9955 SW JOHNSON STREET 9955 SW JOHNSON S:".2EET
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223 Cy--/ lt'`� C>
Phone: 639-4175
Type of Inspection �'V���� 5��",/If
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Date Requested_ L-- Time ��A.M. P,M,
Address � � �� �� O/�i(/S�-)/�/ pefmit #
Owner—__�P� �.t�.�
T Lot # -
Builder
The following Buildin- Code deficiencies are required to be corracted:
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Presented to _ x'�rf
. _----- Approved
__ Disapproved
CALL FOR REINSPECTION
L7 YES -7'
IZCCeiPt #_/� �
C!'r1 OI, r1GARD MECHANICAL PERMIT
Permit
Cicy of Tigard o 3 y .y,, '7
13125 SW Hall Blvd. Desartptlon
11.0. Box 23397 Table 3AMeohantealCode CITY PRICK AMT
Tigard OR 97223 * n
b39-4175 1) Perm: Fee - 0 10.00
2.) Supplemental Permit 3 00
1) Furnace to 100,000 BTU
incl. ducts & vents _ .,0
2) Furnace 100,000 BTU + --
Nems of Development incl. ducts & vents -_ _ -- 7.50
3) Floor Furnace
! fres.
Job incl. vent 6.00
Address Ts. Lot Map o. 4) Suspended heater, wall heater
Lot Block Subd)vlelw or flonr mounted heater — 6.00 _
5) Vent not incl. in _
Name t or name of business) appliance permit 3.00
! i r, i -A. L'M (. , I.1 _ - ----- --- - - — —-
Melling Address PfsxN 6) Repair of heating, refrig.,
Owner i cooling, absorption unit - -- 6.00
city.Slete ap 7) Boiler or comp to 3HP
7, .1.3 _ absorp. unit to 100,000 ETU 6.00
Nana '�- 8) Boiler or comp to 3HP-15HP
_absorp. unit to 500,000 BTU _ - -11.00
Mailing Address none 9) Boiler or comp 15-30 HP
absorp. unit r/2-1 r illion - 15,00—.---
Contractor
5.00 -_Contractor cItyrslst;"- Zip -- - 10) Boiler or comp 30-50 HP
absorp. unit 1-_1.75 million _ 22.50
State Reglst ation No. City Bus. Tax No. 11) Boiler or comp 50 HP
_ absorp. unit 1,750,000 BTU 31.50_
1 hereby acknowledge that I naw, read this application that the Information 12) Air handling unit to
given is mrract, that I am the oNnvr or authorized agent of the owner, that 10,0 CFM 4.50
Pians submitted are in comoilanci with State laws, that I am rngletered whh the State Bulldere Bot.rd, tha the numbe• rjlven Is correct. (if exempt 13) Air handling unit
from State re li.' ationInose give r-,Mon holow)•
p ° 11,000 CFM + 7.50
-- -_ _ 14) Nor, portable
evaporitu cuulei 4 50
15) Vent fan connected
to a single duct 3.00
16) Ventilation system not
included in appliance permit 4.501
1 Signature (owner o. ageni) Date ----- -- - - -- ( -
17) Hood served by
Describs work [] addition❑ alteration❑ repair O mechanical exhaust 4.50
in be done residential H non-residential U --- -- - --
18) D6mestic typa
Existing use of incinPrator 7_50
building or properly 19) Commercial or industrial
Proposes use of type incinerator_ 30.00
building or proporty - 2.0) Other i.e., woodslove, water —
Typo of fuel - oll O natural gas(] LPG(] eioctricL] heater, solar, clothes dryers, etc. 4.50
21) Gas piping one toht,r outlets 2.00
NOTICE
THIS PERMIT PECOMES NULL AND VOID IF WORK OR 22) More than 4-per out.et
CONSTRUCTION AUTHORIZrf+ IS NO'f COMMENCED WITHIN --_ _ SUB-TOTAL _
190 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED -- 4% SUNCHARGE S
OR ABANDONED FOR !k PERIOD OF 190 DAYS AT ANY -------- ---- -
TIME AFTFR WORK IS COMMENCFf) PLAN REVIEW 25%OFSUB-TOTAL TOTAL
JECal _j
Speclnl Conditions - -__-_- _- -----_--_--
____ Date i S4iie _ — V
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N? 783 DATE " y
PERMIT IS GIVEN TO
OF
f0 CONNECT A �r
T( THE SYSTEM OF TIGARD SANITARY DISTRICT
THIS PERMIT MUST BE POSTED ON THE DES RIBED PREMISES UNTIL CON-
NECTION 1S MADE AND INSPECTION OF CONNECTION HAS AF,EN COM-
PLETED. 1
PERMIT FEF PAID $......
By t' 4%
CONNECTION INSPECTED AND APPR9VED
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j � Date�� �� ~� Su lutendent
Address_ �/� S u/. .-�'//ti�'c,J ST Permit No.
Name of Occupant_ �- �����
p /" Permit charge �
Connection fce
— --- ----_ Paid by� - E-.C ,/�.�i//�,•�l
Date connected
Type of Building /1 "/DEx✓c F- Inspection fee e'
Service Rate_ ��2 p Paid by /.r'_/��/�/' Dato—�Z,� '—
Contractor Paid-- —
Size of connection y