11455 SW GREENBURG ROAD-1 +•�r+�..x.�nw..«a»,.xu,+�w.M.rw..w.. .�.�r rw,rh.a+eY+e�wrA �
iYibMax�µ�,mxw.M�NewwAiy
I
i
i
F�':�F7 6�nquaaa� MS SS'aTT
M PE ION 142TICE ,"1
City of Tigard Building Departisent
13125 SA Ball Blvd. Tigard, Oregon 972'3
Inspection :,ina (Rec-O-Phone): 639-4175 Busineso Phone: 639-4.171
Inspections____�
Footing Plbg. Undersl.ab Mech. Rough-in Appr/Sdwl.k
Found. Plbq. lop Out a,as Line FINAL:
Poet/Beam Struct. San. Sewer. Fram!.ng -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Lina Gyp. Bd. -Much.
Date Requaeteds_ �^�� - C,� --._Times AM !PN
Address: Paepit
Builders
THE FOLLOWING COPRRCTIONS ARE REQUIRED:
09
Inspector: 1 Dates
APPROVED DISAPPROVRD APPROVED SUBJECT TO ABOVE
__Cal] For Reinap.
�'-
C11YOFTIFARD ;EWER CONNECTION
PERMI'T
COMMUNITY DEVELOPMENT DEPARTMENT onooM PERMIT #. . . . . . . : SWR91 016
13126 8W Moll Blvd. P.O.BOX 23307.T199W,OrMCNI Mr/41
6031 76 DATE ISSUED: 07/�Ll/rjl.
SITE ADDRESS. . . : 11455 SW GREENBURG RD PARCEL.: 1S135CD-004.00
SUBDIVISION. . . . : GREENBURG HEIGHTS ZONING: R-1
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :5
TENANT NAME- - :
USA NO. . . . . . . .. . . I FIXTURE UNITS. . . ;
CLASS OF WORk. . . NEW DWELLING UhlITS. . : 1
TYPE OF USE. . . . . a 6F NO. OF' BU I LD I NGS: .1
INSTALL TYPE. . . . aBUSWR TMGERV SURFACE. . ; : sf
Remarks:
Owner: ______.____.__.________.____._.. .__._.___.__.__ _..__.___._.______-___-- FEES
JOHN DRENNAN type amol_1nt by date rec^pt
11455 SW GREENBURG RD F'RMT $ 1500. 00 JL.H 07/31/91 21588c'
I NSG $ 35. 00 JLH 07/31/91 2='15E38,7-
'T I GARD OR 97223
F11-ione #:
Cont Tactor
CONTRACTOR NOT Ohl FILE:
C'F1 cane #: 15,:,5. 00 TOTAL
------ - REOU I RED INSPECTIONS
-- _....._
This Applicant agrees to comply with all the rules and regulations Sewer Inspectionof the Urified Sewage Agency. The permit expires 120 days from
the date Issued. The total amount paid will be forfeited if the
per-nit expires. The Agencv does not guarantee the accuracy of the _.—
side sewer laterals. If the sewer is not Incated at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purc.fiase
a "Tap and Side Sewer" permit and the Agency will install a lateral.
