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11680 SW 121ST AVENUE ADDRESS: I � L1 r F- I:Vecords\nilcroflm\targefs\fwildlnq.doc w CITY OF T I O A R® ENGINEERING PERMIT — PERMIT#: ENG1999-00 20 DEVELOPMEN1 SERVICES PRIM. PERMIT#: ENG1999-OCJ20 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/2/99 SITE ADDRESS: 11680 SV', 121ST AVE PARCEL: 1S134CD-04300 SUBDIVISION: BURLWOOr) ZONING: R-4.5 BLOCK- LOT: 003 JURISDICTION: TIG PERMIT TYPE: SOP PUBLIC IMPR'. QUANTITY LIN FT VALUE AGREEMENT DATE: GRAIEROS: ASSURANCE EXPIRATION _ STREET: " PERFORMANCE: SAN SEW: " STM SEW: MAINTENANCE.: " PATHWAYS: " ALL OTHFR: """ $50.00 iTOTAL: $50.00 Remarks: STREET OPENING, TO SAMPLE SOIL AND GROUNDWATER USING GEOPROBE EQUIPMENT. Permittee 1 Owner: Engineer: HILL, .;UDY L F 11680 SVI 121 ST TIGARD, OR 97223 Phone: Phone: FEES Type Ry Date Amount Receipt _ OPEN BON 6/2/99 $2.00 99-315859 MISD BON 6/2/99 $50.00 99-315859 Total $52.00 �fI ( ,( REQUIRED INSPECTIONS _ " ��'�`� L' — STORM SEWER STREET Permittee/Agent Signature: SVS. M.H. & C.B.: CRB LINE & GRADE PIP • LN & GRD SUBGRADE BCKFLL & CMPCT BASE ROCK Issued By: AIR & TV TEST LEVEL COURSE SAN. SEWER WEARING COURSE City of Tigard, Oregon — -- TRAFF & PED cm,f 13125 S.W. Hall Blvd M.H. & C.O. MONUMENTATION P.O. Box 23397 PIPE LN & GRD STREETI IGHTING Tigard, Oregon 97223 BCKFLI_ & CMPCT WALK/APRON/RAMP AIR & TV TEST _ GRADING FOR INSPECTION, CONTACT THE CITY OF REPR'S/ADJ'S TARD AT 21(503) 639-4171 -� ---- " CONTOURS DRAINAGE PATHWAYS EROSION CNTL. SPECIAL_ CONDITIONS: (SEE ATTACHED) (Y�ICITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 411 — 8UP L f. Date Requested �_ AM X� PM BU BLD Locaticr, _ �P �S L' �� U Suite Contact PersonPh 7L - Contractor _ Cl Ph SWR BUILDING Tenant/Owner -- Retaining Wall ELR Footing Access: (�- }-f Foundation 11 t� T r� �' , \ {�)2-E -s F�S Ftg brain �J] ► c�.r fl NCI --SUP-t IrE04 0eeD t��.r SGN Crawl Drain Inspection Notes: — Slab `y�/y`,�[J= , SIT _ Past&Beam /-T- Int Ext Sheath/Shear n Int Sheath/Shear V — `--" Framing _ Insulation -- nrywall Nailing Firewall Fire Sprinkler - Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL UMBING Post& Beam ---! -- -- Under Slab Top Out - -------- - _ Water Service Sanitary Sewer — Rain Drains C IAS 1' FAIL —� -- ^--- ---- - — 11 METANICAL Post& Bearn - -- ---- ._,— ---- Fough In Gas Line ---- ---- ---- �.— — Smoke Dampers (11MV PART FAIL Service Rough In - CL UG/Slab Low Voltage Fire Alarm 7A1-"gir (IYA PART FAIL St Backfill/Grading ---_--- ---- -�- --- - --- - w Sanitary Sewo, -' Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Lir'- [ ) Please call for reinspection RE: — _ [ ]U,-ible to inspect- no access ADA Approach/Sidewalk Other Date 15 Inspector _ -- — Ext Final L')ASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD ELECTRICAL_ PERMIT DEVELOPMENT SERVICES PERMIT #: ELCDB-0440 A6 13125$W Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 07/31/98 PARCEL: 1 ti 1?.4CD-04300 SITE ADDRESS. . . : 11680 SW 121ST AVF' SUBDIVISION. . . . :BURLWOOD ZON I NG:R-4. 