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i:\rec.-rds\microflrn\targets\lluilding.doc
C17Y OF TIGARD (cayli- wARD
COMMUNITY DEVFLOPMENT DEPARTMENT MECHANICAL
13125SWHm1fBlvd. P.O.Box 2J3Q7,Tig",(_Nvgon 97223(SM)&39-4175 PERMI f
DATE ISSUED: 06/10/92
31TE ADDRESS. 11045 SW 106TH AV PARCEL: I51341)A01200
�UBDIVIGIM . . . NORTHERN PINE ZONING. R---4. `zJ
b L 0 C K. . . . . . . . . . . LOT. . . . . . . . . . . . .
i-LASS OF' WC)kK. ADD FLOOR FURN. . . . EVAP COOLERS:
TYPE OF USE. . . . :SF UNIT WATERS- - VENT FANS— ,
OCCUPANCY GRP. . .-R.;,' VENTS WIC) APDL: VENT SYSTEMS:
TORIES. . . , . . . . : VOTLERS/COMPPESGOPS HOODS. . . . . . . :
FUEL TYPES------------ 0-3 HFA. . . . : I DOMES. INCIN:
/ELE/ ..1-1 7
.., -1 lip'. . . ! : COMML., INCIN-
1Ax lrqr-,u,r-. B T U 15-30 HP_ . . . REPAIR UNITS:
IRE OAMPERS?. . z .30--30 IAP. . . . : WOODSTOVES. . :
j(4s PRESSURE;. . ., - 50+ HP. . . . : CLO DRYERS. „ U,
WO. OF' UNITS—-- - AIR HANDLING UN I TS nTHER UNITS. .
BURN ( 100K BTU: 10000 cfm: GAS OUTLETS. :
I URN > =10011, BTU: 1000Q) cfm :
Remarks:
Owner: FEES
. SGOTI TF PEDINO type amol.int by date
1104b SW W61H P RMT 25. 00 JL' H 06/10 192
11GARD OR 972,23 5PCT 1 1. iJLP 06/10/92
�.'5
GJhane #:
Cantv-acto-r.-
OWNER
i_lhune 44-: $ TOTAL
1�eq 0000vi
------- RLUUIkEL) INSPECTIONS
This permit is issued subject to the regulations contained it the Final In5pection
Tigard Municival Code, State of Ore. Specialty Codes and all other
aaclicable laws. All work will be done in accordance with
approved plans, This permit will expire if stork is not started
nithin 180 days of issuance, or if work is suspended for more
than 180 days.
LD
W
Ts,s;r+e1_i Dye
Call for, inE-pec:,tion 639-417F)
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: 1• J 26A'41-
Footing Plbg. UnderslabMerh. Rou7h-i Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/seam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor /W/ater Line Gyp. Bd. -Mech
Date Requested: lf/ U ��—. s Time: AMM PN
Addrees: f— /Fdrml 1:��
Builders
Tho FOLLOWING CORRECTIONS ARE REQUIRED:
0.
H
Lal ----
J
Inspectors natal. b— 3 1
APPROVED DISAPPROVED APPRMD SUBJECT TO ABOVE
Call For PALnrp.
CITY OF TIGARD -- RErEAV,T (IF PAYMENT PE*Cf---IPT NO. :9"*'—f-"i';'Af':'88
Cl-IC.CK AMOIJNT
NAME TEPCDINO, F. SrOl-l' CASH MOUNT 0. 00
ADDRESF� x 1 1045 SW 106TI-I AVE P0YMFNT DATF : 06/ 10/9P
SUBDIVIGION s
OR 97='2:3--
cL URPUllliF V'- r,A`rm[-tir AMOUNT PAID PURPOSE OfPAYMN"r WOUNT PAID
2b. 00 c.-."T. BUILT) VIER 1. P5
111
Air,
TOTAL AMOUNT P(M) 26. 25
F~ Permit No:
Address:
LN - z Issued by: Dat-:
FOR OFFICE USE ONLY.
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONS'rRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued.This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under OHS 701.010(7), need not 5l+bmit this statement. T-is statement will be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 313:
1 1 own, reside in, or will reside in the completed structure.
2 1 understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
' 3. A. I Ivi k, general contractor is --- - - -- -- -- - - --- - -
Contractor registration number_- _--
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. F3. [r=' E I I will be my own qeneral contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contra tors Board If I change my mind and do hire a general contractor, I will
contract wit,i a contractor who is registered with the Construction Contractors Board
and I will imirediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that I have rcid and understand
the Information Notice to Property Owners about Construction Respo+isibilities o, le
reverse side of this form.
21
Signature off Pe�pplicant Date
CONSTRUCTION CO(TRACTORS BOARD
0244J 8191
WHIZ E COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANI