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Fee V
New Installation
C<Replace El Relocation ❑ Addition FJ Alteration ❑ 4%State �_
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RATING TOTAL 2Y i
CC+NTRACTOR � OWNER
WORK ADDRESSW5S 5(,v
PHONE_( �(� APPLICANT_ ________
Haat Input Rating (BTU Per Hour)_ -- Y Ven' Size _ Flue Size --
FLIEL OIL ❑ GASJJ ELECT ❑ OTHER!__
_.._._ ITEPA f.1tZ FEE ITEM NO. FEE
For Iss+.ian:e of I''erinit - FEE ABOVr. Alr Condition Compressor 15 to 30 HP i 10.00
New-upto & ins .100 000 I3TU "`- —`-- -- ►-�
✓ _. Air Handling 10,000 CFM 3,00 ,�I 't
Ti-
_.s_ ..___��._._____�_�
ie'!-]00 001 BTUs & over 5.00 Air Handlinfl Over 10 OUO Cf M 5.00
_4.00 Eva;,nratinsCooler--� -'--- _�-�- 3.00
Wall Floor Suspended 4.00Rar_ge Vent Fan — 2.00
Install Vents Only _�— __ - 2.00-- -Vent 5yetem� - 3.00 =�
Repair - Heat& Cooling _ - ---- __-
4.00 Hood Commercial - — 3.00 4 :�
_-..�____-do---_.__-_
.r Conditihn CompressorUnder 3 HP 4.00 Commercial DWIt System
Qir Conditi �n Compressor 3 to 15 I-IP __-
INSPECTORS COMMENTS_
CI ry BUSINESS LICENSc REQU!RED rOR At.L CONTRACTORS OR SUB CONTRACT011S '
AP►IROVED By� DATE _- - __- ISSUEO By DATE
RECEIPT NO.
Signature of Applicant .__.
w►. ,
t
lit�wwr
PUILDING PERMIT APPLICATION uy TIGARD DATE__ �_ 19__ tje.j..F��yl 3
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATFD BUILDER PHONE -_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND Sp, CIFICATIONS. OWNERP4QNE
LOT NO. L
l
OWNER Tra(awark tiolyieft JOB ADDRESS l4U yW ('"COZY LOL4jME ADDRESS
17.1e.6 E3r.Il-l0 till R.CJ sT. ARCHITECT
BUILDER Dram" tY�3 _ r�lilfl ENGINEEF
ADDP.E33 - DESIGNER
SIRUCTURE ❑NEW ❑RF:MODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITIuN
Q RESIDENCE ❑COMM ❑EDUCATIONAL ❑GCIV'T ❑RELIGIOUS❑PATIO []CAR PORT ❑GARAGE []STORAGE❑SLAG t]FENCE
_ ❑aOND OMOVING ❑CONDI IONAL USE ❑DESIGN REVIEW _❑_COUNCIL APPROVED ❑SIGNS
F
OCCUPANCY- LAND USE ZONE..- l�� BLDG.TYPE F L
FIRE ZONE—
PLAN CHECK BY ?(d h1 HEAT B1!
( unstrucL 6inyls family dwellLng w/attached Wareye. 3 uedruams 1 f:,aths
SE F f, F64C.I.T ION SHF ET ATTACHED.
c,swer Permit ,,20350 - %701,i.00 -
- ;xrn�e 4Zi_ no,
NQ__ST_QfM__1A_FIEA 130E3��@.�12fa.4UM.S 3�[gLl� 4Q1*80( .
BUILDING DEPARTMENT SET BACKS FRONT 20 REAR .36LEFT SID:
RIC'IT RIDE
Permit 1630(30 fit:� ,T f . 3 0TVIA11. — ---
- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check oil A REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED IYAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total 1-44.A ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State. Tax G. a2 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HFATIi,3.
Total %25I. SOL X400-UU
PDC ,si 3100.(]0
By — pl
--
Approved Receipt NI,-yj APPLICANT 05 AGENT `- -�---
— -- - — 1 ����
i
DATE1NSP. TYPE INSPECTION REMARKS PLUMBING DATE I
7 _.. 4C.—.11.o- "1' 01
1 _ '� •• f�Enrk v_ Permit No.
/ 0% My %uP-O-�� Hough-in
r
Fixture
Final _.
HEATING
Contractor
PermltNn ,�9c/ r�,� lf1-29- 11.
Gas or Oil
Roughin
—�— —� -- _— Final
Final
DRIVEWAY
Final
Stom Drainage
(Rain Drain)Final
—�� —�--� Sidewalk
Curb&Street Final
Approach
BLDG.DEPT.FINAL TltMPORARY CERTIFICATE D`CCUPAhCY Final
CERTIFICATE OCCUPANCY --
"T Landscaping
Zoning Final