5 BLOCK:. . . . . . . . . . . LOT. .. . . . . . . . . . . . :003 JURISDICTION: TIG Project Description: Installation of 1 blanch circuit. $ale 7Af-01 ------------------------------- ---RESIDENTIAL UNIT----- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS----- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : Q' PUMP/IRRIGATION. . . . : 0 EACH ADD' L 5O0SF. . . : 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL : .c, MANE. HN/ SVC/FDR. . M V., 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 i ----SERVICE/FEEDE:R---- ----BRANCH TRCUITS----- ---ADD' L INSPECTIONS--- lb - 200 amp. . . . . . : 0 W/SERVICE Circ FEEDER: 0 PER INSPECTION- - : 0 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PIER HOUR. . . . . . . . . . . : 0 401 - 800 amp. . . . . . : 0 EA ADD' l_ BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 -- 1000 amp. . . . . : 0 ------------------F11-AN REVIEW tOOO+ amp/volt. . . . . : 0 ) -4 RES UNITS. . . . . . . . .. ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC'. : Owner: ---- --------- ---_.__._________________.____.___.___.____ FEES ---------------.--- Jl_)DY HILL type amount by date r 11680 SW 121ST PRMT $ 3b. 00 DEB 07/31/98 4 '-� T'IGARD OR SPCT $ 1. 75 DEB 07/31 /98 WN, ,c-D Phone #: 590"-4958 Contraca;or: -------------------------- ----- WEST SIDE ELECT'4I C CC) INC $ 36. 75 TOTAL 1.834 SE 8TH AVENUE ------- REGU I RED I NSPECT I ONS PORTLAND OR 97214 Rol-rgh-in Ele,,t' 1 Final Phone #: 0-131-1548 Elect' 1 Service Reg #. . . O00133 fhis Ferfit is issued Sf bjeLt to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 188 days of issuance, or if work is suspended for sore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 BP,1-8010 thr h OAR 952-881-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (583)216-1987. FIermit.t;ee 9i 9n ato)-e : t� — Issued 4 � � ------------------------------OWNER INS"fAl_LATION ONLY--_,__________________.____-_-- The installation is being made on property I own which is not intended for sale, lease, or rent. ~ OWNER' S SIGNATURE: DATE: _.-----------------------CONTRACTOR INSTALLATION ONLY------------- w -' 5 I GNATURE OF SUPR. ELEC' N: _ t � DATE: 7-.51 -9e I_I CENSE NO: f+++++++++++++++++++++++++++++++++•+++++++++++i.++++++++++++Ff+++++++++++++++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the next bl_rsiness day ++++++++++++++++4-+4-+++++-•4+++++++++++++++.4 +if ++++++++++++•+++++++++++++++i•++++++4-4 CITY OF TIGARD Electrical Permit Application Plan Check_ 13125 SW HALL BLVD. Rec'd By % . Date Recd TIGARD OR 97223 RECEIVED Date to P.E. Phone(503)639-4171, x304 Date to DST inspection 503 639-4175 Print or Type r 1, P ( ) Permit Its G Fax (503) 684-7'297 Incomplete or iNegiblc will nb��e accepted called 1. Jets Address: z I4. Complete Fee Schedule Below: Name of Development_ Number of Inspections per permit allowed Name (or name of business) J�f�� d� ��i`L� Service Included: Items Cost Sum Address /r/ > C sztl 4a. Residential-per unit City/State/Zip 0,,-5� Ea h additional 500 sq.It.or -" $11000 a portion thereof $25.00 1 Commercial ❑ Residential Limited Energy $25.00 _ Each Manul'd Horne or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor Installation only: (Attach copy of all current Ice��es) 4b.Services or Feeders Electrical C ntractor ,Sr JJC �le,c1;01 c- Installallon,alteration,or relocation Address 1,q3�_ 200 amps or less $60.00 2 201 amps to 400 amps ^___ $80.00 _ 2 City ar irc State Zip` _i _ 401 amps to 600 amps $120.00 2 Phone No. - /S- _ 601 amps to 1000 amps __ $180.00 2 Job No._ ?e , - // Over 1000 amps or volts $340.00 _ 2 Elec. Cont. Lice. No. C.