12385 SW 121ST AVENUE r
1
7
1
J
I
12-3135 sw 121.3r
W
i
WL MuTwId a INU
INSPECTION NOTICE
city of Tigard Building Department
13125 SN Hall Blvd- Tigard' Oregon 97223
Inspection Line (Rec-O-Phone): 6?.9-4175 �Business Phone: 639-4171 ,
Inapection: .—"�1 h " `— -----g ~ ►� 1��
Footl.n4 P1'-,q. Underslnb Hoch. Rough,in Apnr/Sdwlk
Found. Plbg. Top Out Gas Line FINALa
/
Poet/Beam St.ruct. San. Sewer Framing -Bldg.
Pcat/Beam Mech. Rain Dri.ln
Insulation -plumb.
?lbg. Underfloor Water '..ins Gyp. Bd.
-Hoch.
IZ
PH
Date Requestadt Times
,4_4
Address: Permt 10 D2Yj2L_
Ruilder•s�'��� �Q� .__I 1 �� ___
TIIE FOLIAM7NO ODMiCTIONB ME REQUIREM l
C
Inspectors r Dates_ (J
4APPRDVND DIBAPPROM APPROVED SuBJIM TO ADM
call For Retnep.
11 Ez'.'C I-I AIN I CAI.
C17YOF TIGA RD
CiTYOFTWARD 1::,E R 11111'
C, is 111 E C':-J 0
COMMUNITY DF'ELOPMENT DEPARTMENT GRIGON
13125 SW HWI BW. P.O.F.riA 23397,119mid,OreWt 97223(603)8394175 71
.: . -'U
0 11..' IkE" H.D 1 1/1 3/':a(
'z31 1'1::. ADDRESS. 12,385 SW 121ST PARCEL 2 S 1.0.3 B 1A-0 W 0
S U P 1)1 VT 13 10 N., Z 0 N I Iq G R 4. 5
BLOCK. .. . . . . . . . ., L01.. . .. . . . . . . . . . . .
..........
CLASS OF WORK. . AI.A' FLOOR f-URN. . . . EVAP COOLERS.-
'TYPE OF U1qYr HCO'TERS. . V E N 1' 1*.-*A Iq S., . . :
0C:CI I PA N C;Y G R P. R3 VENTS W/O API-"L: V E N1 S Y S)7*F-,6:
' C>'1'C)I 7:Efi. . .. . . . . . i-.,i o i i F-,r\s/c,o m r,r�i�soRs HOODC'.
FAUJ. W--3 HP. DOMES. INC1N.-
4305/
3-15 HP., COMITII.- TIqCTIq-
MAX INF:,U'T*.-. B'T'u 15-30 HP. REPAIR UNI'T'S:
FT R F. D A III P U R G"? 30-50 1.1 F,. . . 410()D G1,9 V E S.
(3AS PRESSURE. . . 50+ HP. . . CLO DRYERS...
NO. JFUhII TS __.____...__..._........ Al.'R 1-IANDI-1NI57 UNITS OJJAER UNITS.
FURN < 100K 14'T'(J-. <= 10000 c'-fni. (JAS o u'r I.u r F). i.
FURN 1!r1.00K bTU. 1 1.004'0 e f III
FEES
1'I EKE HIM-,HREY t Y PC, 'An)c)'Alit by date C 0 J:)
1.21385 SW 121ST* FIVE. P 0 Y 111 4 20. 48 .)'LH 11/13/90
P R 11'r It 1.9. 50
11GARD OR 97223 ::PCT $ 0. 98
Flhc)i-i(.--. 0. 684-9737
BELL.. -e-ATINC-) LNC
1551,`.-M SE
CLACK110S) OR 9701.5 ....................
Phorie 0.- $ 20. 48 TOTAL
Ren #. ., - 447
RE OUMED INSr-`EC*T'1C)h16
This permit is issued subject to the regulations contaiifed in the F i iia.1 T vi s p e e t i c)ii ............