Per•rn ttee 5i yr.ature;
I s�_1ed By :
Call for- inspection - 639-4175
CITY13125 SW I1y11 Uhd. PLNCK/RECT #
COMMUNITY DEVELOPMENTFTIGARD PO&o:2'397
DEPARTMENT TPrd,Oregon 97M PERMIT #
(SW)639-4171
DATE ISSUED
JOB ADDRESS: TAX MAP/LOT
SUB: —
LOT: _ LAND USE:
VALUATION:
OWNER -
NAME. ______ � _ I _ S-VIAL NOTCS
_'U
ADDRESS: / / REISSUE OF:
LAST REISSUE:
— _
PHONE: FLOOD PLAIN/
—�- — SENSITIVE LAND:
CONTRACTOR —
NAME: APPROV—_A_LS RE UIRED
ADDRESS: ---- PLANNING: -
-'— ENGINEERING:
PHONE: FIRE DEPT: — —
CONTR. BOARD #:— _ OTHER: — -
----- EXP DATE: -
SUBCONTRACTORS: PLUMB: ITEMS REQUIRED
- - ----_ LIST/SUBCONTRACTORS:
ARCIt/ NGINEER -- --- BUS TAX:
NAME: CALCULATIONS:
ADDRESS: -----— TRUSS DETAILS: _
OTHER: — ---
PHONE: -- --_�--_-`-
PROPOSED BLDG. USE:
COMMENTS: -------____-- --------
APPLICANTReceivedBy:By:
-- ------..—. Date Received:
ciT,y or, TmARD RECEIPT OF PAYMENT RECEIPT NO. :9 1--2 1 588e'
CHECK AMOUNT s 1535. 00
NAME s DRENNAN, J. & D. CASH AMOUNT W. oql
UNT PAYMENT DATF 07/31 /91
ODDRESS Ar,ARTMENT ACC'O
11455 SW OREeNBURG ROAD *.-'w(JBDIV ISION
lIGARD, OR 97P23—
PURPOSE. OF PAymc-.i\i,r AMOUNT PAID PURPOSE OF PAYMENT AMOUN T PA I D
TOTAL. AMOUNT PAID 1535. 00
i /rte
APPLICATION - STREET IMPROVEMENT/EXCAVATION COPY TO:
ORDINANCE NO. 74-14 (WHITE)-FILE
( `` (YELLOW)-IN Sp.
(INSTRUCTIONS ON SEPARATE SHEET) \\ /�1- ® (PINK)-OT AGENCY-b1C�,
® (BLUE) APP
LILICANT
APPROVED r, y APPLICATION NO.:
NOT APPROVEDCITY OI• :IGAKU, ORI',GON
U FEC AMT.: t _12...uyt_ _
PENDING FEE, PMT. [] C.IIY BALL RECEIPT Z)53ZQ
PENDING SECURITY C PUBLIC WORKSDFPARTMENT BY-PENDING AGENCY AGENCY "OK" [] Appliratlon and Progrrss Record
PENDING INFORMATION U MAINTENANCE BOND M�
FOR STREET IMPROVEM[NT"/EXCkVATION As nEauiREu --
ANNUAL „
PENDING VARIANCE ❑ EXPI RATION DATE:
PERMIT NO , DATE ISSUED: BY:
_
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND Ii_ T;ll;_� 6tirxa_�tUl ___.._,__,___
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
— t14�a
APPLICANT —John DrWUlan 49WK•,SW Greenb'ir9 Rd. Tiga d, OR 97223 _# 639--5792
NAME - - ADDRESS CITY PHONE -
CONTRACTOR- Eudaly Bros. Const. 6920 NE, 42nd Ave. Portland, OR 97218 0 288-7469
NAME ADDRESSV !' CITY
r City Standards/Specifications
PLANS BY - --NAME - ADDRESS CITV PHONIC �^--
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): f M•00
DOLLias
EXCAVATION DATA: FOr:OFFICEusE
(2) E
_ 0'0'1 x s
STREET DESCRIPTION _ PROGRESS & INSPECTION STATUS
NAME SURFACE CUT CUT CUT MATERIAL INSTALLEb ITEM DATE REMARKS/TYPE BY
TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY
-- STREET
-- __ N'"D
C tI.0.lt aNl.i moi.(: r.t$Ch j INSPEC - --- -
___-- R TION
E
Q
ESTIMATED STREET OPENING DATE. / 1 S
ESTIMATED STREET CLOSING DATE: / / 1 T
E
- _- - --- s.-�_- D _
(3) SECURITY NO, SECURITY AMTS ._ STREET
. —. 4�.L05ED
SURETY CO.: FINAL
_ _CNEc__It_W -' CASH u so -- 7 INSP_EC.t _
(4) PLOT PLAN INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS J CONDITIONS.
FEATURES, EXCAVATION LOCATION AND EXTENT. 1. Notify Carl Viewey, City
Inspector (#639-4171) 24 hrs.
Lconform
p
rior to starting work.
2. All Work shall to City
PS - C_ - _ _ _ _ _ -' , 1� _ _ _ _ Standards & Spl3cifiratirxls.
