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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
17
12F/c'
I
Date: � -%,,,�. dam' _ Permit No.— _
Inspect& ,e ^
CALL FOR REINSPECTION
.�� �_� .
1�1G •�'�.2-'1i /Q-..79- moi' ,, L
City of Tigard MecI c4kWermit N? PerFoe—
r:iit
New Installation ❑ Replace ❑ Relocation i Addition ❑ Alteration C1 4% State_
HEATING TOTAL
CON F'RACTOR _ OWNER Al ,V',
ADDRESS—W.1-1— kb6tYJMORK ADDRFSS_l2,= 6s�_Ci'j,,((� �-^ ' •
PHONE J4_�, , APPLICANTS -__
Heat Inrut Ratin.} (BTU Per Hour) T Vent Size _ _ Flue Sire
FUEL OIL Cl GAS14 ELECT ❑ OTHER
ITEM NO. FEE ITEM NO. FEE
For ts_strance of Permit �~ EE ABOVE _ Air Condition Compressor 15 to 30 HP 10.00
Neve-�up inc1.100. 9000 BTU ~�_ _ - Air Handling 10,000 CFM -� x,00 c };•
Pie,,--l-100 001 BTU's' & over 5.00 Air H n-1 in Over 10 000 CFM 6.00 k.i'•F
vapo (,tke Coul;t 3.00
N,rall • Fluur Suirwr,ded 4.00 R e ent Fan 2.00 t'•ti;( �i
Instill Vents Only 2.00 Vent System 3,00 '
Flepzir • He7t 1?t Cooling_ __- — -4.00 `hiood Commercial -�_ - 3.00
.tir Con,lition Compressor Unuer 3 HP 4.00 Commercial Duct System 10.00 `
.�i
-
.Qiion Compr.a;or 3 to 15 HP _ 7.50
INSPECTOR'.' COMMENTS
CITYBUSINESSL'CFNSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS
AF'F'ROVED BY__--____ DATE ISSUED EiYDATE____`__
RECCIP1 N0.
gra Signature of Applicar.t
BUILDING DEPAPTMENT, TIGARD N?
PLUMBING PI WIT
holder c' a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be ins.alletf in accordance with the plumbing code of
Tigard. Such installations require inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
i for all contractors and sub-contractors.
Job
Owner-.— �L��----_— Address ��`�� Date__!��! `ti9
.�. .._ -�.. NUMBER OF __ .. TOTAL .,.�.�.._.
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNT
3l to Famath--each � 25.00 �_ V
Duplex_-Each 1 berth unit ___25.00
_Additional bathrooms-each
INDIVIDUAL _rlxT __ Fa COMME11C IAI.
_ 1 to 60 Fixtures In I bulldin •-oath 3.00
_51 to 100 Fixtures In t buildlnfl-each 2.60
101 to 200 Fixture.in 1 building,each _ . — _2.00 _
201 or more Fixtures in 1 bulldinMoach _�_.._� —___ .1•?0__-__
IAI5CEL�LANEOUS
S^wer--each biditional_100 1t.
- Water Servir,e�to.building -.� 6-00
PERMIT for Plumbing Inspection shone 639-d 171
Plumbing Contractor By _ 9111—
TOTAL
RECEIPT NO. Issued By
BUILDING PERMIT APPLICATION coF 1 IGARD DATE___THEUNDERSIGNEDUNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE NNORK HEREIN INDICATED BUILDER PHONE' _----
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONL- -
LOT NO.— --�.
rJWNER + S�+ 1 �1' flti!$ JOB ADDRESS !1t�Qi~1 ` h►L:Oij
HOME ADDRESS
��- ARCHITECT
ENGINEER
BUILDER � 3_g _ ADDRESS OC I0 SIV_ hj311 Blvd, r flVtn DE!AGNE:P
STRUCTURE 0NEW _❑RPMODEL _ ❑ADDITION _ ❑REPAIR ❑RENEWAL. —_❑FIRE DAMAGE [IDEMOLI1ION
[:]RESIDENCE ❑COMM ❑_EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GA17AGE ❑STORAGE(3SLAB [:]FENCE
❑BOND ❑MOV ING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED _ (3SIGNS _
OCCUPANCY— "`i LAND USE ZONE F�/7BLDG.TYPE _FIRE ZONE._.__" PLAN CHECK BY— L _i HEAT-"
elinin• family dwo.ilbn a attached yaregs, 3 t ddrouwtwgergig _�
s--421! arl. ft,
QCp. _Q9Q --__----F1S24EJ 9AD 44 .— _AQ.SIS2fll 3 _
BUILDING DEPARTMENT SET BACKS FRONT ?h REAR aU LE-FFT.S�IIDDE T'l. RIGHT SIDE s_q
Pe,;urt Its..:.,' L�t12'�►` Nf T;,.+T I �' ��
lGt,�UQ .__ THIS PERMIT IS ISSUED SUBJECT TO THE RE.GULAHONS CONTAINED IN THE BUILDING E, NTNG
Plan Check 81.00 REGULATIONS AND AI_L APPLICABLE CODES AND ORDINANCES, .AND IT IS HEREBY AGREED THAI THE
— — VVORK WILL BE DONE IN ACCORDANCE WITH TAF PLANS AND SPECIFICATIONS AND IN COMPLIANCE*!T"
Sub-total 2 49 s OU ALL APPLICABLE CODES AND OROINANCES. THE ISSIIANCE OF THIS PERMIT DOES N11T WAIVE
RESTRICTIVE COVENANTS. C 'NTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 6,64 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
n 000 U0
Total j2,)',*64
100.00
By P1 – --
_ est ApPLICAN f OR AG
f_NT
approved Rempt Na.
DATE INSP. TYPE INJPEC;ION REMARKS PLUMBING I DATE
q-7-7 l _----m_- Contractor - —
&3T }SrAtA _ _ Permit No. �
- 79 c.0 Rough-in
Fixture
laA::A IOU O •J, --- Final --- -- —
y ,� 7 HEATING
jf+P.41"d 4C-/ — Contractor
Permit No. �--
Ir0 Act A/A/L L O k Gas o Oil
Roughdn --
Final
SEWER
` Final "-0_Z
DRIVEWAY
--
Final
Stom Drainage
(Rain Orcin)Final
Sidewalk
vrb&Street Final
Approach
SLOG. BUT.FINAL TCMPORARY CERTIFICATE OCCUPt(1NCY Final
CERTIFICATE OCCUPANCY -�O �C)-
Landscaping
Zoning Final
i