16160 SW KING CHARLES AVENUE i
16160 SW KING CHARLES AVE. ,,_
K-1, NG CITY
■��� 15100 S"�' 116th Avtnwc,King�,it,,Oregon 97224 Phone:639-4082
COKMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instructions on reverse)
DATE
NAME OF r.PPLIc AN-': /UOl?iL1 _ (1,,'G&7I+A- Phone No. (� �' J Z" 7
")DRESS:_/(, I -�_, !:;. , k t o-6 C Af t.-6f 5 14V
ADDRESS OF PROPOSED IMPROVEMENT j,}_tVF y
T.'PE OF CHANGE, IMPROVFIAENT OF: CONSTRUCTION FOR 4H I CH PERMIT IS REQUESTED.
DESCRIBE BRIEFLY - ATTACH TWO COPIES OF PLANS OR DFWINGS OF
PROPOSED PROJECT: Cc;l(L'6✓645-7- r-904--) 14F F'r', T , /� , 5 3
3. NAME AfID ADDRESS OF ..ZNTRACTCR
Iti-"FIZb-, /Yi h 5 71� S ��c t� 74-A45 XA- -?
102L-r- - (;�k J-7Z2--� — PHONE N0.4l ' C LICENSE NO. Jrz_ J F" O
4. NE,.' :HBORS WHO MAY BE AF'FECTEI) BY THIS PF,OITECT WILL, 3E NOT 1 F I EC BY THE CITY.
5. APPLICAT OR HLR/HIS RE'PRESENT'ATIVE MUST BE PRESEIV'i AT THE PLANNING r".dyMISSiON
MEETING NFEXT HELD ON
RE'PR 'S,-tM'ATIVES NAMF. _ PHONE NO.
(Th KiNg City elanuiaq Commission oi'i consider only those applications recv.ved it least five (5) days
prior to a meeting.)
,GNATURE
APDLIC.t TION RECEIVEll BY_"(_ � ��_ T DATE
APPLTCnBLE FEE RECEIVED S J !__ ?Y'/I'AL--L�,G---
PLANNINC (TWISSION DECISION: Approved___ _ Denied--
1
GON�D I'T I ON 5� �l l_� i
%onpli.ations� re valid for sir months only
Z , Girl
Signature- _ — Date
NOTE, Oregon R meluilderl Lai squires that all persons who contract for work on their residence by
registere�lwrth tht Bu:.Iders Boad which means the contractor is bonded and insured on the fob site.
Fir your Protection. Le certai. your contractar is registered by cal,i.ng City Rall Ph: 639-4082,
NOTE: A permit hint also be obtained frorn the city of Tigdrd Department of
Ccnr=ty Development Yes es— No
CITY OF.TIGARD INSPECTION REPORT
The above listed project has been inspected and Approved Denied
Date Comments
Si.gnature_�_
(F3u.iJd4ng i.n,epecto�t ptwst a AvAuAn ons. ( I ) copy to K4Ag City 1
CD 2-87
-IAN I CAL.
CITY OF TIGARDr,ER!hTTPERMIT y;. .
- MEC94---01114)
COMMUNITY DEVELOPMENT DEPARTMENT DATE: T 6,13(JEi-01" * *05/02/94':
13125 SW Hall Blvd.Tigard,Oregon 9722.)*8199 (503)839-4171
SITE ADDRES.— . . :� 16160 SW KING CHARI-ES AVE PARCEL: 251 15BB-04900
SUSD I V.1 b I ON. . . . .. ri e. C', q I ZONING.
BLOCK,. . . . . . . . . . . DILOT. . . . .. . . . . .
CLASS OF WORK. . :NE-W hr-CC." !-"--I-JRN. . . . c EVAP '-OOLERS:
TYPE OF USE. . . . :SF UNIT HEATERS. . ; VENT FANS. . . ..
OLCUPANCY GRF-,. . : R3 VENT':3 W/O 11PPL-t- VENT SYSTEMS:
S i*UR I ES. . . . . . . . : 1 BOILERS/C;9MPRESSORG HOODS. . . . . .
FULL TYPL.E------- HF' , . . : DOMES. A'NCINI
- /GAS/ 3-15 HP. . . . - COMML. INCIN:
MAX INPLIT: B T Lj 15-30 HF'. . . . : REPAIR UNITS:
F IRE DAMPFRS?. 30-550 HP. . . . : WOODSTCWES. . .-
CiAl) F RESSURF. . . s 504. HP. . . . CL.O PRYERS. . :
1\10. OF AIR HANDLING UN I I S OTHER UNITS. : 1
1-:'(JRN < 1001-" BTU- J t 100016 ctin : GAS OUTLETS. : I
I- URN ) --:--100K BTU: > 1,0101110 cfm -
liemar-ks : INSTAL-LING vjwEP HI AIER GAS
1Jwtier,., FEES
AIDIRM INGMAN type ilk m o t.i ri t by dii- te V-ecpt;
16160 SW KING CHf4Rl-E5 PR lyl T $ t"'15. 00 SlIT 1:15/02/94
KING CITY OR 9*7224
Plhoiie
I-1NIl-Prj`/ MAS TC"RG INL
f,4 /Vf L3W 7L�] H
I-'UFqTLAND OR
I'T)mle 4: L44-8131-10 26. r25 TOT(-ij-
58356
REQUIRED INSPECTIONS
'his permit 15 issued subiect to the regulations contained in tho Fi.,lal lnspectjc)n
I igard Mr,miripal Code, State Of OM Specialty Codes and all other
applicable laws. All wovi, will be done in accordance with
approved plans. This permit 6111 expire if work it nt. started
within 180 days of issuance, or if work is susovlded for tore
'han IN days.