• -/ S L Exp.Date Reconnact only $50.00 2 OR State CCB Reg. No_/3.3-06 Exp.Date 4c.Temporary Services or Feeders COT Business Tax or Metro No. _Exp.Date Installation,alteration,or relocation 200 amps or less $50.00 2 Signatore of Supr. Elec'n_ 201 amps to 400 amps $75.00 2 401 amps to 600 amps $100.17- 2 ( Over 600 amps to 1000 volts, License Nr �S� S Exp.Date ___ see"b"above. Phone N, T S / 4d.Branch Circuits Now,alleration or extension per panel 2h. For owner installations: a)The ler,for branct..circuits With pr rchose of service or Print Owner's Name feeder lee. Address i Each branch circuit $5.00 2 b)The tee for branch circuits City Stet@Zip Without purchase of •• // Phone No. _ _ service or feeder fee. First branch circuit $35.00 2 The installation is being made on property I own which is not Each additional branch circuli $5.00 2 intended for sate,(ease or rent. 4e.Miscellaneous (Service or leader not Included) Owner's Signature Each pump or Irrigation circle $40.00 2 Each sign or ouifino fighting $40.00 2 3. Plan Review section (if required):' Signal circull(s)or a amiled energy panel,alteration or extension $40.00 2 _ Please check appropriate item arid enter fee in section 5B. Minor Labels(10) $100.00 IX, 4 or more residential units in one structure 4f.Each additional inspection over ~/7 Service and(ceder 225 amps or more the allowable In any if the above System over 600 volts nominal Per Inspection $35.00 _ Classified area or;Iructure containing special occupancy Per hour - $55.00 _. J as described in N.E.C.Chapter 5 In Plant $55.00 L "Submit 2 sets of plans with application where any of the above apply. 5. Fees: W Not required for temporary construction services. 5a.Enter total of nbove fees $ - --' 5%Surcharge(.05 X total fees) $ --- ----- NOTICE Subtotal $ - ---- 5b.Enter 25%of line 59 for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if r uire (See.3) $ - --NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account Total be/ence Due CITY O F TIG A R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM98-0248 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUEDr 07/28/98 PARCEL: 1S134CD-04300 SITE ADDRESS. . . : 11680 SW 121ST AVE SUBDIVISION. . . . . BURLWOOD ZONING: R-4- 5 BLOCK.. . . . . . . . . . . LOT*. . . . . . . . . . . . . :003 JURISDICTION: TIG -------------------------------------------------------------------------------------- CLASS OF WORK. . :ALT rl-.zb%GE DISPOSALS. : 0 MOBILE HOME SPACEC. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PIREVNTRS, . : 0 OCCUPANCY GRP. . :R33 FLOOR DRAINS. . . . . . : 0 TRAP-IS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . .. 0 FIXTURES-----•-------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SE'jER LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remarks : Hill Owner: ----------------------------------------------------- FEES --- ---------- JUDY HILL type amoo-tTit by date recpt 11680 SW 121ST PIRMT $ 25. 00 JSD 07/28 98 WAIVED TIGARD OR 5PICT $ 1. 25 JSD 07/2 /98 WAIVED Phone #: 590-4958 Contract ot---.-------------------------------- COL-UM13IA HEATING 8. COOLING INC PO BOX 230397 8900 SW BURNHAM ST STE E-110 TIGARD OR 97281-0397 Pf-ione #: 624-2704 $ 26. 25 TOTAL Rey #. . : 000763 ------- REQUIREb INSPECTIONS This pproit is issued subject to the regulations conta'ned in the Misc. Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspecx; ion applicable laws. PH rnrk will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for sore than IN days. ATTENTION: Oregnn law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-000I-Wi0 through OAR 952-008I- 080. Yc, lay obtain copies of these rules or direct questions to MX by calling (503)246-1987. Si g,i Lre W Jssf-ted By- Permittee ++++++++i•+++++++++ .41+++++4-+44-++++4......4 .......... ++ .++++ ++++++++++++ Call 639-4175 by 7:00 p. m. for an inspection needed th next b-LiSiness day ..............................4.......4....................4 ..................... —w CITY OF TIGARD Plumbing Application Recd By` J 131,25 SW HALL BLVD. Commercial and Residential Cate Recd TIGARD, OR 97 223 Date to P E.Date to D (503) 639-1171 � Permit t 110 Print or Type Related SWR s Incomplete or illegible applications will not be accepted called Name of(JevelopmenuProlect FIXTURES (individual) QTY PRICE AMT Job OL1�V[I I Sink goo Address Street d ess // Suite Lavatory 1 9.00 rub or TubiShower Lomb. 9.U0 91dg t CityiState Zip Shower Only 9.00 7 I(, , USC V 7---,)-:;)c/ Water Closet 9.00 Nafne Lc_ ! / Dishwasher � 9.00 Owner Malikv Address Suite Garbage Disposal 9.00 Washing Machine 9.00 c4VIS11811111 Zip Phone Floor Drain 2' 9.00 ( _�� '� .4 ri _ 3 9.00 4' 9.00 Occupant Me"Addross Suite Water Heater 9.00 J Laundry Room Tray 9.00 CitylSlatd ZipI Phone Unnal 9.00 Other Fixtures(Specify) 9.00 1 CL 1 1 e _ 9.00 I Contractor - tali"-i Address 77 Suite 9.00 k 900 C.tylSta!e zip Phone 9.00 i Oreon Const.Cant.B.iard Lic.t Fxxp.Date 9.00 Aarels Copy of %--3-51 ()• .;?-q 900 Cnrrom PJ I � Sewer- 1 st 100' I30.00 Lli enee } -each additional 100' 25.003Sewer CO I dusmess i ax or Metro t Exp.Date T �a Water erviva- 1st 100' I :x0 00 Name Water Service-each additional 200' 25.00 Architect Storm 3 Rain Drain- I%1 100' 30.00 or Mailirg,address Si :e Storm&Rain Crain-each additional 1C0' `1 25 00 Mobile Home Space 25.00 EngineerC.twState Zip I Phone Commercial Back Flow Prevention Cevice or Anti- 25.00 Pollution Cevice DIKaiOe work New p Addition O .alteration O Reoair O Residential Backflow Prevention Device' 15 Co m)to done, 7esidennaLel' 'Jon-resioentiai o .any Trap or Waste Not Connected to a Fixture I I 900 kddtbor%M descnpi;on of work Catch Basin 0 / / insp.of Existing P!umbrrg 4000 L e /1 perrhr 1 1 U l U/1 _ r- asbnp use°f Special, Zequested Inspeclions I i 40.00 li- oerrhr ' � � ✓1 -A" or property` - Ram rain,single famny dwelling � 3000 r �oposed use of Grease Traps 9.0 E-- building or property QUANTITY TOTAL Are ya. appmg, moving or replacing any fixtures? Yes[] No❑ Isometric ar riser cisgnm,s reourra.f Cuanrty Tcisi s �9 LU (If yes sly back of forml_ 'SUBTOTAL -� ;herebv acknowledge that I ha.e read this application,that the information ;even s :orrect.teal I am the cwner or authorized agent of;he owner and 5% SURCHARGE -,:,-at clans s bmitted are n:9maliance with Cre en State Laws. Sign# Owne"Agen Data % PLAN REVIEW 25% OF SUBTOTAL I a - I ` -eaurad only A ttllur!]ty 'cisi ir r, TCTAL Perscn Name I Phone - _ Minimum permit fly is S25-51,16 surutarge.except Residential Backflow rL J yi ow 1 rirUtlI`(/)Z- Prevention Cevice.which is S 15 • 5%surcharge afJL)r"0 v Q(1 i dstMplmapp doc 9198 J D 4 '1/rile, �l.EA�ECCG�ViIR L JECT: Fixtures to be capped, moved or replaced Qty Sink Lavatory - + Tub or Tub/Shower Combination Shower Only j Water Closet 1 Dishwasher Garbage Disposal Washir,g Machine Floor Drain 2" 3„ Water Heater i Laundry _Room Tray__ Urinal ~— y Other Fixtures (Specify) — I COMMENTS REGARDING ABOVE: CC H+ h- L r� W CITY O TIGARD MECHANICAL. DEVELOPMENT SERVICES PERMIT PERMIT #. . . . . . . MEC98-0300 13125 SIN Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE" ISSUED. 