12150 SW SUMMER CREST DRIVE 12") SW SUMMER CREST DRIVE
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r 'VirTY OF TIGARD IMIF:,'�.I- ANICAL PERVIT Receipt# r/�
t Permit #
Descriptio
' Table 3A Mechanical Code---- CITY PRICE AMT
City of Tig—rd - -------- -- -- --
13125 S.W. Hall Blvd 1) Permit Fee 0 0 10.00
P.O. Box 23397
Tigard, OR 9722; 2) Supplemental Permit 3.00
539-4175 1) Furna^e to 100,000 BTU _ 6.00
Incl.ducts&vents
Fur race 100,000 BTU +
2) incl.ducts&vents 7.50
Name of De,elopmenl --� Floor Fumac
3) incl.vent 6.00
Jn), Address_ Suspended heater,wall heater
+. 4) ()r floor mounted heater 8.00
t
Tax Lot- - Map No, -`- Vent not in�I.I,i
_ Lot Block Subdivision 5) appliance permit 3.00
I Name for name of business) ) Repair of heating,refr ig�.—
6 cooling,absorption unit 8.00
I Mailing Address Phone Boller or comp to 3 HP
Owner 7) absorp.unit to 100,000 BTU 6.00
City-state - zip 8) Boilerorcompto3HP-15HP 11.00
_ absorp.unit to 500,000 BTU
Name 9) Boiler or comp 15-30 HP 15.00
_absorp.unit 112-1 million _
Marling Address Phone 10) Boiler or comp to 30-50 HP—y 22,50
absorp.unit 1-1.75 million _
Contractor clty'state Zip 11) Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No. City Rus,Tax No. I 12) Air handling unit to 4.50
10,000 CFM
I hereby acknowledge that 1 have read this application that the Informaticn given is 13) Air handling unit 7.50
correct,that I am the Near or authoriead agent of the owner,that plans submitted erb in
10,000 CFM -1-
compliance with State laws,that 1 am registered with the Slite Builders'Board,Thal the Non portable �,�
number given is correct.(If exempt from State registration please give reason below). 14) evaporate cooler 4.5c'
--- ---- ----
15) Vent fan connected 3.00
to a single duct
-- - -------- ) Vent"ation system not
18 Included in appliance permit 4.50
Hood served by
1 mechanical exhaust 4.50
Signature(rant �—._--
er or spent) )_ bate 19 Domestic type 7.50
De,acribe work ; I addition n alteration 1-I repair Elincinerator -- _
to brl done residential ❑ non-residential [J 19) Commercial or Industrial 30.00
e Incinerator
type Existing use of — -�_
building or properly _-_ 20) Other i.e.,woodstove,water 4.50
Proposed use of
heater,solar,clothes dryers,etc. 1
------ ---
building or property ----- '1) -gas piping one to four outlets 2.00
Type of fuel- oil [-I natural gas [_l LPG I_I electric f_1
22) More than 4-per outlet
NQTir,� -
SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON — ----- -
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENC=D OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER — - -- --
WORK IS COMMENCED. TOTAL
Special Conditions
- --- -- - Date istiued_ S by t
INSPECTIO' N NOTICE
City of Tigard Building Depa.tmens
P O Box 23397
Tigard. Oregon 97223
Phone. 639-41/5
Type of Inspection
Date Requested_ _ y"-�` Time--- A.M. —1114.
Address ; SCJ ��tiJ ��M^.► .2r rpt, - Permit #_4
Owner
Lot _
Builder
The following Building Code deficiencies are requi-A to be corrected.
—
3� ~�nom?F �.lrr�.l�,l N Ca � �i A.RL..A �' ►= /�t�1�T't��I _
y�.1 M r rl. .i---��!"'i-Fes.-�-Z--•�f=TA 4-• �>�`r 5'
�Z� PE!� .�c7 dT tZ �ZIJ ca L/r,'M -r 11)1�1 -
Presented to — C1 Approved
I:,pector _— -- Disappro;ed
Date -- -- - —'-'-��-'�-
CALL FOR REINSPECTION
YES 0 No
INSPECTION NOTICE j
City of Tigard Budding Department l
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of 'n3pection •�._ ��"—�8�-- !_3• _--------
Date Requested_ Time A.M.____P.M.
Address,/ L+d -1],�,�L J �a 'Permit *X
�
Owner_ _ Lotk�_`
---
The following Building Code deficiencie+ •re required to be corrected:
i
Presented to Approved
Inspector _ '��e��:�' �}'Disapprovad
Date
CALL FOR REINSPECTION
�G1 YE8 ❑ NO
6�
BUILDING PERMIT APPLICATION TIGARD ,.
