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8U1 DING DEPARTrMEN1', TIGARD NU
PLUMBING PERMIT 1�
�A
holder of a valid plumbing contra(.-tors license is hereby
authorized to cause p!Umhing work a•; rein noted to be installed in accordance with the plumbing code o`
T igard. Such installations require ins .rain,, by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for in_�pection. City of Tigard Busines� LicensF re uire ,
for all cont c rs rd sub n:ractorti. fob S,
Address = —(/fir-" Date__
Owner _ - -- —
NU`MEn OF TOTAL
TYPE OF PERMIT ITEMS _ FEN OSI EACFIAP:IOUNT
SinqIeFamily-1 bath-etch - 15.00
t)u lax-Each 1 bath unit _---25.01) - -
A ditioa? m
nal bhroos-eich 10A0_— Ta —
1�
hlobitd 15.00 Home 5 gee-each —�__
tINDIVIDUA_L FIXTURE9�COf�inERrIAI --
1
— -- -- --JiJ
-- -----3.00
1 to 50 Fixtures in 1 buildin -each
1_31 to 100 Fixtures in 1 building-oach —_ _— _. _. 2•50 --- - -- —
M _101 to 200 Fixtures in 1 buisding each— —_ _-- 2-(7,0 --- --- —'"—
201 or more Fixtures io 1 building—each
f.t 1 5 C E L L A N E 0 U S ___ ----- — -"- - - -
$ewer-each additional 100 ft. _ — —�10•0,0 — - ----^ - --- 1
Water Service to building _ ._----- ----.- -- — -- `-
_ Other (So�rify) �_ ----- - ------ __ w__.�_
l PERMIT � FoCPlurrlh/nr�Inspection Phone 6.39 4171
4%State _ 2, o o Plumbing Coritrar_tor By
I TOTAL c =, -d �' CEIP7 NO. Issued By _----------
BUILDING PERMIT APPLICATION TIGARD DATE- 19-BILL 3329
THE UNUERSIGNED HEHLBY APPLIES FOR A PER r011 FUh IHE WORK INDICATED BUILLPER PHONE 246_747''10
OR AS SHOWN AND APPROVED IN THl. P:.-COMPANYING PLANS AND SPFCIFIC,4TIONS. OWNER P ONE
LOT NO. 4-isic 3 r'!i'lt n
OWNER Uab Samuels JOBADDREt3b 16 5?� :.i LJ :iYIVaI1 CUU1 T --�
same 8735 SU Lc,hmen St Pt'1d GEg°a� Piercy & La r cla
BUILDER � ADDRESS � _y
STRUCTURE XXNEW ❑ REMODEL ❑ ADDITION U REPAIR 0 RENEWAL ❑ FIRE DAMAGE f.7 DEMOLITION
>13 RESIDENCE ❑ COMM_ ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS E PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY _ " S—LAND USE ZONE f�-7Pn BLDG.TYPE _fin—FIRE ZONE_ PLAN CHECK BY _ dwh HEAT
ooptri ct eingle family duel ing w/atteched gka.rage.. 4 Uedz:oame 3 Baths,
SEE EnPRErTION SHEET ATTACHED.
SEWER PERMIT# 22001 — 1750*00 4ierage_•)f'� ag.ft.
C --- _
CC.LOAD FLOOR LOAD 40_ HEIGHT 2O NO.S''ORIES_2 AREA "1�i" NO.BEDROOMS 4 VALL*7 4,1r�
BUILDING DEPARTMENT SETBACKS FRONT 1 cl REAR .3 LEF T SIDE 0 RIGHT SIDE
Permit _ 1237.00 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 116 bo 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 •3a5• -'� RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED VOR SEWER.PLUMBING AND HEATING.