GRE91 , ROD J. ORs 757.541-.571 applies.
-� -_--- _� Utility prelocation, etc.
-«Ra _^ s _ - - � - - _w ea _..•.� _ _ - - _ 4. 'Praffic control to be provided
for by the contractor, (mm
attached).
n, 1
(S) NOTE THE CITY OF,`'IGARD DOES-NOT, HERESY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 1S THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON,
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPEC Iv*ICATION8 PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
I
APPLICANTS SIGNATURC �' 1 // __ DATE _
CANCELLED TAX LO
203,204,1000,1002,240,
4000-4600.2M,2300,
S EE MAP
IS 1 35 CA
GR
63
600 RG
(r0
�
Soar. 500 N s�.. _1__,
m .46Ac �J �� _ 1 s __�� ►:
a o /400 R O
o _ 59Ac. _
8 300
0
" " i
C.S.10506 $ / 184C N f1�3.0p1 l.4 9 e
--
cs 129 y1 " - 202 A
101
40 a c. 7 780 J
J r~, J �� fes' n r 100 7o
4 Y w --a ; ` c 4.
r. ^' C.S. 5244 14 `n
R =
e r-
g 101 ^ _
k
S N 200 W
^_ 5 N
e t 61 6 1 s i_57 S ) n - s s°I f'N ••VV;Ss77//!
220 77 y r- 623919 205 24 3800 �
s 69*5dw 3500 3601 3600 201 .?/Ac. ./4A c. "'W
�W:D
3 n 2/Ac
N
2 x r,l W e o 0 100 W
O O n � •S - ,,, A 1r1
3700
' 1o0 --ioo` A i4q� Q
., 17f22 1701 a }
.25 ,4c. e•.c z~n 41 so = Ftsff so.se s E ma. or a
T
3U ac s 49^ 1vw
3400 rl S W LEWIS LANE .,
` - —`11NTIAL'OIM All'N
3.3 9
z. 3000 280D
jQ 3 l ��
oo
300 /7 ac_ o
00 _
tl1 �
n S q 3 - . �,
3 N o c 4 5 t> 1090 a
All iJ 8 r 1 tie CD
280Ac. ? SEE MAP
yw , - IS 135DC
H r N 99^31Y
77 4 7r Kl v
23 7129.00
-- 4 2 700 3 12 54 g a. 2702.s
^ s
r .5/ 4c a ./6Ac. y-
n e W n
W
CS, 6963 o !2 rn
n '° "-' 2 701
6.69 co, 9 — Z 194c '1r
g C.S.13,750
"q'S s 69'27 W
r, m
.'4 Ac � n
441.71 wGO
136
a A
MIN. 3" A G IN 2 LIFTSI
STREET AREAS ! ()UT OF STREET AREAS
5AW CUT[
---- 7-77'
SECTION '1 RESURFACING '
• o' • • • � i � t
.ASSACKFILL
CLASS 0
3/4'!-0 GRANULAR Q• ' / / f`
BACKFILL
• o 0X
W
cl0 . W
Z ° •� O. v . O . C m
O .a C O c Q
4 — I �—r J p• •� o j
o O
(L -, •o • o
_Z .a
a
w '` °.•e a
m
PIPE BASE
BACKFILL. IN 3TRE�j'AREA9
L IF3/W 13 AGAINST CURB, FILL ROC•% TO
BACK OF 3/W
2.IF 1/W 13 NOT AGAINST CURB, FILL ROCK
2'BACK FROM CURB
PIPE BEDDING AND
_ CITYOFT117ARD BACKFILL DETAILS
DE51GN by APMOVED 13Y M-AWN by
®QG^^u
--,C,6.L E t-)A I'F- D;ZA.11 N C.
NT5 6/50/65 S-2
MANHOLE TO CONFORM /VJii4 ..S�c�oc! GCS 4-
WITH ASTM C-473 w/n�
A/?o
NOTE:
THIS TYPE OF MANHOLE SHALL
BE USED ONLY FOR PIPE S17.E
OF 24" OR LESS.
