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MAY 7 1992
15695 SW OLD ORCHARD PLACE
CITY OF T1GAkll MECHANICAL 1'EkMIT �—
t.ity (1I '1'igard
13125 SW Hall Blvd . — ---
I'.(), Box 23397 I Tablei 3AMeehan"Code QTY PRICE AMT
Figard UI( 97223
b 31) ;41 7 5 1) Permit Fee 0 -0- 1.0.00
2) Supplemental Permit 3.00
1) Furnace to 100,000 BTU
incl. ducts & vents _ 6.00
2) Furnace 100,000 BTU + - --
Name of Development incl. ducts & vents 7.50
3) Floor Furnace —
incl. vent 6.00
.lob SL cj',. - 0--, C' C F+;h20 — ---
Address Tax Lot ttep No. 4) Suspended heater, wall heater
Lot Block subdivision or floor mounted heater 6.00 _
N me ( or name of business) 5) Vont not incl. in W
U `4T n -t appliance permit -- 3.00
IMafling Address Phos. 6) Repair of heating, refriq
Owner I e�;(vq S- Sw 0` K> f-A1-L 4�-, ( ()] cooling, absorption uni? _ _ 6.00
V-Y�
hn 7) Boiler or comp to 3HP
G✓�(z C) 0n j-1 _ absorp. unit to 100,000 BTU 6.00
8) Boiler or comp to 3HP-.15HP
absorp. unit to 500,000 BTU 11_00
g Address Phone 9) Boiler or comp 15-30 HP
c> y A 0z^0wAy ?b 7•-IZ33 absorp. unit Ih-1 million _ 15.00
Contractor Cltyrstate zip 10) Boiler or comp 30-50 HP- _
Pb r--V' 00- 9773 Z absorp. unit 1-1.75 million 22.5
State Registration No. City Bus. Tax No. 11) Boiler or comp 50 HP
0 0 absorp. unit 1,750,000 BTU 31.50
I nw" acknowledge that t have read this application that the information 12) Air handling unit to
given Ie oonect, Mal I am the owrw or authorized agent of the owner, that
puns submitted are bre compliance with sate bawd. that I am registered with 10,000 CFM 4.50
the Sots Bulldere' Board, that the number given is correct. (it exempt 13) Air handling unit
l,r- State registration please give reason below). 10,000 CFM + 1.50
14) Non portable i
evaporate cooler _ 4.50
15) Vent fan connected -
/ to a single duct _ 3.00
16) Ventilation system not
-Signature-(o her or nt) Date included in appliance permit 4.50
17) Hood served by
Desc,•ibe work EfadditionFl alteration❑ repair[:) mechanical exhaust 4.50
to be done residential [) non-residential [] -------- -- - -
______�_ 18) Qtimestic type
Existing use of �� '` incinerator 7.50
building or property— - 19) Commercial or Industrial
Proposed use ofS type incinerator _ 30.00
building or property — 20) Other i.e.,woodslove, water
Type of fuel - oil❑ natural gas[] LPG❑ electric)V heater, solar, clothes dryers, etc. 4.50
NOTICE
21) Gas piping one to four outlets 2.00
_ ____
THIS PERMIT BECOMES NULL AND VOID IF WORK OR 22) More than 4-per outlet
CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN SUa.TOTAL -
180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED 4% SURCHARGE
OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ----_-_.______ _-- -,PL'
TIME Al-TER WORK IS COMMENCED -----------PLAN REVIEW 25%OF SUB-TOTAL
TOTAL
Special Conditions —
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— Date i4Stled i'/ y/d2 by —� ��
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CITY Ot l I(_AARDNc, � 3 s
ualatin Develo RR9. Co. Inc. 0269 4�
rF� O��il�lin....Adds•ese.......15.6y5.....5. W......0,1.d..-Orcha•rdFPlaceNo......................... �3 �.y�,•i
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Ccrlificatc is hereby given this..-29th duty of....Qctobe............. , 19_. .l `
that said building may be occupied and
that it complies with all requirements of
( ' the Building Code for the City of Tigard, ��j
as approved by the 'Tigard City Council.
tVBf; Puild(ng Inspector
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IN5PECTION REQUEST
for
iNaPECTIC"N T')NE: FPM1T N0. :
DATE: 1is/.�; DATE ;SSIJED :" /
OWNERS NAME : C— I
AJCRE3S: /�, 9 L Sl"- I';' G'.z�iY,�.�,_, �
CONTRACTOR : i66 - /,-/I-
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TEST : Ai- A'c'g" V 3'"'C: 'D . L-,:a-a!ory C
RESULT: ap-rrred :)130 Pendil 7 []
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IN PECT0R DATE
I NOTE ' A•1c^,ti tsa^!amental teat da!u hnr i
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: ' 3 PERMIT NO. :-
DATE: DATE ISSUED : LL_
OWNERS NAME : 710,, ( ' ' - f
ADDRESS: 'T� Z
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CONTRACTOR : ____, 1 ?�_` � _ --- -- j
TEST : Air El, Water[] , VisuWil laboratory 0 I
RESULT: Approved , Disapproved ❑ Pending El
SKETCH:
INSPECTOR DATE
FNOTE : Attach suPPlemental test data hereto]
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: ,ds ,r' PERMIT NO. : _
DATE: 1s/ Z DATE ISSUED :---/
OWNERS NAME : .__.Z�C�, _____,,,�_
ADDRESS: .4,o4 S)4
CONTRACTOR : .---7— C
TEST : Air ❑, Water E] , Visual 0 .�Laboratory ❑�
RESULT: Approved Disapproved [I Pending C]�S KETCH: � I
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SPECTOR DATE
50TE: Attach aupplementol test data beretaa
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CITY oN 5_8 ?S N+! 0269
BUILDING PERMIT APPLICATION TIGARD DATE_—_ --, 19--
THE UNDERSIGNED HEREBY APPLIES FOR APERMiT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE-------
OWNER WNER Mr, ADDRESS 'I.a6�l:'1 °�•iy. Old Orchard PAWMRPHONE
T ENGINEER
BUILDER ARCHITECT ___ —___ DESIGNER
STRUCTURE ONEW ❑REMODEL ❑ADDITION!_OREPAIR [:]RENEWAL ❑FIRE DAMAGE []DEMOLITION
C1 RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOWT ❑RELIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND ❑MOVING [:]CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS P
�_-- .- ----� -.-_-- -- ,.R I
OCCUPANCY_.._ -.LAND USE ZONE BLDG.TYPE.N_—FIRE ZONE— PLAN CHECK BY_
r�' 1 HEAT--.bedroom den family
-- �>ta wa�rin r r!.e i Li l v t 142
2000 33o ;nO
OCC. LOADFLOOR LOAD__—_, __ HEIGHT NO.STORIES AREA __ VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE 10 RIGHT SIDE 4
Permit L 39.OU
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL 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
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
-t724j- RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I%State LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUM1'- SVG AND HEATING.
Total 1'30.3.
APPI.
Approved — Receipt Nn
nr,aRFss
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough-in _
G�1 p Fixture _
Final
HEATING
Contractor
Permit No.
Gas or Oil
Rough in _
Final
--- SEWERS--"4
Final
DRIVEWAY
Final
Storm Draina e
(P.)in Drain) Final
„;&awalk L C—
Curh&Street Final _
Approach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY )Final
CERTIFICATE OCCUPANCY ---
C, it `7h� Landscaping
Zoiing Final
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