12680 SW 111TH DRIVE 12680 SQA 111TH DRIVE
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iN5PECTION TIME' PERMIT- NO. :
DATE. DATE ISSUED :_.��-1_ I
OWNERS NAME :----- -.-
A
AME :_._._.-
CONTRACTOR : ---- - - - - -
TEST : Air C], Water L , Visual 0 , Laboratory 0
RESULT: Approded Q Disapproved O Pending 0
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INSPECTOR DATE I
NOTE : Attach supplemental test data here i] I
1
M 11111111JUN W
City of Tigard Mechanical Permit Permit_--
New Installation D Replace I1 Relocation F) Addition ❑ Alteration )_1 3
TOTAL----------
CONTRACTOR OWNER
ADDRESS WORK ADDRESS
PHONE_ _ APPLICANTS
Heat Input Rating (BTU Per Hour)_ Vent Size _ _ Flue Size
FUEL OIL CJ GAS El ELECT ❑ OTHER
ITEM NVFEE ITEM NO. FEE
For Issuance of Permit3.00 Air Condition Compressor 15 to 30 HP —� 10.00
New- Under 100,000 BTU _ _ 4.00_ Air Handling 10,000 CFM 3.00
New- 100,000 BTU&over _ 5.00 Air �.andling Over 10,000 CFM —5.60—
Floor
.00Floor Furnace_ _ 4.00 Evaporative Cooler _ '3.00
Wall - Floor-Suspended _ 4.00 Range Vent Fan
'nstall Vents Only 2.00 Vent SysterT r -3.00
tepair- Heat& Cooling _ 4.00 Hood Commercial _ _ _ 3.00
%ir Condition Conmpressu, Under 3 HP 4.00 Commercial Duct System
it Condition Compressor 3 to 15 HP 7.50
SPECTOR'S COMMENTS._
'Y BUSINESS LICENSE REQUIRED FOR ALL CONTRACTORS OR SUB-CONTRACTORS _
'ROVED BY DATE ISSUED BY DATE
,EIPT NO.
Signature of Applicant
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CITY OF TIGARD BLDG, DEPT,
12420 S.W. MAIN STREET
TIGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR.
Pursuant to Section(s) of the Uniform Building Code, the
following item(s) require correcting:
_jok R Lo A .w R.j�L�/]LL: _..eCGi. 1 � tZ c.�o Tdr
c�.Q,.o.
L F R fl o.�_ �F/�' .t'.o►h.�� .4___�,.-,r., tic.
Ta �� [.�:ate—mss c� s A.E
- t-.�.,2 .F-.:�-^"
0ate:_�- �y �_ �%_ Permit
Inspector`
-
CALL FOR REINSPECTION
■
CITY OF TIGARD BLDG. DEPT.
12420 S.W. MAIN STREET
TiGARD, OREGON 97223
PHONE 639.4171
CONTRACTOR:
Pursuant to Section(s) of the Unifor.-i Building Code, the
following item(s) require correcting:
Date Permit No.
Inspector 0
CALL FOR REINSPECTION
of Tf1 oa 9 M ech ,7ical Pamir 1 Permit c 0
Installation
fJaY� Fez C`ww
Replace [] Relocation ❑ Addition ❑ Alteration ❑ - 4 % State_
HEATING TOTAL._0 3y
'ONTRACTOR �" .�e! e ai _ OWNER`
s'i .'off L�•t(3'tT'!�1�.. 1.:4t.��4"Q U� ��
ADDRESS •n. + � ��. �. an �r L
WORK ADDRESS
PFIONE APPLICANTS
lett input Rating (BTU Per Hnur)_ \-1 a'-ir
Vent Size
-T-----_---- �`�' Flue Siza
UEL OIL ❑ GAS ELECT ❑ OTHER
ITEM NO. FEE ITEM
NO. . FEE
'or Issuance of Permit SF.E AP,0 V_E Air Condition Compressor 15 to 30 HP
4e'M up to & Inc.100.000 BTU _ 4.00 Air Handling 10,000 CFh1 _ 10.00
=��L
100,001 BTU & over 5.U0 f\ir Handling Over 10,000 CFM 3.00
'oqr Furnace _4.00 Evaporative Cooler 6.00
all -Floor •Suspended _ 3_Vent Fan 3.00
_ 4.00 R�r•
nstall Vents Only _ 2.00 Vr;nt System Z.0`
'Pjir • Heat& Cooling —� 4.00 Nood Commercial 3.00
or Condition Compressor Under 3 HP 4.00 Commercial Duct System 3.00
._r Condition Compressor 3 to 15 HP 7.50 — i0.Oc
�SPECTOR'S COMMENTS
rY BUSINESS LIC'NSE REQUIRED FOR ALL CONTRACTORS OR SUBCONTRACTORS
'?��OVED BY DATE i� ISSUED BY
..CEIP i NO. - ^GATE
a •vim C/
Sicnature of Annliran
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PLUMBING 10:RM1T tvv.