LOCATE MANHOLE COVER
A FRAME OVER LEDGE OF
AT LEAST 12" IN WIDTH
STEPS
MAIN SEWER LINE
CAST IRON COVER _. /MATCH FINISHED GRADE OF STREET
s FRAME
(St• Standard Plan }
SET FRAME IN MAXIUkI 27 FROM FIRST STEP TO TOP
NON-SHRINKING OF CASTING
GROUT __-ECCENT':IC MANHOLE TOP.
STANDARD 48" MANHOLE
RISER �
4 PREFORMED PLASTIC; GASKET
48
FOR P!PE
24" CoR LEL- :.�' -COMPACTED
60,1 CRUSH
- FOR PIPE: .t.� CRUSHED ROCK
27" OR LARGER -, .�.'�1: /V��' tr Arf4,4(
l2`MAX. FORCONC PPE .�: UNpISTURBEA EARTH
` " _ SET IN FRESH
INSIDE DROP: b o o o ar CONCRETE
"OUT.
MAXIMUM 2'0" w �� lr moo:oo v o �o U ��
" ' t ♦ • �-' 12" LAYER COMPACTED
VERTICAL DISTANCE.. —_...-- cr
---------MIK --- --� -- -- BASE MATEAUL(3/'�=0)
INVERT TO INVERT
STANDARD MANHOLE
l/att'Md l�wvNspe Agency
16
Dwq. No. 010
TRAFFIC CONTROL
GENERAL REQUIREMENTS
1. Traffic control shall be provided for, as illustrated, at all
time during work prosecution. No work shall be permitted
during the hours of darkness, nor between darkness to 9:00
a.m. , nor between 4 :00 p.m. to darkness.
2.. Traffic control devices, flagpersons (etc. ) shall be in place
prior to initiation of construction work and shall, at all
times, be effectively maintained.
3 . The roadway shall not be closed to through traffic. The
contractor shall notify emergency services (fire, police,
etc. ) , School District and Tri--Met 72 hours (min. ) prior to
initiation of construction work. Advance warning of imminent
traffic disruption shall. be provided to the general motoring
public by placement of an advance notification sign at each
erid of the construction area 72 hours (min. ) before initiation
of construction work.
4 . The City Inspector shall be notified 24 hours prior to
initiation of work (# 639-4171) .
5. The work area shall be maintained in a clean condition, free
from obstructions and hazards. Effective erosion control
measures shall be provided for.
6. A temporary hard-surface patch shall be placed on all trenches
within the roadway at the end of each days work.
7. Minimum travel-lane widtii shall be twelve (121 ) feet;
pedestrian travel shall also be provided for.
8 . The City reserves the right to restrict construction
activities during Holidays and periods of high traffic levels.
The City reserves the right to add to or modify these
requirements as may be necessary to endeavor to more
effectively control traffic and to assure public safety; such
action shall not relieve the contractor of responsibility.
dj/n-tcgr.JH
C)For o•«loT work uae pion fined
W ••�r ,� I• OVERLAY AREA in the work oreo
uM`.M 4J
34
8M)R 91K111 Media
26 Seal! C7
Trollic cones SSU m— --wcing.,_� E twm 1
60.24
\J
N■�. ■ N■N 4e•'N rttunn NOTE
When.Ork orM tell lone,the can
1eh tone
DIVIDED HIGHWAY A.49k.ex49d.d R11 1_ANE C11SEO EA%"Ono
teploctd wdh"t.FFT ..AME CLOSE'
ONE LANE CLOSURE When teplacMq the metal medan Ml
..�_.— s 9*-O'ot less M.tldth,a ane C"a
feQwred for each dutchon of ttaft,
W here the medMi
an n mote nn 7 O'
(tell bne 1,r.4 he a,td lot one drt
shouter closwe fat the other
rµ� rtt•
eNe 45
1!s
Medaw Mets
. E_ To—L wK A'�� --
�� yrT Orris-ssi D1.351 ^'ti°".
