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INSPECTION NOTICE
City of Tigard Dudding Department
P 0 Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
-7
Cate Requested Time--
A.M. P.M.
Address
Permit 0
Owner
I y
Lot
P-qilder
Tile followirl, Buildinq Code deficiencies are required tj be corrected:
Presented io
Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
El YE8 0 No
CITY OF TIGARD MECHANICAL PERMIT Receipt#
Permit# "`:"s" ,•'-,- . r".1
Description
Table 3A Mechanical Code CITY PRICE _AMT
City of Tigard 1) Permit Fee -0 -o- 10.00
13125 S.W. Hall ulvd.
P.G. Box 23397 -
Tigard, OR 97223 2) Supplemental Permit 3.00
539.4175 Furnace to 100,000 BTLI
1 incl.ducts&vents 6.00
Furnace 100,000 BTU +
L) incl.ducts&vents 7.50
Name of Development I Floor Furnace
Incl.vent 6.00
Job Address �— —�' Suspended heater,wall heater
Address 4) or floor mounted heater 6'00
Tax Lot snap No. Vent not incl.in
Lot Block Subdiv,sion 5) appliance permit 3'00
_ Name(or name of business) Repair of heating,refr Ig.,
b) cooling,absorption unit 6.00
Mailing Address ~�- PhoneBoiler or comp to 3 HP
Owner �) absorp.unit to 100,000 BTU 8.00
l C ty,State — zipBoiler or comp to 3 HP-15 HP
8) absorp.unit to 500,000 BTU 11.00
Name Boiler or comp 15-30 HP
9) absorp.unit!1P-t million 15.00
Muting Address— Phone 10) Boiler or comp to 30-50 HP 22 50
absorp.unit 1-1.75 million
Contractor City State Zip 11) Boller or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
Stale Registration N.) City Bus.Tax No. 12) Air handling unit to 4.50
t u,000 C FM_
I hereby acknowledge that I have read this application that the Information given Is 13) X� handling unit— — 7.50
correct,that I em the owner or authodr.ed agent of the owner,that pleas submitted are In 7t_,)00 CFM A— --—— —
oempllance with State laws,that I am registered with the State Builders'Board,that the Non portable
number given Is correct.(if exempt from State registration please give reason below). 14) evaporate cooler 4.50
— -- _ 15) Vent fan connected — 3.00
to a single duct
) Ventilation system not
18 included in appliance permit 4.50
-- .`____.__.�.•.___-__— 17) Hood served by — 4.50
-°d " mechanical exhaust
Signature(owner ora m; ___ _ Dale 181 Domestic type 7.50
Desnribe work r:] addition ❑ alteration Q. repair El „ incinerator
to be done residential ❑ non-residential [1 19) Commercial or Industrial 30.00
Existing use of type Incinerator
building or properly - 20) Oesterseism clothes dryers,etc.odstove,water 4.50
,
Proposed use of -- —
building or property_ — -- 21) Gas piping one to four outlets 2.00
Type of fuel- oil F1 natural gas F] LPG [ 1 electric 1 I -
22) More than 4-per outlet
Nr TJ ICE --- -- _
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON — --------- - --
STRUCTION AUTHOP .'_ED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
D,iYS, OR IF CONS';(4UCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER -- — --
WORK IS COMA"ENCFD. TOTAL
Special Conditions
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CITY OF TIGARD 639.4171 580
� 19 ;.,,
BUILDING PERMIT DATE ug
TAX MAP —LOT N0. LE SUBDIVISION
OWNER_ A,aVu ,:ulScA'cr JOB ADDRESS b6t;fJ S ►xlualc� aC. _
BUILDER � �._ 9 Nkj 19tt'9 11.181,01 ST ATE REG.NO. 42634_—__ EXP.DATE :�ll ik' _
BUILDER'S PHONE _ "A-2400--
ARCHITECT
,/ A--9400_,ARCHITECT _ PHONE —OTHER.-.-
STRUCTURE
___OTHER.__STRUCTURE IjLI NEW I REMODEL I_I ADDITION REPAIR MOVE LI OTHER DEMOLIPION
P.ESIDENCE COMM EDUCATION I1 IND RELIGIOUS ACCESSORY GARAGE OTHER FENCE
OCCUPANCY ,_LAND USE ZONE"'`' BLDG TYPE SIRE ZONE__PLAN CHECK RY HEAT
..�3ouetxuc6. Oillkle I wily residence W/attatile : arage —
,711 �.�•r ,��Z.rayr�l ?l.�n��. ttL.15SUs' ul b"�5�5 _
SEWERPERMITN j,�Ujj lldUl gardre 480 l bath
OCC.LOAD FLOOR LOAD 4U HEIGHT 1;. NO STORIES 1 AREA 14.-16 N0.BEDROOMS VALUE
- BUILDING DEPARTMENT SET BACKS FRONT � REAR V LEFT SIDE 1 U RIGHT SIDE
Permit 31tl.uu THIS PERMIT IS ISSUF70 SUBJECT TO THE REZIULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check berUU WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS IND SPECIFICATIONS AND IN COMPLIANCE
`--' WITH ALL APPLICABLE CODES AND OnDINANCSS. THE 1 'UANCE OF THIS PERMIT DOE'S NOT WAIVE
PI Ck.Fire RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONT,,..CTORS TO HAVE CURRENT CITY BUSINESS
—l- — TAX PERMITS.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 12.E+4 SSs!t, ,
SDC_ 5VU.UU
Total ;'r68 r64 APPLICANT OF AGENT �
_ —�_ PDCM
z 15U.Uu� �
Prepd. 4U.UU
__.. - -- Receipt No. W . ,._, ADDHE88 - -- --PHO E
Bel,Due 31b.64
—_
Issued By—_—______ PProved By-__
DATE - INSP. TYPF iNSPECTION REMARKS PLUMBING DATE
Contractor
_ Permit No
Hough in
Fixtur—e ---�� _
L— — Final
HEATING
/t ---- -�-v Contractor
Permit No 39
(/ Gas or Oil
L'�O �d ---. Rou-jh-in
�I
-- .✓� %d FTS ---—
Final
SEWER ----
/rids/� D�b��u ,rrfFC.4G(r�C4 Pri�s�/� Final
—P f /"✓f c�/i,y �.,b0� DRIVEWAY
J� 2 — --�� Final —_
Storrs Drainage
(Rain Drain)Final
-- — Sidewalk —
Curb 6 Street Final
Approach
BLDG.DEPT.FINAL — TEMPORARY OERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUFANCY C d I-
4K
— -�—
Landscaping
Zoning Final —
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 7223
Phone:639-411 75
01,
.� ��� ✓ A.
Tyoe of Inspection .�_
Date Requested Time- A.M.-P.M.
Address _ Permit #
Owner _._ Lot #
Builder _
The following Building Code deficiencies are required to be corrected:
f'rese��ted to Appro+,ed
Inspector �_A)
Disapproved
DatP
CALL FOR REINSPECTION
f_J yea EJ MO