i N ho;der of a Valid alumoing contractors license is hereat'
a.' : ;riled to cause plumbing ork as herein noted to be insta.;ed in accordance with the plumbin, code of
Tigard. Such instaliations require inspection by the City Inspector who shat be notified not less than fou,-
;4i hours prior to the time the installations are ready for inspection. City of ,igard Business License required
for aii contractors and sul -contractors.
Gwr2r�Sl�ab � r ►— Addrestba�o b'U /1� p� I r �a�`��ate.
NUMBER OF TO"r1%4 i PERMIT V0.'$
TYPE OF PcR`,;IT I ITFA'.S ':-'c 0?; 2ACH A)aOU`.T I (Office Use ^nlyi
5 ',Ie �nm;ly-1 bJth—nnrh _I 25.00 ��>
Dup:nx—Each 1 bath we t 25.00
AC,I.Con. bathrooms—each �_ 10.00
Ycbl,a Homo Space—each �-- 16.00
;VDIV;DUAL FIXTURE" FEES I
1 to 30 Fixtures in 1 bui'ding—each I 3.10
61 to 'CO Fixtures in 1 building—unr'h 7..50
101 to 2,l Fixtures in 1 building-c,ch_ 2.00
201 or rr,ore Fixtures in 1 buildi a—ecch 1.60
`t ;SCELL.ANE0US i
O-,i;d;r g Swive!r--1st 50 i;
$ewer—anch cdditional 100 ft. j 10.0J _ w
Wa' 'Serving to building � 5.00
'rlv`;a Water Systems—acct. 100 sit.
for Pitimbini 1n;a2cyon Phone 6394;31
G(' Plunthina Contractor By
r=—� '�ll:L. RcraiP'. N0. Issued By
"R"71'�17i�'�'iC►'i��f'iV'AiL #wPZN7
�J7f7F�.>�r'rR'arw^....w...•_._�i.-..
BUILDING PERMIT APPLICATION 11T TIGARD DATE_ _�' 19OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT 'LrR THE WORK HEREIN INDICATED BU!LDERPHONE�
OR AS SHOWN AND i-PPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHON
LOT NO. ^�
OWNER- `)ttM 60ttWC _ JOB ADDRESS 146810 SW 111th Plac'HOME ADDRESS —
ARCHITECT
BUILDER 1011211/ ADDRESS'1 263b 5W Boof band PDetd ENGINEER
—• DESIGNER
STRUCTURE ❑ ^NEW LJRtMODEL� ❑ADDITION ❑REPAIR ❑RENEWAL [:]FIRE DAMAGE ❑pEMOL1TlON
❑ RESIDENCE ❑COMM ❑LDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAH PORT ❑GARAGE ❑STORAGE❑SLAB ❑F ENCS
❑BOND _ ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
— 3 _ _
QCICUPANCY .LAND USE ZONE--.—BLDG.TYPE__".. _ FIRE ZONE__ PLAN CHECK BY HEAT
,,nndtrurt vii gig f&oily dWollij,16 w/attac:hlsed garag* 4 6*druamo 2 Bathe.
SEE CDRRICTIUN SHEET ATTACHED.
vormi t y 203�A .. 004--.DO
40 1 1919 A S5ti��UO.
