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( � P Y OF 'I'I6AaD PLUM lad N(� "'�' :A iW1 Wv
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�) T Tigard CR 97MApplicants must hold GS-"on Reglstrrtion W condW a plumbing PERMIT 0-4175
business or must be property owner/a errtor not hiring outside help. (/
" evoitolornoo _ Plumbing Permit No. S� /
ti N� TUACdrLZ.) ' ORS A121 310 OUAN. PRICE AMT.
Job Tax Lot Map.No.
Addrtes —___- FIXTURES -
L.Or ! Block Subdivlokxi -- 7.50 S_
Simi:
Not". or n une`crTousFeiij-- '- Lavatory -7.50 Z.
(_ 50
L Tub o TubtShower Comb 7
ai imp
� Shower Only 7 50
-_ ----- ..�
Owner W/ tate � 3� - - Wale►Closet-_.. ____.- - -7.50 !
r4f�� f-
i
Z Z--z Dishwasher ?so
� r1 0� `lam_--� --
f 'e Garbage Disposrl /� 750
Nemo _..- -------- WasNng Machine ---- ( 750
l- Floor Drain 7 so._ _
imp Tess -- WalerHealer / 7 50
!! 1
LaundryRTray ray - -, 7.50
Or•cupa d ,ky/Slalo- -- ____- - --- -
JI! Urinal 7.50
f,',j _ Other Fixtures(Specilty) 7.50
r 7.50
?.SO
C<xttract<r �X-,StW --- ZIP -
� MISCE:_L!_4E0US
Uy Bus Tax No gewN t a1 100' koo
,t-e L C /- o 00-- - - -
Soww-ea.Addit.1 ' 16.00 _
va _mare s --- _
.F--� Water Servloe let 100-- - _20.00 1-Ile) r'
I heby oiavNifk to rMl I hunt raid Oils appllcallon,that"Ir l mistlon Water Serviosu.AddN i I5 00
er
phren is cr Fwd.#W I rAm"Viet rad kjo wa 94Aa Guilder's Bowrl,and Aw Storm a Rain Drain 1 e1.100' ._30.E ---
haw a Stole Pka►iWrlg bowies ew 1'N Mx*)0.9 9WW are oor,wA that aN
plumbing ivork will&A done in aon0rdon0e with 4ipf,*>NO i'rrov%i0rw Of Ore Stam i Pyn Drain AddB.100' t 5.00
pon Revisiid Stalurii ill" Mry 447 and 03 wO alptoob►s oodee qM that Mobile Hoax Spam 25.00 -
no twip will be employed u im,kweed under OILS 411V: (it exempt from - -
Stam re*rretioa please ptvo nrawn h,%". Back Flow Prewrraon 7.90HOMlEOWNEM I low"offli r a►a 1 am Min onnw d to property de- Device or Antl�olkrtion Devioo
scribed abars,at►t*ft baMkri l l:vtXxm M nrMlre■pha,di'+q M►MMaUon for Any Tmp or WarM Nd
rrry own two and thra prapayr to not belnp owww'rcMrd for 08M,leoa Of rent Cionrwcsedto a FbALn 7.50
Catch Basin - 7.50
40.00 Per w
SPWGIY laegLomd tn.PeClLry _ _ - •o,00 PW Mr
Aft.d Pktntbht0 will III 11
t S.00 Awn
an EA"
AhrPK RLTFi�BKiPUTI.itE-� w New Bldg.a�iMd.Ad�ron 16.00 win
ay DaaoA»wont tww fj a;.tNbr,C7 aMm>I&M❑ rOP&O iA11 — --- 15wQU
q�d U0 ai
,eim
n+4I rt11MlIEtMOr�M w t1n6«ntI McNM wc++t w awaneAlnn/a1NorM�ait1 M na aomr ,,,s,a.,,,�.r,
eianlpaltlMirlr/o. ta1KIQrtN*0v-wAft 0i taMlde�aaeal+eaa.e+a
pMIM to Wi va',to a ov M2b ski,weep Y) ow
M IIS roll&
BUILDING PERMIT APPLICATION DATE—_ is
THS:UNDERSIGNED HEREBY APPLIES FOP A PERIAIT FORTH E WORK I iLRF'N INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE A.XOMPANYING PLANS AND SPECIFICATIONS. OWNER PHgp
*LOTNO.- . .►
