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INSPECTION NOTICE
City of Tigard Building Department
P G. Box 23391
Tigard, Oregon 97223
Phoney:�33r9--'4175
Type of Inspection L/���rV ✓_6�___�_.. -- --
Date Requested D.L .. ._ Time. A.M. _P.�M-.7
Address r 6 U SpIJ �l Y1 T�I � Permit #_4v `p
Owner_. v���_� ✓ Lo+ -'
Builder -----
The following Buiidinq Code deficiencies are required to be correct-u:
Presentnd to _. k Approved
lnspectar '� -f� _
_ _ _ ❑ Dlsapprovud
Date
CALL FOR REINSPECTION
❑ YES Z NO
CITY OF TIGARD MECHANICAL Heceipt#
C L R M I T Permit# _
Description —v /
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard 1) Permit Fee -0- 0- 10.00
13125 S.W. Hall Blvd.
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
639-417" J Furnace to 100,000 BTU
1) inc;.ducts&vents 6.00
Furnace 100,000 BTU i
2) incl.ducts&vents 7.50
Nome of Development - 3) Floor Furnace 6.00
Incl.vent
Job AddressSuspended heater,wall heater
Address �` 4) or floor mounted heater 6.00
Tax Lot Map NoTient not incl.In
5) appliance permit 3.00
Lot Block Subdivision -- —.
Name•(6t name of business) Repair of heating,rgfrig.,
6) cooling,absorption unit 6.00
Meiling Address Phone Boiler or comp to 3 HP
Owner �) absorp.unit to 100,000 BTU 6.00
city state Zip Boller or comp to 3 HP-15 HP
8) ab,(, p unit to 500,000 BTU 11.00
Name Boiler or comp 15-30 HP
9) absrrp.unit 1/2-1 million 15.00
Mailing Addre� Phone ) Boiler or comp to 30-50 HP
10 absorp.unit 1 -1.75 million 22.50
Contractor City State Zip 11) Boiler or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No. City Bur Tax No. ) Air handling unit to
12 10,000 CFM 4.50
I hereby acknowledge that I have read this application that the information given is 13) Air handling unit 7.50
correct,that I em the owner or authorized agent of the owner,that plane submitted are n,
10,000 CFM +
compliance with State laws,that I am registered with the State Builders'Board,chat the Non portable
number given is correct,(If exempt from Slate registration please give season t pow) 14) evaporate cooler 4.50
15) Vent fan connected
to a single duct 3,00
- —,:W_-- Ventilation system not Y
16) Included in appliance permit 4.50
Hood served by
17 mechanical exhaust 4.50
Signature;owner or agent) Date ) Domestic type
Describe work El addition 0 alteration F1 repair El Incinerator Incinerator 7.50 -
to be done residential non-residential ❑ Commercial or Industrial II
Existing use of 19) type Incinerator 30.00
building or properly _ 20) Other i.e.,woodstovd,water 4.50
heater,solar,clothes dryers,etc.
Proposed usa of _ _-
building or property—_- ._ 21) Gas piping one to four outlets 2.00
Type of fuel- oil f l natural gas i 1 LPG L-1 electric LJ ---
22) More than 4-per outlet
NOTICE 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 SUSPENDED 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 issued
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INSPECTION NOTICE
City of Tigard Build ng Department
12420 S.W. blain St.
Tigard, Oregon 97223
Phone 639-4171 I
Address ------ -- - r.— - -- ----
Permit
Tyr ; of Inspection __-- ------- --- — ----- - ----—
`i
The following Building Code deficiencies are required to be corrected: „t,::.c.�..._. .. - --- ---- -
j
Presented to _ _. _ Inspector ___ —• -- ---
Date ----— -- --
CAL L FOR R&WECTION
❑ Yf6 ❑ NO
— _ A
fi
BUILDING PERMIT APPLICATION 71GARD DATE_—______._/0/ 19_61 3888
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FORTH E WORK HEREIN INDICATED BUILDER PHONE 620"Qa88
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT N 0. . 1 d 9—
OWNER jay
)_OWNERjaV 01,11ar, b1dr.iPS ADDRESS 12100 W Ann Place _ !�!_indmill
_ ARCHITECT
ENGINEER
BUILDER Same _ ADDRESS fat+ _2 s 60x 290_,_ Qti6 DESIGNER Piller_ _
STRUCTURE_ [A NEW ❑ REMODELU ADDITION_ ❑ REPAIR ❑ RENEWAL_ ❑ FIRE DAMAGE ❑ DEMOLITION
f_XRESIDFNCE ❑ COMM D EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY f"-L.LAND USE ZONE R-7 BLDG,TYPE _ 5 N—FIRE ZONE _PLAN CHECK BY HEAT
Construct; aide Family dwelling _w/attached garage. 339edrooms 2 Bathes
SEC CORRECTION SHEET ATTACHED.
SEWER PERMIT# 2,3311 - j%0,00 !Za.f L. -
OCC.LOAD FLOOR LOAD 40_ _HEIGHT _13 NO.STO_RIEs 1 _AREA 1368 NO._BEDROOMS
BUILDING DEPAR MENT SET BACKS FRONT d 0 REAR 19 LEFT SIDE 13:2 RIGHT SIDE J•b
Permit sl99•qO THIS PERMIT IS ISSUED SUBJECT '.0 THE REGULATIONS CONTAINED IN THE BUILDING CODE, 20NINfJ
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check y9• WORK WILL BE DONE IN ACCORDANCE WITH TNF: PLANS AND SPECIFICATIONS AND IN COMPLIANCE
—� WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 2913.bO RESTRICTIVE COVENANTS. CONTRACTOP AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED -)R SEWER,PLUMBING AND HEATING.
4'
Stale Tax `: 7.96
SDC-
Toml z 0 E3•dfa rmf,_. ..
fll PDC# I 96100.00 APPLICANTO-Firo"4
By _
- - duh -A No. 'ADDRE98 -- PHONEApproved
DATE INSP. TYPE INSPECTION REMARK! PLUWPING DATE
3/ �� BSc — Contractor
I Permit No.
_ Rough-in
Fixture -- -- --
1— Final
��.-�' _��- _— —.._----•-- HEATING
Contractor
--- —=_ ---- Permit Nm at? r� �✓A- -8'/
—� — -------- (3ee or Oil---�'"'� 1-
Rough in
— �_— ----- Final -- - -----
-_ SEWER
- Final �/ /r/L e►� —
DRIVEWAY
Final
toRtorm Drainaege
ein 4raln)Final
Sidewalk
Curb 6 Street Final
Approach -- y
BLD:* DEPT. FINAL TEMPORARY CERTIFICATE OCC NCV _
- CERTIFICATE OCCUPANCY Final
/ r/C--�f/ —
4 Lmrdtcaping
Zoning Final
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