07/28/98 PARCEL: IS134CD-04300 ( SITE ADDRESS. . . : 11680 SW 121ST AVE SUBDIVISION. . . . : BURLWOOD ZONING: R-4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :003 JURISDICTION: TIG CLASS OF WORK. . :ALT F-I-OOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . . 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYF'F_5---- ----- -- 0-3 HP. . . . ; 0 DOMES. I NC I N: 0 :GAS 3-15 HP. . . . 0 COMML. INCIN: 0 MAX INPUT: 0 BTU 15-30 HP. . . . 0 REPAIR UNITS: 0 FIRE DAMPERS?— : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . : 50•+ HP. . . . : 0 CLO DRYERS. . : 0 1\10. OF UNITS----------- AIR HANDL_T NG UNITS OTHER UNITS. : 0 FURN ( 100K BTU: 1 (= 10000 cfm : 0 GAS OUTLETS. : 1 FURN ) =100K BTU: 0 ) 10000 cfm : 0 Remarks : Hill Owner: ----------------------------------- FEES ----(WAIVED JUDY HILL - type amot_mt by date11680 SW 121ST PRMT $ 25. 00 JSD 07/8/TIGARD OR 5PCT $ 1. .2.5 ..TSD 07/28/ Phone #: 590•-4958 Contractor: ----------------------------- COL.UMBIA HEATING R COOLING INC PO BOX 230397 ----------------------------------_-- $ 2A. 25 TOTAL TIGARD OR 9723 Phone #: 624-2704 Reg #. . : 00078 ----- --- REDU I RkD INSPECTIONS --------- This permit is issued subject to the regulations contained in the Mechanir:al Insp Tigard Municipal Codr, State of Ore. Specialty Codes and all other Heating Unt Insp applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started �. within 180 days of issuance, or if work is suspended far more than 180 days. ATTENTION: Oregon law rrquires you to follow rules adopted b•, tl,e Oregon Utility Notification Center. Those rules are set forth in OAR 95c q0l 11010 through OAR 952-00I-OW. You may obtain copies of there rules or direct que tions to OUNC by calling �_..... > (503)2bG-9187. — -- By: `` - Permittee SigO - ur Call 639-4175 by 7:00 p. m. for inspections needed the next bl_rsiness day ... ... .+++++++++i++++++++++++... .i.++•+++++++++++++ ++++++++++++++++++++++++++++++ Plan Fr.'d CITY OF TIGARD Mechanical Permit Application Recda y 13125 SW HALL BI 'D. Commercial and Residential Date L Q TIGARD, OR 9722'. Date to P.E._ De(503) 639-4171, x304 PPetrmit rDs1 Print or Type Called Incomplete or illegi_b_leapplications will not be accepted Name of DIoprnent/Prolect Description ev -37A -y I I I Table to Mechanical Code OTY PRICE AMT Job Street Address I A) Permit Fee -0- -0- 10.00 Address Bldg# Cit lstate Zip 1.) Furnace to 100,000 BTU 6.00 , including ducts&vents C��I Name(or name of business) 2.) Furnace 100,000 BTU+ 7.50 Owner including duds&vents Mailing Add ss 3.) Floor Furnace 600 / 15W / y r including vent CP/Stste Zip Phone 4.) Suspended heater,wall heeter 6.00 IT!c Q/2 or floor mounted heater _ Nam or name of business) 5.) Vent not included in apciiance permit 3.00 Occupant Mailing Address 6) Boder or comp,heat pump,air cond. 6.00 to 3 HP:Ptsorb unit to 100K BUT"' City/State Zip Phone 7.1 Boder or comp,heat pump,air cond 11.00 3-15 HP:absorb unit to 500K BTU" ContraCtOrmay 8) oder comp,heat pump,air cond. 15.00 H l i 15-30 HP,absorb unit.5-1 mil BTU" Prior to permit Mailing Address 9) Boder or comp,heat pump,air cond. 22.50 issuance,a copy .