OWNER Millar JOB ADDRESS 1' '1 ab't t:1(1 S78':�.Vt`_ 4'r thaver T,a.ndi.nj_
ARCHITECT
ENGINEER
BUILDERADDRESS P.O. Sox 23291_ TVi• DESIGNER G2M —
STRUCTURE_ LX NEW ❑ F,EMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY Q3—LAND USE ZONE _,RA.s_BLDG.TYPE _.5N—FIRE ZONE— PLAN CHECK BY E�'J HEAT
Constar vf-_•+ Iziml.e family aarancL.q_wr a=rovad ulnnrL._
Sub jec w 'n 35 CCx3G./1l X14XbIlXX8 _ L& td',QT PLA_Ccwt•. ET i.1, _--
SEWERPERMITM 33445( Lilt,,) 3 ba -li 10 [raps garage 530 --
--�-- 20+ 173 3 79,000
OCC.LOAD FLOOR LOAD _ HEIGHT NO.STORIES AREA `N0.BEDROOMS VALUE _
BUILDING DEPARTMENT SETBACKS FRONT 0` 9EAR LEFT SIDE RIGHT GIDE 14
Permit x70.00 THIS PERMIT IS ISSUE►) SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGPEED THAT THE
Plan Check 240.50 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. TNF. ISSUANCE OF THIS PERMIT UOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS.CONT."ACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
Z� �� LICENSE.SEPARATE PERMITS PEOUIRED FOR SEWER,PLUMBING AND HEATING.
'State,4Tax :_;.5DC; 1)0.CIO
SDC- 600.(.10
TotaPDCN APPlIC4 l�TONTBy 0U.0U LI 1+1�.OPJApp _ ._ Receipt No, � iCy AD--- -- PHONEL //
DATE INSP. TYPE INSPECTION EMAR" PLUMBING EDATE
Contractor&W.�f. W10 16.14.fr_7
Permit Nrj- 2,
Rough-in
Fixture
HEATING
Permit No.
.7 A- Gas or Oil
AE/ or,-,'i in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainer
(Rain Drain)Final
Sidewalk
Curb&stfoot Final
Approach
BLDG CERTIFICATE OCCUPANCY
bilp—IT.ir—.NwL—L TEMPORARY CERTIFICATE OCCUPANCY Final
Landocaping
Zoning Final
for inspections call 639-4175
CITY OF TIG ARD 439.4171 DATE
� IL® IfI MIT L Qnc� ,t
UU !! pEEqq � r-
.0. llo 23397, Tigard OR 97223 TAX MAI LOI`�. � —SuGDIvIS*N ...I.
OWNER �._._._
AOS ADOMM �.Li..1 ---yv U J"
BUILDER „_
1A �� ,� �°r' �� ►1�_ STATE REO.NO.._30 =- .��.�x►.DATE -
SUILOER'S PHONE
PHONE G'
ARCt f ..L=--OTHER
HITECT_ -
SY RE HEMI O REMOAEL O A�dT10N O REPAIR O MOVE - O OTHER C� DEMOLITK
LTIIESIDEMCC O COMM O EDUCATION O IND O����RE��L1GIOus O'ACCESSORr O 11ARAOE O OTHER O IEA
OCCUPANCY ” LAND USE ZONE •LOG.TYPE _a_c11_FIRE Yl�NF .o. PLAN CHECK Sr
r
SEWER PERMIT• MotoO
OCC.LVAD FLOOR LOAD ~ N
(.EIGHT JW t 0.STORIES AREA �� SV NO.BEDROOMS VALU IJIT-'
aq
.StOILDING DEPARTMENT SET®ACKS EBONY jj HEAR LES SIDE Lm RIGHT SIDE
s T BACKS �-e����� i
THIS PERMIT K ISSUED SUBJECT TO THE REOULATIONS CONTAINED IN THE BUILDING CODE.TONIA
REGULATIONS AND ALI.AIPLICAIILE CODES AND ORDINANCES„AND fT 0 HERESY AGREED THAT Th
PLOM Check RV WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS %NC SPECIFICATIONS AND IN COMPLIANC
-" WITH ALL APPLICABLE CODES AND ORDINANCES.THE ISSUANCE OF THIS PERMIT DOES NOT MAIN
IL CIL FM RESTRIC"COVENANTS,CONTRACTOR AND SUS CONTRACT TO HAVE CURRENT CITY SUSINES
TAX PERMff&SEPARATE PERMITS REQUIRED IQR SE`A F IL►1 NO AND HEATINA.
