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6835 SW CLINTON STREET
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type 6 Inspection --
Date Requested _. �_ Time A.M.��((_//P.M.
Address -( '.C .__— Permit
t
Owner Lot # _
Builder
The `ollowing Building Code deficiencies ere requires' to be corrected:
Presented to -..._ - _�.-_--- (Llipproved
Inspector -----_ ------- ---_...-- - �- Disapproved
Date
CALL FOR RFINSPF.CT1ON
LJ YES 11 NO
CITE' OF TIGAR Receipt#.-
D MECHANICAL PERMIT Permit#
Description
Table 3A Mechanical Code CITY PRICE AMT
City of Tigard 1_
1,,125 S.W. dull Blvd. 1) Permit Fee 0 -0- 10.00
P.O. Box 2339' - - —-- -------–-. — --
Tigard, O,1 972k!3 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents 6.00
2) furnace 100,000 BTU + 7.50
Incl.ducts&vents _
Name of DevelopmentFloor Furnace
3) incl.vent 6.00
Job Address -� - Suspended i,eatc,,wall heater
Address 4) or floor mounted heater 6.OU
Tax Lot Map No. Vent not incl.In
5) appliance permit 3.00
_ Lot Block Subdivision - _
Nome(or namn of business) Repair of heating,refr ig., 6.00
-_ A `t —��- 7 l ) cooling,absorption unit
ill) �- LCA N lcr'S� J� __ 9' _P
Mei In Address Pt10ne Boiler or comp to 3 HP
Owner , �, {: _ 7) absorp unit to 100,000 BTU _ 6.00
City/State Zip 8) Boiler or comp to 3 HP-15 HP 11.00
(�; absorp,unit to 500,000 BTU
Name ! Boiler or comp 15-30 HP
9) absorp.writ 112-1 million 15.00
Mailing Address , Phone 10) Boller or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor Boller or comp to 50 HP
Cltyf9tate Zip 11) 31.50
absorp.unit 1,750,000 BTU
fee
Stalle'Reglid6stion NoCity Bus.Tax No. 12) Air handling unit to-. 4.50
as 1 ? 7 10,000 CFM
I h&reby ecknowlndge that I have read this application that the Information given Is 13) Air handling unit 10,000 50
10,000 CFM I
wr,eut,than I am the owner o,authorized agent of the owner,that plans submitted are In -- --- -- - --
compilan:;e with State laws,that I am registered with the State Builders'Board,that the 14) Non portable 4.50
number given is correrl (It exempt from State registration please give reason below). evaporate cooler
15) Vent fan connected
to a jingle duct 3'00
- --- - ----- Ventilation system not
16) includedir,appliance permit 4.50
Hood served by
17) mechanical exhaust _ 4.50
Signature(owner or agent) _ Date 18) Domestic type 7'50
Describe work F1i addition alteration F1 repair f I - incinerator -
to be done residential non-residential ❑ 19) Commercial or industrial 30.00
—type incinerator
Existing use of ---
building or properly _ 20 Other i.e.,woodstuve,water 4.50
Proposed use of
heater,solar,clothes dryers,etc. _
-- _
building or property -- — 21) Gas piping one to four outlets ( 2.00
Type of fuel oil 171 natural gas LPG CJ electric ❑ --_
22) More than 4-per outlet
NOTICE --"—
SUB-TOTAL ;
THIS PERMIT BECOMES NULL AND VOID IF WORK CR CON- ---- - --
S TRUCTION AUTHORIZED IS NOT COMMENCED W,rPIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION Ori WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME.AF CER - --
WORK IS C7MMENCED. TOTAL
Special Conditions______,
-- - - ---- --- —-- _ _ -- - --._. Dafa issued