TIIE UNOEASIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER AN E� S
OR AS SHOWN ANO APPROVED IN THE AC<'AtdPAf4YING PU111S ANO SPECIFICATIONS. LOT NO. �' `'
JOB ADDRESS J � AaCNITECT
ENGINEER
ftESIGNEa
GUILDE
AooREsS .._.._...._.-
sraucltlaE D NEW fJ OEMo_ o�,'�AoarloN _ aEs'AII�ENEwAL _U FIRE DAMAGE ❑ oE��
❑ CARPOaf ❑ GARAGE GSTORAGE ❑ SUgo
(j r-:SIOENCE ❑ COMM ❑ EOUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PANO �
FIRE ZONE �N C'hECK 9Y --HEAT"---
OCCiiPANCY LAND USE ZONE BlOG.rYPE - _
daSEyvER PERMIT/ - 6 3. ,
S / NO.STORIES ,-*fO.BEoaOOMS— vAUE
OCC.LOAD FLOOR LOAD HEIGHT --,�-
—� ()IN(3 0!�PARTMENT FRONT ...... REAR LEFT SIO£
BUILRIGHT SiQ��'
SET ftACKS F
THIS PCRI.AIT IS ISSUED SUSjECT TO THE REGULATIOIIS CONTAINED IT THE RVif.Y AG CEOirlt
E.
E..
REGULATIONS AND ALL APPf�CABLE CODES AND ORDINANCES,
AND IT IS HEREBY AGREED
�P1lert Check WORK ATIOWtLL S DONE IN ACCORDANCE WITH THE PLANS ANIS SPECIFICATIONS AND IN COM
WITH .ALL APPLICABLE CODES AND ORDINANCES.THE ISSIIANCE OF THIS PERMIT GOES NO
Su9 folal / L� LICENSE SEPARATE PERMITS REQUIRED FOR SEWER.PLUf qIrTOR AND SUB N LAND HEATINtnS TO"AVE L�RRENT CITY B
II 1 ,r n
Stili Tu
- / _ SOC--
Total / �7�7 6 5 ApPL1C:ANTOnAGENT —
POfo
By
,. Rec+101 Na. RppRESS
Approved
SOC -----
POC —
SEWER CONNECTION
SEWER INSPECTION 8
SEWER SUR NARGE S
Comsrental
BOILDING RCCFiPT
NAME: DATE
ACCT. N DESCRIPTION AMOUNT
10--432 Building Permit Fees
10-431•-600 Plumbing Permit Fees f _
10--431-601 Mechanical Permit Fees f
10-230-501 State Building Tax
10-433 Plans Check Fee
30-443 Sewer Connection (20X) f
30-202. Sewer Connection (80X) f
30-144 Sewer Inspection s
51-448 Street System Dev. (1varge (SOC)
52-449-610 Parks 1 System Dev. Charge (PDC) f __
5�-449-620 Parks II System DQv. Charge (PDC)
31--450 Stora Drainage System Dev. Chrg (SSDC)
10-230-•505 TRFD (95X) S _
R 10-478 TRFD (5X)
14--L30-506 Washington County Fire N1 (95X)
10-A78 Washirogton County Fire N1 (5X)
10-220 Amart/Wedgewood
TOTAL
(be/1214P)
r
SEWER PERMIT
Unified Sewera, a Agency L���• _ DATE
of w.shir,gton County CITY OF ^�
OWNER : J ��� ��Y � ,) �� U�v��_ — F'Ho►vE =_ �L63Z,
OWNER 'S ADDRESS: � �'��—��) �'�-���S� �• ---- - - -
TYPE OF INSTALLATION :
SIDE SEWER [] LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY =
❑ NEW Cl EXIS ;tNC SINGLE. FAMILY ❑ COMMERCIAL
EXIST . (PRIOR TO 7-- 1-70 ) ❑ MULT. RES. [-1 INDUSTRI% L
FIXTURE UNITS_ ___. DWELLING UNITS I__
ADDRESS OF STRUCTURE : - -- --
Permit Conditions: Tho applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount paid will be torreited should expiration occur.
The Agency does not guarantee the accuracy of the location of side sewer laterals. If the sewer Is not located at
the measurement given, the Installer shall prospect three feet In all directioiis from the distance and depth given.
If riot so located, the installer shalt purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
wit' Install a lateral at the location specified by the installer.
FEES:' �p
PERMIT FEE $
CONNECTTGN CHARGE ---
LINE TAP 1;4STALLATION �---- --- - --
r.. ISSUED BY
OTHER ---- ----
_ o�
TOTAL
3V APPLICANT C)A_i F
SE19�'ER PERMIT
ADDRESS OF STRUCTURE 8-13-0 _gCO_(' ' r0-4G5+ %*---_—
TAX MAF' 15 ( - ? TAX LOT 2000 SYSTEM 1000
0
L'I'T � --BLOC K _—�� _ 0 F= _ -- --- -- - ----
APPROVED BY DA1 f- I � ISSUED B�Yf DATE
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D. U. S _ REMARKS . ----�- -- ------- t� -
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