15570 SW 109TH AVENUE-1 15570 SW 1U9TN AVENUE _
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Ins:af:a!;on -C' RS]'aw Q R*IWA ;M 0 AdditiAflikration
C. i RtiCTOR _ �>�R-h C_. ��rL�.�/1C.'L �• L'. 01�I�ER� - i
AD;1RcSS_ ��• J �ff�c e-Aap� WORK ADDRESS U)
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PHONE APPLICANT
Heat Input Rating (BTU Per Hour) or,, — Vent Size _ �ir Five Size_
FUEL OIL D GAS 'lk ELECT 0 OTHER__ --
ITEM NO. FEE ITEM NO. FE
For Issuance of "ermi, I �_—T-�J.00 Air Condition Cor•„pressor 15 to 30 HP �0_r
New- Under ;00.003 8TU �__ I 5.00 Air Handling 10,000 CFM 3.(
New• 1Q0,000 BTU &over ��� �T-- 5.00 ! Air Handlrtrg Over 10,000 CFM �1 5
Floor Furnace _ __ 4.00 Evaporative Cooler _ 3.(
Wall-Floo: Suspended 4.00 Range Vent Fan _ � 2.t
Install Vents Only ��Z•00 Vent_System 3!,
Repair- Heat & Cooling _ _ 4.00 _ Huod Commercial 3 i
_Air Condition Compressor Under 3 HP _ 4.00- Commercial Duct System yI 'IO.t
.Air Condition Compressor 3 to 15 HP + 7.50 . ter
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INSPECTOR'S CC)rJwtENTS�__� __• _____ __
CITY BUSINESS LICENSE REC)UI'(L7 FOR ALL CONTRACTORS OR SUB-CONTRACTORS
APPROVED BYDATE ISSUED BY— DAT
1 _----------�_____ -----_-- --- J
RECEIPT NO.
774 Signature of Appti nt
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BUILDING PERMIT APPLICATION G1TYoy TIGARD DATF 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
C'R AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
LOT NO, •i i%JMMU I " .+.
OWNER ,tJ IC t- r JOB ADDRESS i :T,a Z[l9tPl HON1r.ADDRESS
"I ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNCR
STRUCTURE [:]NEWElRt MODEL- CADDITION _❑REPAIR []RENEWAL— ❑FIRE DAMAGE ^^ ❑DEMO'_ITION
❑ RRESIDENCE: ❑COMM ❑EDUCATIONAL ❑GOV'T ❑FIE! IGIOUS❑PATIO []CAR PORT ❑GARAGE ❑STORAGE;JSLA13 [:]FENCE
❑BOND 0MOVING ❑CONDITiONAL USF ❑'DESIGN REVIEW ❑COUNCIL.A,IPROVEO ❑SIGNS
OCCUPANCY--SLAND IJIE ZONE—_— BLDG,TYPE. FIRE ZONE-3 PLAN CHECK BY ULH HEAT
IFietrUct 9irtlgle fam_ly dwelling Irl ettsco eq. Ualra ue. 3 ufturuoma,
_.. r Fil93tt11� uq' a1-:k 13 ;W 5Ur�Merfikld Laiia, -- ---
U7L; NO.BEDBQOMS ___ A_LD.�_._'
__..ELQOFI LOQ �a 0 f�.E.LGHI.- j �_ N 4..�SID R I E S t _ AREA«: .
BUILDING DEPARTMENT SET B• CKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
-- - -- - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check 1(P�JU REGULATIONS AND ALL ,APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE. IN ACCORDANCE WITH THE PLANS AND SPFCIFICATIONS AND IN COMPLIANCE WITH
Sub-total *(�� AL'. APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
— --- --- R�IRICTIVF COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SFWER, PLUMBING AND HEATING
'4U1.04 Ijk;
Total
! M, 2 $100.00
By
__ _ __ — f APPLICANT OFi AGF N I - -
Approved Receipt No
DATE INSF. TYPE INSPECTION REMARKS -- — PLUMBING DATE
Contractor
Permit No. i(P
14Ptj6/ at ----- Rough-in
-z(,-7 - r � - ---- -- Fixture --
11-iS'7 Final —
—T� — HEATING
Contractor p 4
:'jrmit No. '� 5 6 ti 3
Gas or Oil
-- u— Rouih4n — —
- -- - rinel
SEWER
DRIVE. VAY
—
Final
Storm Drainr,m
(Rain Drain)Firoel
Sidewalk
Curb&Street Final
Approach
19L6G. DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
"""ping
Toning Final
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BUILDING PERMIT APPLICAT►UN `; Y TIGARQ DATE ' 1 � !_� N2 2,26
,F �
J 9
14F UNDF RSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICA"i ED BUILDER PHON -
—_.
�lR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPFCIF(CATIONS. OWNER PHON
�✓� 14CLOT NO�
1 OL013 ADDRESS I_S� 7C) ���• ( el 1-10 _ ADDRESS k �
/+ vL& T
ARCHITECT
ENGINEER
ADDRESS DESIGNER
'VRE O%EW ❑RFMODEL ❑ADDITION ❑HLPAIR RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑COMM ❑EDUCATIONAL ❑GOV•T DRF L ml')US DPATIO (SCAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
-]H(IND ❑MOVING ❑CONDITION^I. USE ODLSIGN FIEVICW 0(OUNCIL APPROVED [:]SIGNS
r+NCY'0: .LAND USE ZONE IS=S_BLDG TYPE s]1�( -'RE ZONE PLAN CHECK BY.--- _NEA 1
FL4DR_-1.Q�? nR_LA f. N_Q_B_F _yBLS1�_GO
—_ BUILDING DEPARTMENT SET BACKS FRONT REAR L E F T SiDF RIGHT SIDE
- "� --' THIS PERMIT IS ISSUED SUBJECT TO THE R;GULATIONS ONi.'%INED IN THE BUILDING CODE, INNING
'Ian Check �� er.) REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 17 IS HEREBY AGREED THuT THE
- -- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS,IND IN COMPLIANCE WITH
Llr) Intal ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVF COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
`date Tax TCS LICENSE SEPARATE PE RMI'FS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Tc)tal
---- -------- ------ - APO( ICANI OP AGENT
t,w rived Re- -ipt NO.
ND(ipE 55------. ..W�----- `----6HON�- - ----- —
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CITY OF TI ARD _
ing Department • 12420 S.W. Main —Tigard, Oregon 97223 • Phone 639-417
ILDING
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Perm
it No,
�i Date Is ouec; _ - --- ---- - - )ate E xp,res
issued 10 Buiidwg Lvcatior+
Owner _----- _— ��---
------.__ Address of
Builder _..___._._.._.._--------------_._._._.__--_____ Address of
Permit Issued i✓v .--.-----------....__.___ ._._.__..--_.__—.
Notify Building Department 24 Hou,-s Prior to the Following Inspectim
C1 EXCAVATION OR FILL .int PLUMBINcaY
X-,FOOTING � HCATING
C_7 REINFORCING STEEL A WALLBOPRf�
rSFFsAMlNe^, fFINAL
This Card Mast Be Conspicuously 'posted, Facing the Street Until Compietimi
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