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CITY OF TIGARD MECHANICAL. PERMITReceipt #Permit#
Description � ��
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397 —�— _--
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 '0 Furnace to 100,000 BTU 6.00
incl,ducts&vents
2) Furnace 100,000 BTU + — 7.b0
Incl.ducts&vents
Nan is of Development 3) Floor Furnace 6.00
incl.vent
Job AddressSuspended heater,wall heater
Address 4) or floor mounted heater 6'00
Tax i_ot Map No { 5) Vent not incl.in 3.00
Lot Block Subdivision appliance permit
— Name for name of business) — Repair of heating,refr ig.,
6) cooling,absorption unit 8.00
Mailing Address Phone 7) Boiler or comp to 3 HP 6.00
Cwner absorp.unit to 100,000 BTU
City State Z;p 8) Boiler or comp to 3 HP-15 HP 11.00
absorp.unit to 500,000 BTU _
Name 9 Boiler or comp 15-30 HP 15.00
absorp,unit'/a 1 million
Mailing Address Phone — 1 U) Boiler or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor city state— —�— zip 11) Boiler or comp to 50 HP 31.50
_ absorp.unit 1,750,000 BTU
State Registration No. City Bus.Tax No 12) Air handling urn to 4.50
10,000 CFM
I hereby acknowledge that I have read this application that the Information given is 13) Air handling unit '7.50
10,000 CFM i
correct,that I am the owner or authorized agent of the owner,that pines submitted are in — ----
compliance with State laws,that I am registered with the State BuildersBoard,that the Non portable
number given is correct.(if exempt Irom State rogist ation Neese give reason below). 14) evaporate cools' 4.50
Vent fan connected
- - -._�..__- -- — -----_--- — — 15 to a single duct
3.00
- 16) Venit ration system not 4.50
included in appliance permit
/ . Hood served by
17) mechanical exhaust i 4.50
Signature towner of aUenti .- _.. Dale Domestilc type
Describe work C-I addition alteration I I repair [I18) incinerator 7.50
to be done residential I I non-residential (; 19) Commercial or industrial 30.00
Existing use of type incinerator _-
building or properly _.__... ' J _ _— 20) Other i.e.,woodstove,water 4.50
Proposed Life of heater,solar,clothes dryers,etc.
building or property_- 21) Gas piping one to four outlets 2.00
Type of fuel- oil I I natural gas I-1 LPG i-I eh,Warir, I ,
•- 22) More than 4-per outlet
NOTICE --- ---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 WOR;' IS SUSPENDED OR PLAN t`EViEW 25%OF SUB=TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL
Special Conditions
- - - - --- -- Date issued_— -- b
--- -- -
INSPECTION NOTICE
City of Tigard Building Department
P.U. Pax 23397
Tigard, Oregon 97223
Phone: 639-4.175
Type of Inspection _
Date Requested Time AM P.M.
Address '_S S 2 ? _f�'dd� Permit #
Ownersdl-2'o C� Lot #
Builder
The following Building Code deficiencies are required to be corrected:
r C-0 L)I Q) G 1-5Lz)C' 2N
v= eo..rLt4 rf _
Presented to Approved
Inspector �a/JG� _ ❑ Dlapproved
Date
_ - J
CALL FOR REINFECTION
❑ YEa ,C NO
6200
CITY OF TIGARD 639.4171 DATE _ _ �_ is
3UILDiNG PERMIT -
Insp. Line 6J9-4115 TAX MAP ___LOTNO. --- SUBDIVISION86 Cnttaalu i
i OWNER_ 1reCl�;wood i1UlII4^[S Inc. JOB ADDRESS 14RO _
BUILDER _ Lts; _ STATE REG.NO. -tad._.,.._-_.,, EXP.DATE
BUILDER'S PHONE 192-3561
ARCHITECT _ _ --- -,-_--- _ -- _-- PHONE _ OTHER
STRUCTURE `f NEW C? REMODEL 1-1 .ADDI ION [I REPAIR MOVE 1-1 OTHER QEMOLITION
RESIDENCE COMM EDUCATION IND 1-1 RELIGIOUS ACCESSORY 1-1 G"RAGE OTHER I FENCE
OCCUPANCY ;. _LAND USE ZONE ' "4 BLDG.TYPE FIRE ZONE - PLAN CHECK BY HEAT+
rt►rr Single tawily f,WA.114}, •,erage, all per app 'roved plays.
.''11.1U tel- Lo d,; citue r....i gw,_ NEYNIX Iii AuArt r:.nr,�, k_
� i.:n1.i.►lif�t+er. r;ecop+E flour. —_--
SEWERPERMITkZ bL'tli
OCC.LOAD FLOOR LOAD 41`1 HEIGHT l i NO STORIES 2 AREA L'�#" NO.BEDROOMS VALUk
BUILDING DEPARTMENT- SET BACKS FRONT _,E,- REAR LEFT SIDE RIGHT SIDE
Permit 149.utj 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 126•�� 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
Pl.Ck.Fire RESTRICTIVE COVENANTS. CONTRACTOR AND$UB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
-- - TAX PERMITS.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 11,90,
SDC - hIJ11.pC!
Total -.2fal 11hi _ APPLICANT OR AGENT
PDC*I. 150.110
Prepd. _r.�a.1.,..---- -
`_ Receipt No. AbbRE89 - - _--- ---� —PHONE
Bal.Due
-- _ Issued By---:- —Approved BY-
DATE INSP. TYPE INSPECTION REMARKS - PLUMBING —DATE
i o riwLs_
-- Contractcr —jL C �6
io-ice - '� ' F — Permit No q31-
Rough
Rough in
C _ - Flxtufe
Final -�
1/ — —�-� ------ HEATING I}-
/ Contracts A I (3 Oh
Permit No, y yZ
N'oGas orOli
---
Rough-in
-- --- final -!
SEWER - -
•�- — Final �
DRIVEWAY
- —•---_� Final
Storm Drainage —
(Rain Drain)Final
Sidewalk --- -
- Curb 6 Street Final
- ---- -- -----
Approach —
BLDG.DEPT.FINAL TEMPOFIARY CERTIFICAT OC( PANCY Final
CERTFICATE OCCUPANCY -- - ---
/� /2 Landscaping
Zoning Final
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