spacing EMb
MOTE Aad AWA
r.. When work Otto rt m left should.. the cone e to h4 a3T
r.o placed to c*" the MN sheuldet
40.49 DIVIDED HIGHWAY
SHOULDER CLOSURE
eMA
(lisib.Na) (As
l_ _ 500 300' �O<Yx
11(1011132 regaind) --
► 'roper— I 1 —
-—— —— — F Tp91oi
-!OQ 1,ODt 300! W:rs A.ea '5001! -;01
26 Traffic cones on giTg i m on
f x ,=so 1 »«.".dl 2-LANE, 2-WAY ROADWAY
w 5i0ULDER/ONE LANE CLOSURE -
Do
NO1 .ioct x:�e1 Nal lie.3Q"coli JUMP) —
ev
S R16Kr �+• RIGHT 4C.4s p'
T,P,•t• ' e2.1* T •C 30
IAs krovoledl a
o t r
n —�—— vi
Median Alto
�77�_. _... _I/2 Mile, 1 �K10'f
DO / 00
NST I ee.4e - AS 4e. I- BUMP 101111111111 AMA
60024
es ore to tw paced to close TV._C1 T Tp.-t' LEST *.e*
■1 '1 lM tstte.el
;rons,l,on sry :•e lobe DIVIDED HIGHWAY r!oTi.
, AHEA^"ono o.onsrtion signs dddiond"DO NOT PASS"ond-hBRUPT EDGE"signs with
inn on orecs wrier# the median OVERLAY _AREA oppraprrole rrder to w installed ollernolH, an both sides
c lofure,l reit Inst all M of Myh.o, of 1/1 mile m!erveis throughout oxer la, or cors
DN OVf Rt AT WORK USE THIS PI.AN IN WORK AREA area where applicable
I width,o one lane closure
lion of traffic and on interior
E
NOT[
INN.CAI!M Town MIM is
ewo
Aeal.0 I!I T eM b IM
wr•
,�• nwlGlitrll OAAtTtlf'
00 MOI SLAII
frn.iiw.
1 x To be eccomponied by Dr Nei.S-1,S-6,S-6,S-12 O 2129-C.
-oodt GENIRAL NOTES NOTE �wmaMo
All material od workerwI op sholl be on accnce loilk
A Isigns ore to be Type-0-unless otherwise noted on plans the current State of Oregon Standard Specrftceltent
.Sr going and traffic cones shown to be installed in conjunction with this -- fe_Highway Construction
rwk areas.shall move with Me walk areas
}TAif OF OaliOA
•Trucmovemens sow
k thn thus �'^
- ----� ''-•��� Of PAR iME NT Of TRANSPORTATION
-` ---- —--- -Where trucks err entering ond leov,n9 the work area life STAT[ MGHWAY DIVISION
.ONE LANE CLOSURE STANDARD
[.tendaz6-troff,e cones 1000•from the end o1 the Work nree *long TEMPORARY PROTECTION
L rhe pnted line to form o truckoc celuohon lone
•Where ,racks are permitted to craft the median,a -ONE LANE a DIRECTION OF TRAFFIC
CLOSi/RE'IIefI lone).wolf be required Mr each direction of freffrt SS
HQULQEF ONE-LANE CLOSURES,
-In area► .here the median es 9'0"w less use sign fires skews on OVERLAY OR WORK AREAS.
It
Parenthesis
This *Bf pRfR'RE0 TO STfX'"sign})odll he used only in conjunction with IM JANUARY 1980 •
fLAGriER AHEAD sign. REVISIONS PPI O O
•When nplac," the metol median borrow,a left lone closure will be#*quoted IRE --`-6(SC4711TQh
fa ant duecl,ot of tralfic nod a Ihouldut closure for Ttit other at�eQ LAGrM fi— url�3—
rAT ifM t[MnAI WOTIf�R-Y'1't/—S Ziff STAT[Mltwfiartgois !•
DRG.N0. 2201
INSPECTION NOTICE
F
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested 1E , me _.. /.f
Address
Owner — Loth
-
Builder �" 7
_ �� — -- -The following Building Code deficiencies are required to be corrected:
c
rrs- Cd 9L
o va y z e"llj c ra/Rr-
I
C'At/g L
IQ t Tzv�/c b A �—
Presented to Approved
Inspector -___ ❑ Disapproved
Date __._-_
CALL FOR REINSPECTION
0 YEa ❑ No
ME.'.0
CITY OFTIFARD
�CrryoFTWARD P 1T`
li::R 111 0. 1'1LC90 01 !3
COMMUNITY DEVELOPMENT DEPARTMENT
VIRPYI..
