10765 SW BLACK DIAMOND WAYPM
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DDRESS �(? �k9 PERMIT N0.
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' PERMIT CHfiRGE none
CONNECTION FEE
PAID BY
DATE CONNECTED
TYPE OF BUILDING
SERVICE RATE %�c� IN15PECTION FEE ,2z
CONTRACTOR PAID BY DATE
SIZE OF COWN WIO A SES511E:NT __ PAID
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CITY OF T.IGARD HEATING PERMIT
DATE PERMIT NO. _– RECEIPT NO.
BY FEE
1„ Permit shall be obtained prior to commencement of installation.
2., Permit shall be obtained for all appliances which are to become a fixture
to the building„
3 Relocation, replacement: a° r changes to burners and duet work
require permits,.
4,, All work t be concealed must be before cover un,
New Installation Replace ❑ P.elocation ❑ Addition ❑ Alteration ❑
CONTR-AWw t 1-wwR r ty OWNER DvN N azb ►?n Co►-Jb
ADDRESS �, p C�'Y� __- - _ WORK ADDRESS IM,'S
SW le, k ddlt►',%yNd I�JT
Ac.k-NmA,, C's�LgON APPLICANT hf
TELEPHONE NO,
FURNACE - MANUFACTURER _ _:r C.L� _ TEL.EPHONE NO,
HEAT Ir put rating (Btu Per Hour. _ Vent Size _ Flue Size
FUEL 01 ❑ GAS ❑ ELECT OTHER _
TOTAL SO. FT, Top Floor _ _ Main F'loot � Basement _
GENERAL
ITEM NO. FEE AM'T ITEM NO, FEE AM'T
For Issuance of Permit 13,0 _ Boilers over 50 Hp _ R5.,00 _
New - Under 100,000 Btu I +4 0 Air Handling 10, 000_ CFM � � 300 _
New_
100,00 I}t1] 5,.0 Air Handling Over 10, 000 CPM_ 5,:00
Floor Furnace _ 4,:0 Evaporative Cooler 3.00
Wall - Floor _- SujijEde7---4, 001 _ Vent Fan 2000 _
Install Vents _ 2"0 Vent. System —_ _ 3—.00 _
Repair - Heat & Coo lin 4, 001 _ Hood 3.00
Boilers Under 3 Hp C001 Domestic_ nciner_ator 5.00
Bofiees 3 Fo 15 H'11p_
aI 5 _ comm:incinerators 0.00 _
Boilers 15 to 30 H 0„0 Other Not Listed
Boilers 30 to 50 H 5 :0
INSPECTOR' S COMMENTS
APPROVED BY _ _ BATE _ ISSUED BY — DATE:
Signature of Applicants
T-7 f-7 5
k� i sos
�:�-� S E V11�R PE R�lil IT ;y�� :�552
Lfj
n Sewerage Agency
of Washington County CITY OF _T.i.uar d DATE 4-7-78
OWNER: -- __nonnerharn Const. Cok. PHONE :
OWNER 'S ADDRESS:
TYPE OF INSTALLATION:
4_TY� t UILDING SEWER ❑ BUILDING SEWER. AND SIDE SEWER
TYPE OF OCCUPANCY:
xfE NEW xf-7SINGLE FAMILY ❑ COMMERCIAL
Ej EXIS-,. (PR'OR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL.
FIXTURE UNITS DWE�LING UNITS l
ADDRESS OF STRUCTURE :
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFIED SEWERAGE AGENCY. WHEN CALLING FOR INSPECTION,
PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION EXPIRES IN ONE--
Hi"'1DRED AND TWENTY ( lzo ) DAYS. THE AMOUNT PAID WILL BE FORFEITED SHOULD
EXPIRATION OCCUR.
FEES:
PERtAIT FEE $ 25.
CONNECTInN CHARCF 600. /
SIDE SEWER INSTALLATION
ISSUED BY _
OTHER
.--TOTAL �_. 625.
� _ APPLICANT DATE
4 . ' SEWER PERMIT N�' 1585091i uicGartl �r;, b, ,W
ADDRESS OF STRUCTURE 10765 SW Blank Diamond Way
TAX MAP TAX LOT
�YSTEM fanno croak
LOT 31 BLOCK OF
APPROVED BY DATE ISSUED BY DATE
D . L1. ' S 1 REMARKS hldg. #2021
BUILDING PERMIT APPLICATION 11T TIGARD OATF'
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE--_�
LOT NO.— - —---
OWNER CbaaTy LLlti� . JOlII�DDf<ESS 1.0765 'SW blark : tem()��41'"RESS
AR(_111I C7
ENGINEER
BUILDER 0k418$1 ADDRESS DESIGNER
STRUCTURE ONEW ❑FIT f1ODEL _❑ADDITION ❑REPAIR ❑',ENEWAL ❑FIRE DAMAGE— ❑DEMOLITION
❑_RESIDENCE ❑COMM _❑EDUCATIONAL CIGOV'T ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARACS ❑STORAGE❑SLAB ❑FENCE
— ❑DESIGN REVIEW ❑COUNCIL APPh OVED ❑SIGNS
LJBOND ❑MOVING ❑COWDITIONAL USE
HEAT-..
OCCUPANCY LAND USE ZONE_— BLDG.TYPE.___.___—FIRE ZONE— PLAN CHECK BY.—_� -
+1 r+ r► �t�►1� d�i�llinr� w/c L e,,1,, 3 becirgum 2 babh _ --
r.�-tmle►u+l� 10621 aW 11116t►,
9—C s;,. FJ.Q4H I.�?3p A� —_� St�L— 20 NO 51 U15—x--L>IlE9 L•ip T NO.BEI2LtS?SZM$_b fALUE 39,15%.
BUILDING DEPARTMENT5ET BACKS FRONT REAh LEFT SIDE RIGHT SIDE.
Permit 111.17.00
dC9 THIS PERMIT IS ISSUED SUBJECT TO THF REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
1(1
Plan Check • REGULATIONS AND ALI. APPLICABLE CODES AND ORDINANCES. AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
--- I RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 'S•2t3 LtC'NSE. SFPARAT+F��PyE�SRMITS REQUIRED FOFI SEWER, PLUMBING AND HEATING.
�*i-:�' � 430u.-
Total 173.2�� P.0. +1By
�1t7t3•
� Receipt No. APPLICANT OR AGENT _
Approved -
_ -
A
i
DATE INSR TYPE INSPECTION REMARKS PLUMBING DATE
LI_ICI,7g Contrartor
Permit No.
Hough-in
Fixture
_ Final
HEATING
® Contractor
Permit No. 7/ 32 Z S- lq— 7 r�}
tae or 011
Rough-in
' Final
— SEWER
Final
DRIVEWAY
Fine!
Stom Drainage
(Rein Drain)Final
S Idewel k
_— Curb&Street Final
Approach
BLDG. DEPT.FINAL TLWPORARY CERTIFICATE OCCUPANCY Final
CERTIFICAT'OCCUPANCY --
Land-caping
Zoning Final