OCC J�QgR �. t,QQ��Q� { L_� �YQ STORIES_ AR_Eg_ No.BEnROOMS VALUE"
BUILDING DEPARTMENT 20 ;}R ----
____ SET BACKS FRONT REAR LEFT SIOE RIGHT SIDE
Permit "r20:r.Y]C! _ = ---- —_
102, c� THIS PERMIT IS ISSUED SU13JFCT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY ?.GREED THAT THE
WORK WILL HE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Suh_total 317• A ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT i)OF.S NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total w . 7C :JL.,L - 400.Xlu
ev F1
FIN 01 $100000
APPI ICINT c7R AGENT — ---- -
Approved Receipt No O 3 j
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
p
/•Zb//_r79 Contractor
�a'� Ls.•- FSS sy_ Q/( ------- -- - Permit No. /0 7f
Plough-in
r o e Fixture
/!•]G• 11 t //�Q/a tri O/Y _ _— A_ -- Final — -
LL'g •7y Ilu�� -1 2 --- - HEATING —
7L�- Contractor
(dam,,- • a Permit No. 67-)-
1.)it
7'"!.)it Gas or Oil
/ l�/¢Q �cN. �l. C— �(5,/►PP^� Rough-in
1-...22—$O cIP 5 A L app"V a s Final
SEWER
---- — -- —_—_ Final `/ 7 L— 9 3t'Ic --—.—
DRIVE—WAY
Final
-------- ---------- StoMt Dunnage
(Rain Drain)Final
Sidewalk
Curb&Street Final
_ Approach
BLD6. DEPT.FINAL Tt.MPORARY CERTIFICATE OCCUPANCY Final
—
CERTIFICATE OCCUPANCY
2112
/ �i� P Landscaping —
Zoning Final
Y r�GARD DATE
r
IN
BUILDING PERMIT APPLICATION OF
THE UNDERSIGNED HEREBY APPLIES FOR APESMIT FOR THE WORK HEREIN INUICATkD 1PUILDCa F`. �39" 40
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING, P!_ANS AND IJF'FCIFICA iIONS CWNEF?P�' Q�b
/� �j (�' LOT Nr �V f 101�19
JIB ADDRESS ��$Q�^�_ �'�� .11.x.
sw
1
SUP- CR �GI,M�,. ADDRx.2(0
ESS ---._ -.__ ._ •
STRUCTURE NEW ❑FwonOEL ❑ DDITION ❑REPAIR ❑RENE►NAL Ll 1H,: E
�RESILIENCE ❑COMM ❑EDUCATIONAL ❑GOV'T URELIGIOUS,UPATIO�[_J—,,AR PORT- 0GARAGE I]STOR? GE CS'—4,i ( "FF%
.:._ —_.___��— - -_.- Wiz•--- � ..__,
OC CUPANC� J I A'N'n 1.17F 10 Rt0GfTYPE 3-tV FIRE lOr.- "I AN,
'HF('K Fly
crLt�9' dye
SEWER_ PERMI-T-- /e G$8
H
Ei wV_VQRIE-5_ AR-IE4 /��9 174 .40200
BUILDING DEPARMEN
TT
---- I BACKS FRONT REAR 38 -- L.EFI SIDE 9 /3
P-en•nt Op -
PCRMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINFO IN TI,F
PIAmCheck 0 Z, ILATIONS AND ALL APPLI:ABLE CODES AND ORDINANCES, AND IT IS h Lr-ESY aGRtEG TTin't
—� +Th WILL BE DONE IN ACLURUANCE WITH THE PLANS ANDSPECIFICAI IONS :.ND IN I'C4'pl.'4N F
Su7•tolal - f'(? .+LL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PEFINII UCIES NOT V,'
-- �� -- 'TTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTRACTORS TO HAVE 0URPEN7 CITY qt1!14
State Tax LO I .ENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMPING AND HEATING
Total — �• 7 DC
r#
APPT•ICANT QP AGENT
LAt+urwPd .e�pt Nu
SDC - $ //00
PDC - $ L # / 06
SEWER CONNECTION $ &A,>
SEWER INSPECTION $ 2�
SEWER SURCHARGE I
Comments: �CO�� .9-/6-
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