11925 SW 118TH AVENUE 11925 SW 118TH AVENUE
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CITY -OE TIGARD MECHANICAL 'PERMIT Receipt#Permit#
Description
City of Tigard
Table 3A Mechanical Code OTY PRICE AMT
--
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 11 Furnace to 100,000 BTU 6.00 t l
incl,ducts&vents
Furnace 100,000 BTU +
2) incl.ducts&vents 7.50
I— Name of Development Floor Furnace
3) incl.vent 6.00
Job Addreas11925 SW 11$TIISuspended heater,wall heater
Address TIGARD_. ORECOTT 97223 4) or floor mounted heater 6.00
Tex Lot Map No. Vent not incl.in
Lot Block Subdivision 5) appliance permit 3.00
Name(or name of business) 6) Repair
fabsorptionheats refir
nii9 6.00
MARCIE & CLF,N WITTY --_
Meiling Address PhoneBoiler or romp to 3 HP
Owner T T r l2 r, SI.1 118T►T 111 03,9 7) abs')rp.unit to 100,000 BTU 6.00
cityiState ZipBoiler or compto 3 HP-15 HP
TIGARD� onrr,ON 9123 9 ) absorp.unit t500,000 BTU 11.00
NamsBoiler or comp 15-30 HP
AAA TTEATINC I& COOLTNI7� it _ 91 absorp.unit!%-1 million 15.00
Malling Address PhoneBoiler or comp to 30-50 HP
291r) N17 TTNInN AVT' :84 2171 10) absorp.unit 1-1.75 million 22.50
Contractor City/State Zip - Boiler or comp to 50 HP
PORTLAND, OREGON )"?1 ^ 11) absorp.unit 1,750,000 BTU 31.50
State Registration No. City Bus Tax No.- 12) Air handling unit to _
4.50
10,000 CFM
I he-doy acknowledge that I have read this application that the information given is 13) Air handling unit 7.50
correct,that am the owner or authorized agent of the owner,that plans submitted are in 10,000 CFM +
compliance with State laws,that I am registered with the State Builders'Board,that the Non portable
number give i Is correct.til exempt from State registration please give reason below). 14) evaporate cooler 4.50
Vent fan connected
��-� ------— - - --- 15) to a single dura 3.00
---� - -��-- - - Ventilation system not
16) included in appliance permit 4.50
oc� . 17) Hood served by 4.50
(� !��- 12 1 1,Y.18 6 mechanical exhaust
Sign (owner or agent) JUDate Domestic type
Describe work Ll addition n alteration Ll repair -) 19) incinerator 7.500
to be done residential [0 non-residential 11 Commercial or Industrial
Existing upe of 1 r�) type Incinerator 30.00
buikgng or properly RF 3IUI.'+r'I 20) Other i.e.,woodstove water 4.50
Proposed use of heater,solar,clothes.fryers,etc.
building or property SAME
21) Gas piping one to tour outlets 2.00
Type offuel- oil L7 natural gas NJ LPG I 1 electric ❑ -
22) More than 4-per outlet
�!l4T�E SUB-TOTAL
THIS PERMIT BECOMES NULL. AND VOID IF WORK OR CON- - - -
STRUCTtON AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 100 DAYS AT ANY TIME AFTER -- - - -- -
WORK IS COMMENCED TOTAL 1 '• 7
Special Conditions
-- Date issued ___. -. _a. by
■
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Time _ A.M.___ P.M.
t ---
Address r\ Permit #__
Owner — -- % L Lot
Builder __-
The, following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector -- -- ❑ Disapproved
Data 2 '/c�'= t-.�a ,_
CALL FOR REINSPECTION
0 YES ❑ NO
PERMIT TO CONNECT
Tigard Sanitary District �-' c
PERIvil" N? 935 DATE
PERNIIT If, GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIC-ART) SANITARY DISTRICT W
AT -.
THIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL:CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $ i"
..TI(:,1R1) SANITARY DISTRICT
................................
By
WHIM/.
CONNECTION INSPECTED AND APPROVEI?
Date -�_ BupeHntendent_ _ _
i
Address Permit No.
Name of Occi ,ant Permit charge
Connection
Paid by ---
Date connected
Type of Building -----_- _-- Inspection fee _
I
Service Hate ---_- - -__.. Paid by __ -_Date_-___---._-_�_ j
Contractor Assessment _Paid
Size of connection