� ' 30-50 HP:absorb unit 1-1 75mit BTU" of all licenses C rstate zip Phone 10) Boiler or comp,heat pump,air cond 3750 BTU— are requited if 'DI as - >50 HP:absorb unit 1 75 mil BTU" --- expired in COT Orlg n Conal.Cont.Board-..to.# Exp.Date�7 11 ) Air handling unit to 10,000 CFM 4.50 database �) '' U1"7 _ Architect Name 13) Non-portable evaporate cooler 4.50 or Mailing Address 14) Vent fan connected to a single duct 300 Engineer CitylSlate Zip Phone 15) Ventilation system not included in 450 appliance permit Describe work New O Addition O Alteration O" Repair O 16) Hood served by mechanical exhaust 450 to be done Residential A- Non-residential O Additional Description of work: 17) Domestic incinerators' I 750 �C� al warh �er 18) Commercial or industrial type 30.00 W �)5},t ) Q Incinerator Existing Oe of 19) Repair units 450 building or property _ 20.) Wood stove 4 50 Proposed use of 2 i.,, Clothes dryer,etc. 4.50 building or property _ -- 22.) Other units 4.50 1 Type of fuel-oil O natural gas. LPG O electric O 23. Gas piping one to four outlets 2.00 I hereby acknoi-,ledge that I have read this application,that the 24) More than 4-per outlets(each) 50 I information given is correct,that I am the owner or authorized agent of r the owner,that plans submitted are in compliance with Oregon State CITY SUBTOTAL laws r, Slgnatur of Ownarl It Date *SUBTOTAL i �//, 5%SURCHARGE LIJ (� y / S erson a Phone PLAN REVIEW 25%OF SUBTOTAL TOTAL 10, I ` i:4nechpmt.doc (rev 9 'Minimum permit fee is S25+5%surcharge "Residential A/C requires site plan showing placement of unit. h? CITY OF TIGARD - COMMUNITY DEVELOPMENT DEPARTMENT h1EC.HAN I C;AL 13125 SW Hall Blvd.Tigard,O;aQon 97283.8199 (503)839-4171 PE RMI T PERMIT #. . . . . . . : MEC94•-0: 71 DATE: ISSUED: 12/29/94 PARCEL: 1S1134CO-04300 .31T"E r-OORESS. . . : 11680 SW 121ST AVE `+Ub1)I V!2 I ON. . . . : BU RLWOOD ZONING: R-4. 5 13LOCK. . . . . . . . . . . LCT. . . . . . . . . . . . : 3 -------------- CLASS OF WORK. . :ALT FLOOR FURN. . . . : EV017' COOLERS: TYPE OF USE. . . . :SF UNIT HEATE:RS. . : VENT F=ANS. . . : OCCUPANCY GRP. . :R3 VENTS W/O APPL: VENT SYSTE1*f1!3: `TORIES. . . . . . . . .. i BOILERS/COMPRESSORS HOODS. . . . . . . : FUEL "fYF'ES - _._.__. .__.___.._.._ 0-3 HP. . . . : DOMES. I NC I N: " /OIL/ / / 3--15 HP. . . . : COMML. (NCIN: lhAX INPUT: LlTU 1'.-j -30 I-II--'. . . . : REPAIR UNITS. F IRE DAMPERS?. . : 30--50 HP. , . . : WOODSTOVES, . : GAS PRESSURE. 50+ HPI. . . . CLC) ORYER5. . : AID. OP AIR HANDLING UNITS OTHER UNITS. . f-URN ( 100K BTU: 1. (== 10000 C--fm: GAS OUTLE:'TS. : i URN ) =100K BTU- > 1100127 cfm: Remarks : OIL FURNACE Uwner: ____.___________.__________________ _______.___._.___.________ FEES .aUDY HILL type amoI.int by date recpt 1680 SW 121ST F'RMT $ 25. 00 JF 12/29/94 - `JPC, $ I. r;5 .1F 12/29/94 - 116ARD CIR ''hone #t —'DntraCtOr: __---__..—_._.___--_____--------_— I J W I LF"GRT SHECTIrIE=TAt_ & HEATING 30 NW x:;31 ST AVE iILLbBORO OR 971L:!4 -'hone it: f 26. 