State Tax 4;• '�• 40 IWO.00
Total $364,90 SDC —
By Pi PDC# 1 .' S100.00 AP LICA ANTORAGENT — - --
Approved duhReceipt No. ADDRESS-------------- PHONE -.-
w mw in
DATE IN8P. STYPE INSPECTION --_—REMARKS PLUMBING DATE
�4%-7 r0'm — -- ----- - — Permit No. lt,6 53
a'-'%-4 p Rough-in
Fixture
.RC1-5f0 &L r. —o _ —�- Final _ — —
�b'�-�t0HEATING -
���s�-H —__ --- — Contractor
//-7' - - - Permit No
�L _s, Gas or Cll L—
Rough-in
— — ---- ---_-- Final --
- -- ----- ---- SEWER
Final
-- --------- ----- DRIVEWAY - ------
- -------- -- Finul
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINALTEMPORARY CERTIFICATE "FY
NCY
CERTIFICATE OCCUPANCY Flnr,l
Lnndsceping
—-- Zoning Final —
A
BUIL DING PERMIT APPLICA T ION TIGAZ:) DATE _.19-.84
THE UNDERSIGNED HEREBY APPLIcS FOR A PER?AIT FOR THE WORK H:REIN IND I ''A TED BllILDcR PHONE ��'
OR AS SHOWN AND APPROVED IN THr.,000�P%PANYING PLANS AND SPECIPICATIONS. O'.w4 R F-;O';`
0-1.1 ER �0�) JAMh JOBADUFESS „ '� +XRW%-_—Cy p pr4iQH4FEt?T"' �A--�i1/
r• —_� ADDRESS S►u �r,Rh�l f DESIGNER
BUlL�EP � �� —
STRUCTURE NEW ❑ REMODEL ❑ ADDITION' 73 REPAIR C3 RENEWAL ❑ FIRE DAMAGE C1 DEMOLITION
RESIDENCE
�C} CCM%I ❑ EDUCATIONAL J GC)V'T C RELIGiOUS C PATIO C CAR P(.-,RT ❑ GARAGE C STORAGE E SLA.BC FENCE
C<.l.iipANCY _�'C` —LANO USEZONE CZ.:_� BLDG.TYPE __FIREZONE--3__PLAN CHECK BY o,y�_- HEAT—
3 �al�da
SEWER PERM Ir —.------
OCC.LOAC FLOOR LOAD— �fU--HEIGHT 2(D, NO.STORIES_ZAREA,20 q NO.BEDPOOMS -VALUE /00
BUILDING DEPARTMENT SETBACKS FRONT _REAR Z 3 LEFT SICE J9, Y— RIGHT SIDE
237
Permit Q THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE EUILDING CODE, Z011;N3
1 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
IPIanCheck ^— .�WORK WILL BE DONE IN ACCOP.CANCE WITH THE PLANS AND SPECIFICATIONS AND IN CO3APLIANCE
- WITH ALL .APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV_
Sub-total SS'5 RESTRICTIVE COVENANTS. CONTRACTOR ANO SUB CONTRACTOR.'TO HAVE CURRENT CI'-Y BUSINESS
LICENSE.SEPAPATE PERMITS REQUIRED FOR SEWER,PLUP181NG AND HEATING_
zitaui TaxTotal _ "T
SDC—
PD APPLICANT OR AGENT
BY -- �_ ------- - —
Receipt No. AOOHESS— — PHONE
Approved
DC
SEWER CONNECTION S � .
SEWER INSPECTION� PECTIL'N g
-_-_
3EIjER SURCHARG- S
Lo+* 34- 1 qjJX- I a�;4•��
'4
fAa;h Ryer-�U�p�) 2ca n
.27
Co x 24 �}4
7x 3 �-I
2� x 92 �
a .�"0 7
L040 e,1--- L.eud. 2 yr 3-9 7e-?
,23 x /(a-fp 38-$
4049 �' r�za g 3
2#3 24 -7 5-&
� , (C)
_•.�Mh ys��yi�s7V71w,
::aiYaseovr �tdxx�nrc,at. a12�a�!'atX�Y:2�lli�Kt�' iik3S}R,'�tiL!!'i�d �•"�+
(_ IMechanical Permit NT Pet mit--$3 00 _- -_
Fee3_�60_
_
New Installation X Replace ❑ Relocation ❑ Addition ❑ Alteration ❑ 3%State—.-
TOTAL--
CONTRACTOR
..._TOTAL—_CONTRACTOR NoCollister -creating & Aj-r -C=d, OWNER Bob Samuels
ADDRESS_ 21940 W. Baseline Rd. , Be-AV-,- WORK ADDRESS_ 63.75 �[, Sylvan
PHONE _§49-S5Q+$ -. .._ . . -_ APPLICANT__ftColl JStar_lLeat.1ng &
Heat Input Rating (BTU Per Hour) 125L_000 Vent Size �" Flue Size 6
~
FUEL OIL ❑ GAS PU ELECT ❑ OTHFR T —
1 ITEM NO. FEE _ _ ITEM NO. FEE
For Issuance of Permit _ 3.00 _Air Condition Compressor 15 to 30 HP 10.00
New• Under 100,000 BTU _ 4.00 _Air Handling 10,000 CFM __ 3.00
New• 100,000 BTU&over _ 5.00 'Air Handling Over 10,000 CFM 5.00
Floor Furn+ae_ 4.00 Evaporative Cooler 3.00
_Wall - Floor-Supertded _ 4.00 Range Vent Fan _ 2.00
Install Vents Oniy _ _ 2.00 Vent System _ _ 3.00
'Repair • Heat&_Cooling 4.00 Hood Commercial3.00
Air Condition_Cunrpressor Under 3 HP 4.00 Commercial Duct System _ 10.00
Air Condition Compressor 3 to i 5 HP 7.50 —
INSPECTOR'S COMMENTS_
s.'.' CITY BUSINESS LICENSE REOUIRFD FOR ALL CONTRACTORS OR SUB-CONTRACTORS
y_. APPROVFD BY DATE ISSUED BY _ — _ DATE
RECEIPT ND.
— - -.�—
Li
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Sign a'tur plicant
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