Slate Tai f Ir
OC
40
S -
TOI&I A 1 (GAN A
ISO, DueS 2,t R.c ;pl No. Af1DAFS5 "ONE
I�swd S _—Aworwd By
SSDC --- $
sac
PLC
SEWER CONNECTION f �
SEWER INSPECTION f �s ��"�' ��/'r
SEWER SURCHARGE
r�
�,rl 1 1 Vt 0 IVM!"1U IVICZ,rfy1HIVIl,rHL 1`CI'glVl! 1 PermitrM __ -u
Oescriptic n
Table 3A Mechanical Code CITY PRIC4 AM_T
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee 0 0 10.00
P.O. Box 23397 —--- —---__--- ------- --- -— --
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 1) Furnace to 100,000 BTU 6 00
Incl.ducts 6 vents f
- —_y--- -------
---
Furnace 100,000 BTU +
2) incl,ducts 6 vents 7,50
No f Development 3) Floor Furnace 600 _-
�„ � N7 incl.vent
Joh Address 4) Suspended heater,wall heater 600
Address
f CZ5 or floor mounted heater
-
Tak Lot Map No 5) Vent not incl.in 300
Lot V-6 8101.11 subdivision appliance permit
name of business) 6) Repair of heating,refr ig., 600
I / — cooling,absorption unit
ll+ng cess phone 7) Boiler or camp to 3 HP 6.00
Owner _ absorp.unit to 100,000 BTU _
City'slale zip _ 8) Boiler or comp to 3 HP-15 HP 11 00
absorp.unit to 500,000 BTU
Na T1e g) Boller or comp 15-30 HP - 15.00
absorp.unit 1/2-1 million
Mailing Address --- phone T 10) Boiler or comp to 30-50 HP 22.50
absorp.unit 1-1 75 million
Contractor cnyrstate zn 11) Boiler or comp tc 50 HP 31 90
absorp.unit 1,750_,000 BTU_,
State Registration No ry Bus tax No 1?) Air handling unit to � �
_ 10,000CFM
I herebyacknowledge 13 Air handling unit . 5n
edge that I have read this epphcaUpn that the information given �s ) 1(7,000 CFM r
correct,that 1 am the owner or auhonzed agent of th r owner,that pians submitted are in ----------- --- -- —-- -
complianCe with Mate laws,that I am registered wM.i the state Builders Board,that the14 Non portable
number given is correct (If exempt from State registration please give reason below) ) evaporate cooler 450
15) Vent fan connected 300
to a single duct
---
16) Ventilation system not
included in appliance permit 4'
Hood served by _1
17 4'�
mechanical exhaust 11 y J
sono re(owner or agent) Dale Doo"WIC type
Describe work Cl addition Cl alteration [j [Irepair -) 1��_ incinerator _ _ _7 S0 to be done_— residential non-residential [ 1 r 19) Commercia!or industriRl 3000
Existing use of type Incinerator -
building or properly_--___- Q� -� k 20) Other i e.,woodstove.water 450
Proposed use of
heater,solar,clothes dryers,etc
- — ----- - - -
building or property_ _ 21) Gas piping one to four outlets ( 2,00 Z -
Type of fuel- oil O natural gas ® LPG L) electric C l - - --
22) More than 4-per outlet
NOTE 'SUWTOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON -- ------- --
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE j y
DAYS, OR IF CONSTRUCTION OF, WORK IS SUSPENDED OR PLAN REVIEW Z3!!1b OF SU&TOTAL C.j
ABANDONED FOR A PERIOD OF ISO DAYS AT ANY TIME AFTER ---- - - --- -- --
WORK IS COMMENCED TOTAL
pedal Cemdillons_
Datelssued by