13126 SW IWI Blvd. P.O.Box 23397,T4pd,OreW 9772.'1 Arj,46?" 08/21/90
",17h 111: T
L,13
"D 0
1 S 1 35C -4 J400
11.455 SW C-)RE RD
G)U1-?DTVTSTON. UREENBURC, ZONING: R-12
BLOCK. LOT. . . . . . . . . . .. .. .
CLASS OF` WORK. PIL'T FLOOR FURN. . . . . EVAP COOLERS
I'YVIE OF:* USE::. . . . SF, UNl*T HEA'TERS. VENI' FANS.
OCICUPONCY 1`7RP. ItR.3 Wi-NP3 WIC) V E N'T S Y S)I'E 11 S
S'TORIES. E-4()II—L-"RS/(.,DMF:IRE..SSORS HOODS. . . . . . . «
F,U E L 'T y P F.-. HP. 1)0 ITI G. T N C T N
C10111L. INCIN:
G 3-15 H P..
MAX 11,1V1U1,: DI'U 15-30 H R 1::P()I R U N T I'S
r:'TRE DWIPER57'. HP. W(]ODG'T0VES.
Gf),:; PRF.:'SSURE. 504- H CLO DRYF'.:W3.
N(0.. (OF U N 1:I'S f-ilR HANDL.M(i 1.)N I TS CYTHER UNI I'S 11
V'URN < 100K xmi-. t 10000 (�fni-. G()S (0 U I'l r.-'.T S. 12
r:'URN )---.100K DTU: > 10000 (_,fnI-
F;,0.111 A r k,�; :: ()(I C1 j.rI q q'i r� f t.t-r ri�:t c:r- ii I-)(i IIA 1-i o t'- w A. -1.F?,r 1-i e a-t F.!-r
JOHN DRENW)N type A ra a t.t n t t)y Gate -r r4 c.,1i t
1. 1.49r5 SW GREENBURC-) P R N'T sG 22. 50
1.. L 3
'11G)AR1) OR 97223 1::1 A y 11 1; 23. 63 J 1 1-4 (48/27/`0
1::1 1-1 c.)ri ci 0-, 6,39 5792
C)W N E R/C,0 N'T R P CT 0 R
1-i a ri e 23. (-3 I'OTOL
#.. . :: OWNI::"R
REQUIRED I M 5 P E C'Tl 0 N S
This permit is issued subject to the regulations contained in the F-:i1l'-.0 1I-ISpec-t-j.r)1I
Tigard Municipal Code, State of Ore. Specialty Codes and all other ..................................................
applicable laws. All wark will be done in accordance wito
approved plans. This permit Will expire if work is not started —--—--------
within 180 days of issuance, or if work is suspended for more ............
than 188 days
........... ...................
1: i.-t-t P f- S i.1 11 A t U'I'(*
........... .......... ........................... .........
Call fo-r :ii-,spectiuri 639-4.1.'75
\ Permit No:
.\� Address:
IF N- IO
Issued b Date:
STATEMENT:
INFORMATION NOTICE 70 PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note. Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
1. 1 own, reside in, or will reside in the completed structure.
2. A. My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. I will be my own general contractor.
i
If I hire subcontractors, I wil! hire only subcontractors registered with the
Construction Contractors Board If I change my mind and do hire a general
contractor, I will contract with a contractor who is registered with the
Construction Contrac►ors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Inforroation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Signa ure of ermf pp Ican t bate
CONSTRUCTION CONTRACTORS BOARD
0244J 10124189
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPI.ICANT
RECEIPT OF PAYMENT RECEIPT NO. 90---204127
ITY OF TIGARD U-iECK AMOUNT C).Ocl
NIAM E DRENNAN, JCASH{ASH 'AMOUNT a 23.6
r'ir)DRESS a PAYMENT DATr a 0a/27/9()
SUBDIVISION
TIGARD, OR 97223—,
PI IRPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
C --0173 22.°'0 ST. BUILD Pf:p
HANIGAL PE MFC90
I 14Q5 SW GREENDURG
10TOL AMOUNT PAID 671.,
36; cp —'qOo
Receipt M
CITY OF TIGARD MECHANICAL PERMIT Permit# -
13125 SW HALL BLVD-
p.
