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BUILDING PERMIT APPLICATION DAIE
1 HF UNDERSIGNED IIFREBY APPLIES FOR A PERMIT FOR THE WORK HERFIN INDICATED FIUILDER PHONE . 684-7543
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICA'IONS OWNER
OWNER ,Tay Miller JOB ADDRESS 1.;:1'5$7 541' C. . ior Drives LOTrt�A.�v�_l��n��'C
ARCHITECT
Bktl11 ENGINEER L.Taft #1596
BUILDER ADDRESS _ _ —A DESIGNER
STRUCTURE ® NEW ❑ RLMODEL ❑ ADDITION O REPAIR 0 RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
D(RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO 0 CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY _LAND USE ZONE BLDG.TYPE -_.--=FIRE ZONE—.__PLAN CHECK BY LT HEAT——
Const:ruct single-fairily dwelling w/attachesd glrw tC 11 per._clopruved plans. —
Sublect: to 85 code. REIASSTIF' of 6829
SEWER PERMIT M 34530 ( du) 3 baths, 10 traps ria'7rqe area _4_04 _
OCC.LOAD FLOOR LOAD 4_0 HEIGHT an NO.STORIES Z AREA 1596 NO.BEDROOMS 2 VAIU12000
BUILDING DEPARTMENT SETBACKS FRONT REAR 47 LEFT SIDE _9 RIGHT SIDU 6
Permit 349.00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATION ", AND ALI. APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 40.00 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE Ct 'ES AND ORDINANCES. THE. ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total _ RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 1.7.45 5` 250.0
SDC— GOO.tIO
)
Total 406.15 ------
PDCN I jri0 00APPLIC A E -
rApp�o,ed
40.00 1 `
366.45 Receipt No. '' � ` ' Abid- _._-�--- ---___..--.— HOS—.N�__ Z�F
DATE INSPP, TYPE INSPECTION REMARKS PLUMBING DATE
Contmco,
/0� � � Permit No.
Rough-incp
—
Fixture _—
�L-/�� Final ---
/�� HEATING
Contractor t'qi3�!
Permit No. 1ft3
Gas or Oil
Rough-in --- —
Final
---� �- -- SEWER
Final
DRIVEWAY
Final _
Storm Drainage
)Rain Drain)Final
--' -- Sidewalk
Curb&Street Final
Approach
BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
CITY OF TIGARD BUILDING DEPARTME1 - PLAN CHECK NO. :-
PLAN CHECK APPLICATION DATE RECEIVED: �Z
P.O. Box 23397, Tigard OR 97223 P/C DEPOSIT PAID:,
This is to certify that the attached sets of plans have been submitted for plan
check pursuant to the Oregon Structural Code and Fire & Life Safety Code, ��, edition.
PROPERTY OWNEOWNT R'S ADDRI,SS:
CONTRACTOR: TELEPHONE: 11
JOB ADDRESS: L -, `"� ��,L1 ��Q � , LOT NO. & MAP: LO TL ;t-- T)
T ll
DESCRIPTION OF WORK:
Approvals Required SPECIAL NOTES
CPlanning Dept. Reissue
O Engineering Dept. O Flood Plain/Sensitive Lands
OFire District G Sewer Availability
O Other O Other
Items Required
vList of subcontractors
OBusiness Tax
Calculations
OTruss Details
O Parking Plan
0 landscape Plan
0 Other
COMMENTS:_
City of Tigard Bu'lding Department
BY: 4// I
PLAN CHECK NU.
for inspections call 639�/175 U/ 705
PERMIT Nom.
CITY OF TIGARD 639-4171 DATE
BUILDING PERMIT
P.O. Box 23397, Tigard OR 97223 TAXMAP �"46LOTNO. Li SUOOIVISION LQ _
OWNER
JOB ADDRESS
BUILDER /01597 S�1%. y I L4, 1/1� /G a
A �/" IJ P� !/ .I h STATE REG.NO.
� `
BUILDER'S PHONE
ARCHITECT — _ PHONE_ O*HER
STRUCTURE -� NEW ❑ REMODEL ❑ AOOITION C) REPA(R ❑ MOVE Y ❑ OTHER C7 DEMOLITION
RESIDENCE ❑ COMM ❑ EDUCATION ❑ INO ❑ RELIGIOUS, ❑� ACCESSORY Q GARAGE. C)OTHER ❑ FENCE
OCCUPANCY LAND USE ZONE ��� BLDG.TYPE —FIRE ZONE__PUN CHECK BY K. I,VAT
_ Construct single fami 1y dwe1 i i`n� r �7 -aPfr-V9A-4,LLaA6 ---- -
;Itl)ject to QQAQ
SEWERPERMIT e, (1d,I) baths. /Utraps aaraae
OCC.LOAD FLOOR LOAD HEIGHT f--G) NO.STORIES 2 AREA /��(p NO.BEDROOMS-VALUE o� -
BUILDING DEPARTMENTSET BACKS FRONT REAR Cl LEFT SIDE 1 RIGHT SLOE (f
PermllC,3 " THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND OROINANCES.AND IT IS HEREBY AGREED THAT THE
Ptan Chock O WORK WILL BE DONE IN ACCORDANCE W11H THE PLANS AND SPECIFICATIONS A40 IN COMPLIANCE
wrTH ALL APPLICABLE CODES AND ORDIFN
NCE •. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
PI.CIL Flri RESTRICTIVE COVENANTS.C�MTRACT0 DS CONTRACTORS TO HAVE CURRENT CITY BUSINESS
TAX PERMISEPARATE PCkM,(TS REOUI FO EWLU
ER,PLUMBING MBING AND HEATIN0.