' '(-.$V,mjttee
ISSI.ted By .
CIl for inspection 639-4175
City of Tigard MECHANICAL PERM? Planck/Pec. #
13125 SW Hall Blvd, APPLICATION Permit #
Tigard, OR 97223
(503) 639-4171
.»° .
escripuon
Table 3A,Mechanical Code QTY PRICE ANIT
Job �(��(n0 SGU lCIA� CGI,I(ds 1) Permit Fee -0• 0 10.00
Address w---
C_/ c 2) Supplemental Permit 3.00
urnace o BTQ--"-
V017M 10(p&A AI-J 1) incl. ducts a vents 6.00
urnace u BTU-+—
Owner 1 (0(("o '(ftL'G Cf� 2) incl. duds R vents 7.50
Floor Furnance
-7''Z 3) incl.vent 600
uspen heater, wall heater —
s 'L 7!4 4) or floor mounted heater 6.00
Occupant vent not incl, in
5) appliance permit 3.00
neA pair of heating, re ng.
rj cooling, absorption unit 6.00
E, R'� /y� ,, 5 ��✓ boiler or comp,C eaTmp,air cord-'7) to 3 HP;absorp unit to 100K BTU 6.00
�� --S-Ter or comp, eat pump,air 6-5-5 0—.
—
Contractor
741'70 � 7 7 r.7 8) 3-15 HP;absorp unit to 500K BTU 11.00
y Boiler or comp,heat pump,air con .
12 Qe7-88.56� 9) 1!-30 HP;absorp unit.5.1 mil BTU 15.00
' ' / •' Tier corop, eat pump,air cond,---
0 n 5SSC 10
) 30.50 HP;absorp unit I-1.75 mil BTU 22.50
hereby ac ow ge a ave readis app ica ion, a ,a —777&cr comp, iT a`,imp,air cond.
information given is correct,that I am the owner or authorized agent 11) >50 HP;absorp unit 1.75 mil BTU 37.50
of the owner,that plans submitted are i i compliance with StateTi an ing 6-n t to
laws,that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 450
that the number given Is correct. (If exempt from State registration, '71ir a i mg unT--
please give reason below.) 13) 10,000 CTM+ 7.50
porta e
14) , .porate cooler 4.50
"—' an wmn-e-cled—
A
15) !o a single duct 3.00
enVeauon system not
16) included in appliance permit 4.50
Hood served y
17) mechanical exhaust 4.50
escn wo naw0 audition CY a era on repair 17- ommercia-foIndustrial
- —
to be done residential 0 non-residential O 17=LM91
pe incinerator 30.00
xis ng use o'- ,��, %e.,wo 5-uvea wa er
building or property t" _ 1,p 190ieatet,solar,dotl1es dryers,etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
Type of fuel-oil 0 natural gas* LPG O electric O 21) More than 4 p)r outlet
_ ice—
Minimum Fee$25.00 SUBTOTAL. �J
PERMITS BECOME VOID IF WORK OR CONSTRUCTION ---
AUTHORIZED IS 140T COMMENCED WITHIN 180 DAYS,OR 6%SURCHARGE
IF CONSTRUCTION OR WORK IS SL,SPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 2S%OF SUBTOTAL
AFTER WORK IS COMMENCED. _
TOTAL
Special Conditions — — -
Date issued r - by
A.MEC PMT
.°iAmnMH
I
. ��
INSPECTION NOTICE �
city or Tigard Building Department
13125 ON Uall Blvd_ Tigard, Oregon 97223
Inspection L e (Rac-O-phone): 639-4175 Puniness Phone: 63 4171
l .� �. �� "
Footing Plbg. Unucruiab h. Nou h p Appr/Sdrwlk
Found. Plbg. rop Gut Gas Line FINAL
Post/Beam struct. Ban. Sewer Framing -Bldg.
Pont/team Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -8ech
Date Requested: T . AM PM
Builder:
THE FOLLOWINr. (,ORREL"rioNS ARE REQUIRED: /
7-e �--
-
r S- ia - r '
Inspectorr___ V`✓ �`� ____ Dates
APPROVEr DISAPPROVE:) r APIROVED SUBJECT TO ABOVE
(� Call For Reinsp.