Tiurd Municipal Code, Sxzte of Ore. Specialty Codes and all other
applicable laws. ial work will be done in dIrC07dance with
approved plans. This permit will expire if work is not started
within 180 dart, of issuance. or if work is suspended for more
than 180 days.
................
171erniittee
lsst.led By-
............ ........................... . .....
Ca.11 fo-r J.i1s;pec,,tiori 639-41.75
RECEIPT OF PAYMEINT RECEIPT NO, :9(')---2067,tl7
I
CHECF. AMOUNT 20. 48
NAME PEI.A. 14EATING (-]ASH AMOUNT (.),00
ADDRESS t 355(.1 %7 ["TAllrj AVE PAYW:NT DATE 1/13/90
SUBDIVISION
C,,- A(J.'AMAS, OR 97015- 121-95 SW 121ST
PURPOSE OF PAYMENT AMOUNT PAID F'URPOSE OF r,AYMENT )MOUNT PAID
MECHANICAL PF MEC90-026'02) 19. S() 0011-1) Pt"--'P Q. gEl
TDIAL AM0.1W F-All-)
WtR Iii t■I► tar MEN a>N �
CITY OF TIGARD MECHANICAL PERMIT Receipt # --_
Permit # -------- -._--
I ascription
Table 3A Mechanical Code CITY PRICE AMT
City of,igard
13125 S.W. Hall Blvd. �� 1) PerrnitFee _ -- 0 0 10.00
P.O. Box 23397 5 �� /_ 7Q� —
lp 2) Supplemental Permit 3.00
Tigard, OR 97223 —
639-4175Furnace to 100,000 BTU 6.00
1) incl.ducts&vents
2) Furnace 100,000 BTU + 7.50
incl.ducts&vents
FloI� Name of Development 3) incl.vent Furnace 6.00
incl. _
Addr4) Suspended heater,wall heater 6.00
Address f!538Sg �,G� 5-�- or floor mounted heater
Tax Lot Map No. ,�) Vent not incl,in 3.00
Lot Block Subdivision __appliance permit
Namp lot name of business) — 6) Repair of heating,refrig., 6.00
cooling,absorption unit
Mailing P.ddress /J Phone 7, Boiler or comp to 3 HP 6.00
�Pty absorp.unit to 100,000 BTU
/a 1S1S" �U 1 -f73 7
City/State Zip 8 Boiler or comp to 3 HP-15 HP 11,00
Matl) 117
_ aosnrp.unit to 500,000 BTU
Name 9) Boiler or comp 15-30 HP 15.00
eLL 1
4 M C<, /AJC. .absorp.unit 1/i-1 million
Melling Address Phone 10) Boller or comp to 30-50 HP 22.50
ra-f_ r4 OFTY OFT
absorp.unit 1-1.75 million
Contractor city/Stale Zip 11 Boiler or comp to 50 HP 31.50
-
dm* v — ) absorp.unit 1,750,000 BTU
61ale Registration No. City Bus.Tax No 12) Air handling unit to 4.50
10,000 CFM
I hereby acknowledge that I have read this application that the Information given Is 13) Air handling unit 7.5010,000 CFM +
correct,that I am the owner or authorized agent of the owner,that plans submitted are in
compliance with State laws,that I am regislereti with the Stale Builders'Board,that the 14) Non portable 4.50
number niven Is correct pt exempt from Stele registration please give reason below) evaporate cooler
15) Vent fan ;onnected 3.00
to a single duct
-- -— - -- Ventilation system not
16) 4.50
included In appliance permit
17) Hood served by 4.50
I mechanical exhaust
91gnature towner or agent) Date t e) Domestic type 7.50
Describe work L7 additi m W alteration CJ repair CI Incinerator
to be done residential 6?' non-residential O 1 g) Commercial or industrial 30.00
-Existing use of type Incinerator
building or properly — 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers,etc.
building or property — -- 21) Gas piping one to four outlets 2.00
Type of fuel- oil l-' natural gas ❑ LPG ❑ electric CJ
22) More than 4-per outlet
bQT= SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 $o-10 AI�SURCHAROE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL
Special Conditions
�_ _ Date issued ----._--------.__--.-by -