State Tax �c S S5 DC
SOC— - -- -- . —
Total vL y j APPL
-+T-- PDQ. �)
Prepd.v ----�U GJ �+� —PHON(
// Rec6.pt No AODR J
Bal.Due — (d y
L.uoa By__-.-.--------approved By
SSD(_
5 0 C - '� 0 ---
RECEIPT �!
POC - � �J� DATE PD. _---_----
SCOCR CONNCCT ION 5 _z U _ AMOUNT PU._
SEWER INSPECTION 4S�
SCWER SURCHARGE SC", f d AA *� \
Cr
:o m m e n t e:
CITY OF TIGARD MECHANICAL PERMIT Permit#
7M*tSAN`Oaary rrmx AIIT
City of Tigard 1) Permit Fee -0- -0- 10.00
13125 SW Hall Blvd.
P.O. Box 23397 2) Supplanental Permit 3.00
Tigard. OR 97223 -- ---
835 4175 1) Fumaoe W 1 C�.;a0 BTU 6.00 (� u
inc,-.d du sts S vents
2) Furnace 100,000 RTU-+ — 7.50
Ind.duds&vents
Nertte d oe�M rpnwrrl 3) Floor Furnace _ 6.00
incl.vent
Suspended heater,wall heater 600
Job ^�"� f — 4) or floor mounted heater
Andress .S" S `✓ /� Vont not Ind.In �——
Ta Lot -7.A v MIO No. .2'.51 /5'4 cl 5) 3.00
appliarx a Prxrr►I! -- -- -
Lot i Broot� StAxft No^,2W h gape!!d heating,ref!ip
— Nnrte(p ntrnte a bttrtrteeel 8) 6.00
coding,abawr tion unit
6"Z Boiler or comp eo 3 HP
�ei 4 O'e 7) absorp.unit to 100,000 BTU 6.00
Owner
Boiler or oonyp to 3 HP-15 HP 11.00
CMy/State ZIP A)_absorp.unit to 500,000 BTU
0) Boiler or 00171P 15-M HP 16.00
absorp. -I Rd lim
ta'Iterts 10) U1111 i-1. Wow_ �•�
nv 1t) BoNworoumIre60HP 31.5u
slow Room~No ante...r.:rio. t2) Air har�ftp Uvdt b 4.50
10,000 CFM
Air harK*V ur* -- 7.50
wd
t nv.ey .de,owedge rrr t t,«e r Mi epPt,*km wt w k*"~Q'--im 13) 10,000 CFM+
ooneol fha I @M the aarwr or WAral"d egad at w ow w.ow 0"a►twilmd wo in —
cavow as wth Aub tees.#0 r etrr r*ON a wih w ate°e eul►itus'8attrd.s,.i the 14) NonpoirMbIle4.50
�xrieb«pMw+r axna.fx t•�t�or owetwe tent S",flee«04*e moon bekw) V e"i Pomle 000006W
15) vent van oorneded3.00
w
to a shale duct / Z
--- - 16) Ventilation s)rstern not 4.50
enchx*J ir'JPpNanoe potmN -
-- -- - Hood eved by
1/� 17) sr
4.60
meofarrtk;ai exhaust !{ �Z
a l _ _Def 18) Domestic we 7.50
Incinerator
Describe work ❑ ❑ alteration ❑ Weir [l _to be dorm residential tort-reakfentiAl ❑ 1 q) Commercial or industrial 30.00
type Incinerator
Existing use of ) Other i.e.,woodatov*,water -
btAk%ng or Property L — p) heater,War.dollies d ars.etc. 4.50
Propo*W use of
building or property _ ___ _---__ ___-_. - 21) Gas piping one to four outlets / 2.00 ?/�
Type of fuel o-I i_1 natural gas LPG U electric L_),4—
_)
4 ---. 22) More then 4-per outlet
gQj .k SUB-TOTAL 3( $U
THIS PERMIT BECOMES NULL AND VOID IF WORK Jit CON.
5%p 446 SURCHARGE
STROCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 JL - .
DAYS. OR IF C ONSTRUCTM OR WORK IS OUSPENDED OR MAN RBVI!'w!d%OF SM-70TAL 6 ,3
ARAND ONE()FOR A PERIOD OF 18o DAYS AT ANN TIMF AFTFR r TOTAL
WORK IS COMMFNCFD
Spodal Condltlons - --- -
f ale issiir_r1 t�� FC'7
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