LVD.p. O. B4OX 23397 Description CITY PRICE AMT
Table 3A Mechanical cove
TIGARD, OR 97223
(503)639-4175
1) Permit Fee -0- -0- 10.00
—..---
Name of Development 2) Supplemental Permit 3.00
Job Address 1)
Furnace to 100,000 BTU 6.00
incl.ducts&vents
Address Er pNO. ' Furnace 100,000 BTU 1 7.50
Tex Lot map ap 2)
incl.I.ducts&vents _
_
Lot Block Subdivision Floor Furnace
6.00
Name(orname of bunineas) 3) incl.vent
f/ Suspended heater,wall heater 600
Ms*q Address; Mona c,i'/-tj/,i 4) or floor mounted heater
Owner ,- :' S,��
Vent not incl.in 3,00
City/state 5) appliance permit
Ci /ZL3 —
Repair of heating,refrig., 6,00
Name(or name dl bushtess) 6) cooling,absorption unit- `
4Boiler or comp to 3 HP 6.00
Mei*V Mess Ph" 7) absorp,unit to 100,000 BTU -
Occupant City/staft ZIP _
Boiler or comp to 3 HP-15 HP 1100
8) absorp.unit to 500,000 BTU
9) Boiler or comp 15-30 HP 15.00
Nam Naabsorp.unit'/2-1 million _
- N -_ --
o lf" LA U '6 Ai AiA iv Boiler or comp to 30-50 HP 22.50
MeaVAddrraa Rama 10) absorp.unit 1-1.75 million -
1(�rl SL��C7�r1« Ci4 y;G 7L /1/y
Contractor )
1 Boiler or comp to 50 HP 31.50
city/state m ) absorp.unit 1,750,000 BT U _
Air handling unit to 4.50
State Registration No City Bus Tax No 12) 10,000 CFM - --
Air handling unit 7.50
1 hwel j scicnowledge that I have read this application that the information given is 13) v10 rt1(jCFM +
correct,that I am the owner or authorized agent of the owner,than plans submitted are in �n N portable 4.50
compliance with State taws,that I am registered with the State Buikfers'Board,that the 14)
ra rate cooler
number given is coned 111 exempt hon state registraticx,please give res"below►. e _pe -- _
15) Vent lan connected 3.00
- to a single duct_
__. _-- ---- - Ventilation system not 4.50
-_ - _ - -- 16) included in appliance permit
- - Hood served by
_.------------ --- - - 17) 4.50
mechanical exhaust -
- - - Date 18) Domestic type 7.50
Signatre(owner or agent) incinerator
Describe work ❑ additionalteration1—alteration I repair I ] Commercial or industrial
I o be done residential 1 _-1 non-residential H 19) 30.00
- __- ---- type incinerator --__- __
Existing use of Other i.e.,woodstove,water 4.50 //
building or property-�_—...--.---- --- ---- 20) heater,solar,clothes dryers,etc.
Proposed use of
building or property 21) Gas piping one to four outlets / 2.00 ,
Type of fuel- oil H natural gas I J LPG I 1 electric I I
22) More than 4-per outlet
NOTICE - — SUB-TOTAL _-
1TiIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -----� 5%SURCHARGE
STRUCTION AUTHOR17FD IS NOT COMMFNCFD WITHIN 180 --
OAYS, OR IF CONSTRUCTION OR WORK IS SUSf'FNDFD OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A Pthi.)D OF 1H0 DAYS Al ANY TIME AFT"R TOTAL
WOf1K IS COMMENCED ----
Special Conditions---- -.- _- - -
Date issued- by