwA* Dir C%,*. ftm A Pi*%Ormin A60 100' 1500
gait%w &*On Chop**447 and N3 mid appGoOki-edea and Ow M*%"am 21100
no klOp*4 be WPO*pd anises Oro m eunder OM W) fit dim-0 from —
plawOhre mmisenbe". 6*0 Flow Prvvwftm
"OMEOWNEAS-I hwvby-stilly to I wn Ow-tater 030 the prowly ft- Dw**cc Anf*ckb3n Device ?50 -
aarlIt 0 dic i at whtdt I 1 -1 1 1 propose io nmft a pkvvift' - I Ion lar AM Te"or Womb W
NNY Oft"um and#6 po a"fq Is not being oxu*uftd to sob.lowe or rem OwwavaledlomPbAipm
Ce"Samin 7 go.
kw.of E".ft"" 40-WF*1,*
Ps*omWd V"ecbom *WOO P-WO*
A%w.at ftmift
on Exh"
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CITY OF TIGARD MECHANICAL PERMIT
Permit# -�
rDescription —
Table 3A Mechanical Code QTV PRICE I AAT
City of Tigard —-- -- _
13125 S.W. Hall Blvd zee 't) Permit Fee -0- -0- 11,00
P.C. Box 23397 ------- -- —
T'Uard, OR 97223 2) Supplemental Permit 3,00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents / 6.00 -
��/ — Furnace 100,000 BTU 4 - ---
_ 2) 7.50
incl.ducts.&vents
Nome of Development 3 Floor Furnace�( ) incl.vent 6.00
172
Job Address -Z `- 4) Suspended hr iter,wall heater 6.00
Address or floor rnountud heater
Tax Lot No/S'/ 3 l' , , Vent not Incl.In
Lot Block Subdivision 5) appliance permit 3.00
Name(«name of businell Repair of heating,ref r ig.,
11411
?� 6) cooling,absorption unit 6.00
Mailing Address p� Boiler or comp to 3 HP
Owner 7) absorp.unit to 100,000 BTU 6.00
clryistata Zip 8) Boiler or comp to 3 HP-15 HP� 11.00
_ absorp.unit to 500,000 BTU
Name l g) Boiler or comp 15-30 HP
absorp.unit 1/2-1 million 15.00
Mailing Addie - plpry Boiler or comp,to 30-50 HP 22.50
10) absorp.unit 1-1.75 million
C;�ntract°r cltyistate - Zip Boiler or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31.50
State Registration No. - -- City Bus.Ten No, 12) Air handling unit to -� 4.50
10,000 CFM
I harehY acknowledgeAir handling unit
that I have read this appllcatlon That the information given is 13) 10000 CFM 4- 7.50
correct,that I am the ow ,
'c or authorized agent of the owner,that plans submitted are in
Complfence with Slate lawn,that I am registered with the State Builders'Board,that the Non portable
number given is coned (II exempt from State registration please givo reawm below) 14) evaporate cooler 4.50
15)- - Vent fan connected
to a single duct 3.00
—"- --' Ventilation system not
- a------ `--- _ 16) included io appliance permit 4.50
Hood E,erved by
17) mechanical exhaust 4.50 1/.J
ur®( or agent) i nate Domestic type
Describe work ❑ additi- ❑ alteration ❑ repair ❑ 16) i•iclnerator 7.50
to be done _ residential non-residential ❑ v Commercial or industrial
30.00
Existing use of — 19) type incinerator _
building or properly _ Other i.e.,woodstove,water T-
Proposed use of 20) heater,solar,clothesdryers,etc. 4�
building or property _ _
/ -— 21) Gas piping one to four outlets 2,00 Z
Type of fuel- oil 0 natural gas LPG ❑ electric ❑ '-
22) More then 4-per outlet
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON ------- ------- Y SUB-TOTAL �' c
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE / y 4
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ------PLAN
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER --- REVIEW 28X OF SUB-TOTAL / L.
WORK IS COMMENCED. TOTAL
Special Conditions
Dels issued - by ��
BUILDING PERMIT APPLICATION DATE 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATEn BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPF(',IFICATIONS OWNER _0U
PHQN bel
LOT NO.___1i _!
OWNER ilei a W1orl.ase t t O JOB ADDRFGS13901. SW 11 1 11dun t_L" . !
— -- �-— ARCHITECT
ENGINEER DESIGNER 1TRi.Ci Cy #10
BUILDER__ iJS11( ADDRESS ---
STRUCTURE D NEW E-1 REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
_ 'RESIDENCE ❑ COMM ❑ EDUCATIONAL. ❑ GOV'T ❑ RELIGIOUS ❑ PATIO_El CARPORT 0 GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY LAND USE 7_ONE BLDG.TYPE FIRE ZONE PLS; CHECK BY _.__HEAT_._---
flC1LR�r> r"t: G111 1€'
family e1WC'1.._ i•ng � /--t.t.achcdr�ilr_m90# X3.1. )ter z�p� —
C e �� 4`; ccad�I. Subject t0 An*kxx t 360. REIW,,T,�E raf 6597
_Sub ac
SEWER PERMIT Ii 34075(ldy) 2 baths, 9 trails g&JCr.1C3+IG E1zt!3 40 -
OCC.LOAD FLOOR LOAD HE:iGH7 _ O.STORIES r— AREA Z NO.BEDROOMS 3 VALUE go4o�
BUILDING DEPARTMENT SET BACKS FRONT -~ — REAR - LEFT SIDE---�- -RIGHT SIDE
37 3.00 - —_______ _ _
Permit _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
— - REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check l WORK 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
Sub-total _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
18.65 LICENSE.SEPARA,Tf PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
State Tex _ 7, SDC— 1500.00 t
Total40. - PDCfi 1. 15 0.0(�-APPLIGAN7 OR AGEN1
By I,�
— -- Recelpt No. ` ADDRE98 PHONE
Approved
DATE INSP. TYPE INSPECTION
REMARK! PLUMBING DATE
Contractor
rpermit No.
Rough•in
v� Fixture
Final
HEATING
Contractor
r Permit No.
Gas r Oil
Lx _ OIL-
/ � Rough-in
/ SEWER
i Final
DRIVEWAY
Final
Storm Drainage _
- (Rain Drein)Final
—" Sidewalk
Curb,"-Street Final
Approach .�.
HLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
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