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CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursu;:�,it to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
Date:—_/ - .�-.�- _ Permit No.
inspect?SF�Z_'
CALL FOR REINSPECTION
a
BUILDING DEPARTMENT, TICARD Tn
�-� PLUMBING PERMV
NXLIM2 R,,_Qkk_, ``: � _ ___.�, holder of a valid plumbint contractors license is hcrebv
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing cone of
Tigard. Such installations require inspection by the Cit, 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 requii'-d
for all contractors and subs�cntractors, Job
Owner \ ��f�f` >`2r? _ Address
NUITEM OF � TOTAL
TYPE OF PERMIT ITEMS FEE ON EACH AMOUNUN f II
S__
Sin le Fe —I beth—each ( r 25.00 V4' N
Du lex—tach 1 bath unit 25.00 M
Additin#91 bathrooms—each � 10.00
Mobile Home Space—each _ 15.00
INDIVIDUAL FIXTUREe(COM At.
1 to 50 Fixtures In 1 building—each 3.00
61 to 100 Fixtures in 1 building—each _ 2.50
101 to 200 Fixtures in 1 building—ear, 2.00
_201 or more Fixtures in 1 building—ear.h 1.50
MISCELLANEOUS
Sewer—each adriltional 100 ft. 17.00 _
'Nater Service to building__
Other (Sperif {�-------7y I
PERMIT = 2, r'-= For Plumbing Inspection Phone 639.4171
4%state _ Plumhing Contractor By
TnTAI _ nFrFinT n1n lee"0A P"
L"I t y O D I I L ?1 ci M Lhallical NE'1mit
N,vi Inst;'Hat on eptacu Relocation Addition I Altcratinn r i74 47 State___ _ !
HEATING + TOTAL Z Z IV;_`---
COPJTFiACTOft 0 W N E 6
L!:raRr.;S �., �� � _ WORK ADDR[SSA��Lc1lf0-40
o
PIiCINE APPLICANT V 1
.._..___ _-_.....--_---_-..--_.___.-..____--- k,
Kent Input Rating (BTU Per Hour) _ � Vent Site Flue Size b
r �J
Ur L OIL D GA9= ELECT C_l 0' HF-ii«
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit F:F; 00V[, _ Air Condition Compressor 15 to 30 HP 10.00 t
Na,wUp to_& inel_.100,000 BTU __ 00 Air Handling 10,000 CFM 3.00
idew__100 a 001 BTU & over J - _ - Ei. Air Handling Over 10,000 CFM '5.00
Floor Furnace_ _ `4.00 - Evaporativa Cooler
iyalt •_Floor . Suspended - - -- _- 4.00 Range Vent Fan
Install Vents Qroly —"—"-- 200 Vent. . Vent_System_�--r-_.---_-__._____.�` 3.00
'Reoai'r-Nowt& Cooling_ - - --Y_ ._ 4.00 y Hood Commercial
Air Condition Compressor Under 3 EIP - - ~ -- --4.00 V Commercial D11ct System
Air Conditir,n Comurrs—so r 3 to 15 HP
IN.•PECTOR'S COMMENTS
CITY BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SOn CON f.",,ACIOHS
/41PROVED BY DATE � ISSUED 8Y- _ _ DATE
r^,E:CEIPT NO _ .r
r1° Signature of Applicant
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I
BUILDING PERMIT APPLICATION CfY TIGARD DATE_
THE UNDERSIGNED HEREBY APPLIES FOR APE tM1T FOR THE WORK HEREIN INDICATED BUILDERPHONE _
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNLRPF/ON[
L� a
LO`i NO.
OWNER " is JOE!ADDRESS 1 { I"dry Lt 140ML ADDRESS
^.rv003L,/(%C, yam..ARCHITECT
BUILDER ADDRESS !Inzi # } ENGINEER
DESIGNER
STRUCTURE ❑NEW ❑RUmnDEL ❑ADDITION ❑REPAIR ❑ �-1RENEWAL 1_1FIREDAMAGE [:]DEMOLITION
[1 RESIDENCE ❑COMM ❑EDUCATIONAL 0GOV'T ❑RELIGIOUSOPATIO ❑C.+RPORT OGARAGE ❑STORAGEOSLAP QFENCE
L_tBONO ❑MOVING ❑CONDITIONAL USE C1 DESIGN REVIEN ❑COUNCIL APPROVED []SIGNS
OCCUPANIIY_.__LAND USE ZONE__BLDG.TYPE_--FIs;E ZONE— PLAN CHECK BY____ HEAT
--.:
�— _
.)nstz,uLA singlo rxmJ 1y Owallin
ia-•lseu& of t)ermit sf:1911 Sid Chicuty � t.. ) -
5awsr Normit 020307 -- 1701,.O[7
jA r'jk 10 A4 6l PI Q
40___►iEI HL AREA-----1 a :kWRS'QMU._...__1/AJ.�IE t
BUILDING DEPARTMENT SE BACZS_ f1�0NT -1.-.-REAR. LEFT SIDE 11RIGHT SIDE 13
-
Permit
Plan Check ,��}�(]O 'CHIS PkRMIT IS ISSUED SUBJECT TO THE REGULATIONS CON(AINL7 IN THE BUILDING CODE, ZONING
REGU_ATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREEC THAT THE
Sub total 173.nd WOR W.WILL BE DONE IN ACCORDANCE WITH THE PIANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
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 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AN,13 HEATING.
Total ? 174• _ ',0 . 6400,00
--- -
'f�,
BY 1 ;�1�Ip•f�Cl
------- APPLICANTOilAGENT
Approved Receipt No. U.+'�'
---•
-DATE INSP. TYPE INSPECTION REMARKS PLUMBING - DATE
r Contractor
h ;9 72 �C /moo S%•� �e•n F.ormit No. /%-f- .jG q0 ��'7-7
s L.lu e - o NI Rough-in
('-,),V P, 0/( _ Fixture
✓S"�'D /� �P s� C — -- - Final - —
_ HEATING
— Contractor f
--- -- Pet mit No.
Gas or Oil
---- Rough-In
u _
- •— - ------ SEWER - -- -- -
---- - — ---- Final /• �(-ko -
- - DRIVEWAY
Final
4tortn Drainage
(Rain Drain)Final `—
Sidewel t
- - ------ 'I Cuio d Street final
--- - Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPA/iICY Fine
CERTIFICATE OCCUPANCY -r
G Fap,ng
inal