25 TOTAL_ -- ---- — REWIRED INSPECTIONS --------- his permit is issued subject to the regulations contained in the Mechanical Insp l;gard Municipal Code, State of Ore. Specialty Codes and ail other Final Inspection duplicable laws. All work will be done in accordance with _ approved plans. Tris permit wiil expire if work is not started within 188 days of issuance, or if work is suspended for more .Man 180 days. r— ermittee vlgn�at�_�re: i u s s l..1 e d B y : Call for inspection — 639--4175 .NSPECTION NOTICE City of Tigard Building Dep■*+sw +t 13125 Sw Sall Blvd. Tigard, Oregon 97223 Inspection Line Rec-o-Phone)t 639-4175 Business Phone: 639-4171 Inspections - Footing Plbg. Und slab Rough-in App./8dw1k Found. Plbg. Top Out oao Line FI Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Koch. Rain Drain Insulation -Plumb. Plhg. Underfloor Nater Line Gyp. Bd. Date Requestedtp /� �J Time: _' } AM yPM Address:_�� I3U 1t�1. Permit #s1)1ac7C! -y3 l Builders (0 4 9��_� THE FOLLOWING CORRECTIONS ARE REQUIRM 1— CO Lt.) Inspectors bates 11LAPPAC)vxv DISAPPROVED APPROVED SUBJECT TO ABOVE VV��'�� Call For Reinep. 11(JAXV LQ l City of Tigard MEC'-IANICAL PERMIT Pianck/Rec. # 13125 SW Hall Blvd. 1a,�P L I CATI ON Permit # Tigard, OR 97223 OttC" ,"rq (503) 639-4171 Aft r 73AMOchanir-W -- J Table Code t]TY PRICE AMT Job s�_ Z� 7 t) e .0. 0. 10.00 Address '—' � cQ 2) Supplemental Permit 3.00 - Mace ba incl,ducts&vents 6.00 ..................... --Pumace100i0121 g 7,50 Owner O 54� =)'-` 21 in ducts&vents Floor FuMMEW 3) incl.vent 6.00 - „`. ----�”– suspe a7 eater 4) or floor mounted heater 6.00 a caurr--— -----74-RT-nb1 Fri.in 5) appliance permit 3.00 `---To epair aT'i ee1fAjg', 6) cooling,absorption unit 6.00 - er or eom'pT�pump,a+r Gond 7) to 3 HP;absorp unit to 100K STU 6.00 ----7%Qor or oomp;I'eat pump,a!r con . u, 9 r 8) 3-15 HP;absorp unit to 500K BTU 11.00 f � Contractor ior co'' mp,R is pump,air 0556.- 9) on .9) 15.30 HP;absorp unit.5.1 mil BTU 15.00 r or camp, eat pu p,air cc . t a 10) 30.50 HP;absoip unit 1.1.76 and BTU 2250 i `.ere y acKncwrafge twat ave F-50 is application,tnat me t5ollor o►cam a pump,-air cono, information given is correct, that l am the owner or authorized agent 11) :.60 HP;absurp unit 1.75 mil BTU 37.50 of the uwnet,that plans submitted are In compliance with Slaw r handling unit to laws,that)am registered with the Cansbuctlon Contractor's Board, 12) 10,000 CFM – 4,50 that the number given Is correct (If exempt from State registration, itin uni please give reawn below.) 13) 10,000 CTM+ 7.50 14) evepor2M cooler 4.50 _. — --- "'_'frena- n n acCec7�`•-^ 16) to a single dud 3.00 7115–tTe-don sy5 m not 16) Included in appliance permit 4,$0 – -- 1,106d SIX Y 4.5t1 �..' ,� 17) mechanical exhaust _ — 0 W2 wo new a ion a raison Ri pair ommeroi br n i Tm to be done residential 0 n -resiContlal O 1B) type incinerator 30.00 '-Ti-18-507-01-47y.- - womstuve.water building or property_ '__� 19) heater, solar, clothes dryers,etc. - 4.50 — Proposed utse of 20) Gas piping one to four outlets 2,00 C1 building or property ._ ix21) More than 4-per outler — i"' Type offuel-oilnatural gas Q LPG(� gle-tric t7 V) J all Minimum Fee$26.00 SUBTOTAL` s PERMITS BECOME VOID IF WORK OR CONSTRUCTION Iz S AUTHORIZED IS NOT COMMENCED WITHIN 190 DAYS,OF 5%3UHCNARptd w IF COf::TQ irr(ON OR WORK IS SUSPENDED OR -' ABANDONED t-; A A PERIOD OF 190 DAYS AT ANY TIME PLAN ALVIKW 26%OF SUBTOTAL AFTER WORK IS COMMENCED. TOTAL 2 Special Conditions Data issued _. �, by irMlW1M7' DEC' 23 ' 94 10: 50 503 664 71297 PAGE . 02