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CITY 'OF TIGARD MECHANICAL PERMIT Rec3ipt#
Permit #
Drlscription
Table 3A Mechanical Code QTY PRICE AMT
City of Tigard 1) Permit Fee -0- -0- 10.00
13125 S W. Hall Blvd.
P.O. Box 2;3397 2) Supplemental Permit 3.00
Tigard, OR 9722.3 _
639-4175 1 I Furnace to 100,000 BTU 6.00
incl.ducts_&vents
2) Furnace 100,000 BTU -1 7.50
incl ducts&vents _
Naive o1 Development 3) Floor Furnace — 6.00
Incl.vent
Job Address I 4) Suspended heater, )heater 6.00
or loor mounted heater
Address -- - --
Tax Lot Map No. 5) Vont not incl.in 3.00
Lot Block Subdivision appliance permit
Name(or name of business) ) Repair of heating,refr ig.,
8 cooling,absorption unit 6.00
Mailing Address Phone 7) Boiler o•Comp to 3 HP _ 6.00
Owner absor-.unit to 100,000 BTU _
City State - Zip - 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU
Name 9) Boiler or cL.np 15-30 HP 15.03 -
absorp.unit 1/2-1 million _
Mailing Address Phone 10) Boiler or pomp t(,30-50 HP V 22.50
absorp.unit 1 -1.75 million _
Contractorcity,state — zip 11) Boiler or comp to 50 HP W.50
_absorp,unit 1,750,000 BTU
State Rtrgistrawn No. City Bus.Tax No. 12) Air handling unit to 4.50
10,000 CFM _
! hereby acknowledge tl��t 1 have read this apnllcatlon that the Information given is 13 Air handling unit
1(),000 CFM + 750
correct,that I am the oww4r nr authorized agent of the owner,that plans submitted are in -
(omplience with State laws,:hat i om•dgistered with the State Builders'Board.that the 14) Not portable 4.50
number given is correct.(it exempt f,om State registration please give reason below). evaporate cooler _
15) Vent fan connected 3.00
- --� to a single duct
- - -- --- - 16 Ventilation system not 4.50
included in appliance permit
17) Hood served by 4.50
mechanical exhaust
Signature(owner or agent) _ Date 18) Domestic type 7.50
Describe work O addition f I alteration 1_1 repair I I Incinerator
to be done residential t-1 _ non-residential f 1 19) Commercial or industrial 30.00
Existing use of type incinerator
building or property „0) Other I.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc.
building or property - - __ 21) Gas piping one to four outlets 2.00
Type of fuel- oil ❑ natural gas n LPG l-I electric f
22) More than 4-per outlet
RQM1E SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION
ON STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 UAYS AT ANY TIME AFTER -- --
WORK IS COMMENCED. TOTAL_
Special Conditions
Date issued _by __
. .:�i4��J"Y''���v .Y i .. '11rM1. ,. .. -.r...WY4"M'./�TY•r. ..' ..:., y.,; ..., . .. • yr r
w 4 ---
CITY OP I0-29p :
BUILDING PERMIT APPLICATION TIGARD DATE t4 �5'r �
�
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
OWNER PHONE � 4`�..t'
OWNER R• S , McKelvey V ADDRESS ---,-- _ - B�IILDERQFIONE —
uwri l ENGINEER
JWILDER ARCHITECT ----1DESIGNER ''
STRUCTURE ❑NEW REMODEL _DADDITION OREPAIR _ORENEWALLI
- FIRE DAMAGE�-1 OVEMOLITION
ORESIDENCE ❑COMM ❑EDUCATIONAL OGOV'T ORELIGIOUSOPATIO ❑CARPORT ❑GARAGE OSTORAGFOSI-AB ❑FENCE
DBONU ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY--.F-LAND USE ZONES.—___BLDG.i YPE FIRE ZONE__,. PLAN CHECK BY HEAT_
11G1.4wt1is C:>iI'port --- (tow AjGu.'j -.LIiQUr 10*11L -,J6ttW6Gf) ucv?.;9tyFi dwelling
OCC. LOAD_ FLOOR LOAD HEIGHT NO.STORIES — AREA VALUE I:Q•l3U
— BUILDING DEPARTMENT — SET BACKS FRONT _HEAR LEFT SIDE RIGHT SIDE
Permit -_—~- - - -�--
"- 1.' 3 PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINEt1 IN THE BUILDING CODE, ZONING
Plan Check PEGULATIONS AND ALL APPLICABLE LODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
YW`9K WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE COPIES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES Nt'T WAIVE
-- RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWr:7, PLUMBING AND HEATING.
Total
BY
-- ------ ----- APPI ICANT OR AGENT
[A�p,oved Receipt No
AUURE55 --�-- PHONE
r)ATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
QA
Contractor
e - 1� ►.err ' Permit No. _
(�
,--
Rough-in
_ Fixture
-- Final_ —
HEATING
— _ Contractor
Permit No.
Gas or Oil
-- --— —_—�__
Rough-in
Final
— ———---- -- --- —.
SEWER
Final
-� ---- DRIVEWAY
---- -- ----
Final
Storm Drainage _
(Rain Drain) Final —
--- _ -- — �1 Sidewalk
-- — Curb&Street Final
—' _0---- Approach
BLDG.DEPT.FINAL 1 EMPURARY --T CERTIFICATE OCCIIPANCI'
CERTIFICATE OCCUPANCY I Final
Landscaping
Zoning Final
i
Address //g'/'ti Permit No ,ki
r ;
Permit charge -�
Owner o�_,_y „ h��_, Connection fee 9 7
Paid by
Typc of building li-Lc , Date connected
Sprvice rate Inspection fee -2.1-)
Contractor Paid byl Date
Size of connection Assessment raid
`r
`7
r
PES'wIIT TO CONNECT
Tigard Sanitary District
3/4
PERMIT N9 '1366 DATE / /
PERMIT IS GIVEN TO t
Or
TO CONNECT A
TO THE FYSTEM OF TIGARD SAN/'PART DISTRICT
,1
AT
THIS PERMIT MUST BE POSTED THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECT N OF CONNECTION HAS B1SEN COM-
PLETED.
^ d
PERMIT FEE PAID =...-w..7�,,,,!�,y,�„�•+'a ,TIGARD SANITART DISTRIPT
BY
CONNECTION INSPECTED AND APPPOVED
Y Date Su jiAntendent
INSPECTION NOTICE
City of Tigard Building Depa,tment
P.O. Bax 23397
Tigard, Oregon 9722:.1
Phone: 639-4175 /
Type of Inspection __ �V ✓�A G, I , 'j,
Date Requested L) - Z Z. Time
/ A.M._ _P.M.
Address J ( �7 j '^S�l-�f i u L Y� Parmit #_YV 50
Owner 7 ' ` C( U` Lot # ,el
Builder
The following Building Cod( deficiencies are required to be corrected.
Presented to
-- --- - �� Approved
Inspector
Disapproved
Date - c:
CALL FOR REINSPECTION
❑ YES b NO