16325 SW ROYALTY PARKWAY ADDRESS:
Orecords\microflm\targets\buiIding.doc
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City of Tigard Huildklg Department
13125 Sw Nall Blvd. Tiga:Pd, Oregon 9722
Inspection Line (Rec--O-Phone)t 619-4175 Business Phones 639-4171
Inspections___ -- `-i t' 1(_ -- ----- --
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Can Line _ ALi
Post/Beam Struct. San. Sewer Framing
Post/Beam Necks. Rain Drain Insulation -Plumb.
Plbg. Underfloor water Lin& Gyp. Bd.
R
Data Reduestedt--- ------ Timet An PN
Address:
— — Permit /:__i
BuildAtt�
THE FOLLOWING CORRECTIONS ARE REQUIREDt
innpecCOCt- ---^_ -- -- Date tk) / —1
__ KPPRC'FED —� DISAPPROVED _-` APPROVED SUR.JEC�T` To A'OVL'B
T
For Reinap.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
P,k .'1
City of Tigard MECHANICAL. PERMIT Pjanck/Rec. #
13125 SW Han Blvd. APPLICATION Permit #
Tigard, 01-1 97223
(503) 639-4171
Description —
Table 3A IAOianical Code Q1Y PRICE AMT
Job •~ -U �'�4�r 1) Permit Foe — - -0 -o- 10.00
Address —
Il 2) Supplemental Permit _ 3.00
.•»« T'f - ',imace to 100,
1) incl.ducts b vents �- 6.00 DU
Nr•v kH••• // urnace 100.001 B W i
Owner l Y« ^y1_� ll �it� 1 2) incl.duds A vents —_� 7.50
r Fumanm
C ?) incl-vent 6.00 --
•�•t« buspend ate,,wawa eater
( 4) or floor mounted heater _ 6.CO
«• - Von(not-W in
Occupant 5) appliance permit 3.00
�r �* lepau o iraunq,relrg.
6) cooling,absorption unit 6.00
Boiler or compTat fwmp,air Anu. ---
55?f Li[C; - 7) to 3 HP absorp rine to LOOK BTU - 6.0)
r.a.n.«• toiler or comp,heal pump,air cond.
w t lav rl toll
8 3-15 HP ab-,o unit to 500K BTU 11.00
Contractor ,•,• - „ � Boiler or coinp, ivpump,air cond.
r� 0 /7 9) 15 30 HP absorp unit.5-1 mil BTU 15.00
•—N. iter or comp,heat pump,air cond.
10) 30-50 HP absorp unit 1-1.75 mil BTU 2250
re y ac w qe a1 have rea is appp iiGation, 5—atatit ie— Boilet or axnp, heat pump,air co . i
information given is correct,dint I am the owner or and orized agent 1 1) >50 HP absorp unit 1.75 mil BTU 31.50 _
of the owner,ttkit plans submitted are in compliance with State Au handling unit to
laws,that I am registered with tlhe Construction Conlra;tofs Board, 12) 10,000 CFM 4.50
that the number given is correct. (If exempt from Slate registration, r�ian ingg unit —
please give reason below.) 13) 10,000 CTM+ 7.50
—Fl—on porthble
14) evaporate cooler 4.50
v� Vont Ian connectix
15) to a single dud 3.00
—!— Ventilation system not
16) included in appliance permit 4.50
« .. o se .ry .by —"---- - --
17) mechanical exhaust 4.50
scribe w r rw addition a leration repair Commercialor industrial
to be done rasidenti,l('� non- cidential O 18) type incinerator 30.00
Existing usa o Urn(re,,w stove,water
building or property — i_ 19) healer,solar,clothes dryors,etc. 4.50
Prr,rhosed use of 20) Gas piping one to four outlets — 2.00 (J�
builc1ng or property
21) Mora than 4-par uiidet
Type of fuel-o1 O natural gas 0 LPG O electric n — - — -'-
NOTICE ----
- Minimum Fee$25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180[JAYS,OR 5%SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR - - -
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PIAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED. -�
TOTAL
Spedal Conditions
Date issued by -
-SEP-27--193 MOR-19:10 Tt):C1TY OF KING CITY FAX [40:503 639-3771 #941 F01 _
Post-It'"brand fax transmittal memo 7671 .--f"9.. 0. 1
KING CITY Co. From
C
��s•r M100 SW.116th Avenue,Bing City,Oregon 9,224 Phonp Dept`�._ , r, one 3 r:
COMMUNITY I ■■ � �V )) y j Fax
ADPLICATION FOR -
�1/i (Instructions on reverse)
DATE__1__7
1. NAME' OF APP C1LWT: der` )�7 `1 _ __ Phone No.
ADDRESS: 1 Jlr
ADDRESS OF PROPOSED W
2., TYPE OF MANGE, IMPROVFMFM OR C ONS'I' UCTION FOR. WHICH PERMIT IS REQCIF.STED.
DESCRIBE BRIEFLY - Mllwu COPIES 9F S OR PRAWI S OFL
PROPOSED PROJECT.
3. N AND S OF OONTRAC'i`nF�
�21 t1 r JA 4
_� ��T�WE
PHONE140. ' _�,_LIC'3~IVSE NO.,&611
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJECT WILL BE NOTIFIED BY THE CITY.
5. APPLICANT OR HER/NIS REPRESEMATIVE MUST B:7 PRESENT AT THE PLANNING CCWISSION
MEETING NEXT HELD ON___�
REFRESEM'ATIVES NAME __ __PHONE NO. __--
(?he Ring City Plaanin Comeission sill consider only those applications received at leas: fire (5) dols
prior to a i
SIGNA73RE — --
`;2^ 3
APPLICATION RECEIVED BY L( -DATE
—
APPL I CABLE FEE RECEIVED
PLANNING C1CM"tIS ICkT DFCISION: Approved_ _— Denims —
CONT)T T T ON
roved a pli tions are valid for sit moths only
Signature``-_ tt a-- ! {Q��G Ante _—
AWE: egos Bosebuilders Law requites that all persons who contract fur work on their residence be
`iegistered with the Builders Burd which atlas the contractor is bonded and insured on the job site.
For your prosection, be certain your contractor is registered by calling City Hall Ph: 634 4082.
NOTE: A permit runt also br. obtained from the City of Tigard Department of
Ccsirmamity Developrl-ent Yec_ _. No
CITY OF TIGARD INSPECTION REPORT
They above listed project has been inspected and Approved,_Denied__
Dat a—_ CC rvnen t s ___
Signature
(Su.1..P.d ng .impe 4,L pf=Ae- A&tmn. Ong- (1) copy to K,&w Ci ty
CD 2-81
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT NO. :93-244543
CHECK AMOUNT 26. 25
NAME a B&T GAS SERVICE CASH AMOUNT t 0. 00
ADDRESS a PAYMENT DATE a 09/27/93
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
M E E�H—AN I CAI.. PE 25, 00 ST. BUILD PER 1. 25
NJRMA smirH
16325 SW ROYALTY PKWY
TOIAL AMOUNT PAID 26. 23