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CITY OF TICARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Unifr m Building Code, the
following item(s) require- correcting:
d0/a"C— ASPOF
--��.•�?, �, ,rte _r,'�,' ---__—_
Date: Permit No.
Inspector� ..1
CALL FQ? 9;EINSPECTION
1� BUILDING DEPARTMENT, TIGARD
PLUMBING PERMIT N?
holder of a valid plumbing contractor., license! is hereby
authorized to cause pluml3ing work as herein noted to be inst:afled in accordance with the ;-4umbiog Code of
Tigard. Such installations require inspection by the City Inspector who shall be notifier. rot less than four
(4) hours prior to the time the installations are ready for i,ls.pection. City of Ticar: 1;1::,iness License ruruired
for all contractors and sub-con tractors.- Job
�Y , Address IM W��Bata__11 "��.�
Owner _ _ ,..
NUMBER OF TOTAL
TYPE 01°PERMIT ITEMS FEE ON EACH AMOUNT
fSIDENTIAL
Single Family-1 bath—each 25.00 _,�_ .��• I
Duplex—Each 1 bath unit _ _. 28,00
Acditlonat bathrooms—each 2 14,00
blobite Home Space—each �v _ 15.00 r
INDIVIDUAL FIXTURES(CQM1 ERCIAI,=
1 to 50 Fixtures In 1 building—each 3.00
_51 to 100 Fixtures in 1 building—each _ 2.550
101 to 200 Fixtures in 1 building—each _ _ _- 2.00 _
I201 or more Fixtures in t bullding--each 1.50
MISCELLANE0US
Sew!r—sacn additional 10)It. _ 10.00
Water Service to buil d_in -�_ ,__ 5.00
Other 15 ecir l
l PERMIT 'r iSO. For Plumbing Inspect%on Phone 639.410
I
4%State Plumbing Contractor By
TOTAL RECEIPT NO. Issued By
�.ty of Pgard McChaniCjKg9r 1'� Permit-.___- 300 -� -
Fee_ U y
New Installation CI Replace D Relocation CI Addition [-) Alte ation ❑ 4%State z
HEATING � TOTAL__.----Z-Sr_._.._ �
CUN TRACTOR OWNER W
WORK ADDRESS ` w
-
PHONE APPLICANT
He]t Inp-.tt Rating (BTU Per Hour)�_� --� Vent Sire � � �-Flue Size -- u
FUEL OIL C7 GAS ;�1 ELECT C� OTHER -
ITEM NO. FEE ITEMNU. FEE
For Issuance of Permit - - F.'EABOVE - Air Condition Compressor 15 to 30 HP - 10.00 t,
_
-�- - _-_.-._- -- -- ---- -- - -- --- --- -..._---
NFn,-up inC � LVO 000 BTU _ _ 4.00 _Air_Han_dling 10,000 CFM _ _ �"--'�'
-�---- 3_._001
I'laav-�00,001 BTU'y & over. -_ - - 5.00 Air Handling Over 10 000 CFM- -- --- 5,00
r a
t i i fun 4.00 is vaporative Cr:,,Ittr - -- --- ---- -- _-- 3.6U
WoI Floor Suspended 00 Range Vent Fan 2.00 .•-
I*+st9ll Vents Only - -' - - - -
- --__._.__ _ '..
?. Vent System — -
F ------- -- _ 3.00
tr�pair • Hct& Cooling — ------- -------- -_ ...--------------- -----------•------ -
4.00 load Commercial — -" 3 —
•\:r Coil Zion C')m ressor Under 3 HP __..------------..___ .---_ __..----•---
p 4.00 Crrnrnercial Duct System
. tr onditioa Compressor 3 to 15 HP 7.60 -=---•;,,,�,-,. -.
IN5PEr1'0F1':, COMMENTS
CITY BU'IPJESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB CONTRAC'1-On5 ~—
APPROVED BY�-- DATE � ISSUED BY DATE
RECEIPT NO ----- -
714
Signature Of Applicant ���
N;�w, v1E *tlkF�rNwdyMycserrain+�v;1�rv'�V"""'Y►N"+4+�u+"Targrrc+r���a�^�-... . .. � .>;•j,�
CITY
BUILDING PEt�MI i APPLICATION OF TIGARD DA,
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR `HE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE.
LOT'NO..
OWNER Art LUtx d1 C ^ JOB ADDRESS lL '- .� f.'U ChiLG . ,� •i.f 4 _" e
?,f8� S W �f-a�ME ADDFE:SS
ARCHITECT
GUILDER _ a'„IM1. ADURES5 13 1$++M ENGINEER
rr�� DESIGNER
STRUCTURE _ IJNEW _ ❑FwmnDEL ❑_ADDITION ❑REPAIR ❑RENEWAL [:]FIRE DAMAGE_ ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGECISLAB [:]FENCE
❑BOND DMOVING ❑CONDITIONAL USE ❑bfS;GN REVIEW ❑COIJNCIL APPROVED ❑SIGNS_—
At
Q:CUPANCY—LAND USE ZONE__ f- BLDG.TYPE `� FIRE ZONE; PLAN CHECK BY1?ld It
areut U :w. r+1.nr�lw family dwolling w/ottalchad garage e+f,.droome
w -1 tib w of poi'm-I t -121 - (12840 W Chicory Lt, ) --
9 ��OAU FI_OOR�7�1P___ _�1EI.C�HT - 4� NO.STO$I.�_t /AREA �_I�SLEEAB_QS7iYIS VQ� y ��1t1•
N
SETBACKS FRONT REAR 30 LEFT SIDE " RIGHT SIDE 0
PermIBUILbING DEPAI'11TM
THIS PERMIT IS ISSUED SUBJECT TO ,nc REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Check 10,00 REGULATIONS AND ALL APPLICABLE CGOES AND ORDINANCES, AND 11 IS HEREBY AGREED THAT THF
WORK WIL- RF. DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 1711,. 1 I' ALL APPLICABLE CODES AND OFTDIN<,NCES. SHE ISSUANCE OF "HIS PERMIT GOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOP AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State TeX LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AN%] HEATING.
Total
_ 'C)C ,111rF, n
By
ApprovedReceipt N
� �- nPPj (CANT OR Ac;Er,r _
No
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
�l•/fI' �i/ �� •r. _ -- -- — ---- Permit No. 4b Y7 W
re P eu r Rough-in
: G4 Fixture
�t I e a IC F!nal
HEATING
Contractor G
Permit No. 7 d /0
Gas or Oil
Roughdn
----------- Final
NEWER
Final 12-20-71 Or 46K
DRIVEWAY
Final
Stor)h Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BLDG.DEPT.FINAL. TEMPORARY CERTIFICATE OCC.17NCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
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