13615 SW 121ST AVENUE-1 13615 SW 121ST AVENUE _
1
6
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 23397 /
Tigard, Oregon 97223
/
Phone: 639-4175
Type of Inspection
l
Date Feyue V) J / Time AM:o�-UU P.M.
/sled -.--
Address / ,! � Permit 0a/3 3
Owner _ Lot #
Build3r
The following Building Code deficiencies are required to be corrected:
0 A �_—
Presented to
Inspector i �f"— u Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
MECHANICAL. P11 nM.I:I
4r,
art. I-_-'E'P113:T NO. : ME8621.33
C17YOFTIIFARD
CIT'YO;TIGARD
OPF60N /I
(',JMMIJNITY DEVELOPMENT DEPARTMENT DAIE 15SLIEU : 1.0/26/11
13125 S W Hall Blvd..P.O.Box 23397.Tigard,Oregon 97223.(503)639AI75 r-I Pm-r .N13 88213,13
,100 ADDPESS : 1.363.5 SW 1(21.151' AVE
I AX MAP/I II SUD .
1. AND II
T (TIM NO: No
WOW< CI AS : All..11.441A'1101`4 0.00K A1:
III HANDI P <J.0
USK 'IYI%"I::, : S.CNII FAKII I";'UPNA(M J.00K+ AIR HANDI 10K
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51 EVAP.E;(:)0LV::k'
VENT' FAN
V L'.II VEN'Y . SYS'11I
<311-ip HOOD
NO. STUR111].'S I.L.P I C'.0 1111 .3 J.51••11»'
D141I - UNI 1"i /C:(11 1.:a—.301.4P 11SICINEPATOR l(:"(Jm
I Y P 1:
ir..1.- 1.4 1_1:4/C.III M 11 ;50•—.`.101-11'a M."I LIN11'S
MAX INI I'_*-.L,1:1)/C 13 M P 11110+H P OTHII
F"I UMII GAS P'LPING II L.L.1
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IN 1.,'561.5 SW J.P.J.951 WE 1:1 AN PEV :.W
Pk.1*13 j:: Ii/I . 50
E T (34 9741., 1*XT I I r'�E L
I'l-4011I (50'.3) 60,14 !OYFII I A 'I AX I's
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This permit 15 Issued subject to the regulations contained in Title 14 ......
of the TMC, State of Oregon Specialty Codes.zoning regulations
and all other applicable codes and ordinances, and it is hereby 141,1
agreed that the work will be done in accordance with the plans and
specifications and In compliance with all applicable codes and
ordinances The Issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permit!. This permit will expire and become null and
void it work is not stE rted within 180 days or If work is suspended or
abandoned for a porlod of 180 days any time after work has
commenced It shall tie the responsibility of the permittee to assure
all required inspections are req bred end approved
Permitter, Signature
Issued RY .-INSPEC;TION 6,3Y--elI _715-
SEPARATE PERMITS REQUIRED FOR wom OTHER THAN DESCRIBED ABOVE
I
BUILDING PERMIT APPLICATION TIGARD GAT _ AuPusc ��._�,�a !14 4966
THE UNDERSIGNED HEREBY APPLIES FORA PERMIT FOR THE WORK HEREIN INDICATED RUiLDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWN'R PHO14E
LOT`1O.
OWNER �,e1�r: nll,tkaj_ _—_JOB ADDRESS 3615 !71a 1211&;
ARCWTECT
ENGINEER
BUILDER _ "�mp ADDRESS DESIGNER
STRU:.TURE ❑ NEW f__l REMODEL ® ADDITION REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
O RESIDENCE ❑ COMM CI EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT C7 GARAGE ❑ STORAGE ❑ SLABC] FENCE
OCCUPANCY LAND USE ZONE _ x4.78LDG.TYPE FIRE ZONE__.__PLAN CHECK BY ____HEAT___
1 _
Jlg11 hpt[�31<_-1Lll-'Cil L?an_ of fill ior-lYtirlYCv ESUrul.
Streets to be kept clear of Oirt. ;fust cunLri)l to 1w Proviuca.
SEWER PERMIT N
OCC.LOAD FLOOR LOAD HEIGHT IVC STORIES AREA NO.BEDROOMS VALUE
_ BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGH F SIDE
Permit ,— THIS PERMIT IS ISSUED SUBJECT TO IOF REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING I
REGULATIONS AND ALL APPLICABLE CODC%AND ORDINANCES, AND IT IS HEREBY AGK'OEED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATInNs AND IN COMPLIANCE
WITH RLL APPLICABLE CODES AND ORDINANCES. THE ISS11-'rvVc Ur THIS PERMIT DOES NOT WAIVE
Subtotal_ RESTRICTIVE COVENANTS. CONTRACTOR AND SI'" tUNTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax •Gil
SDC---
Total
-Total
PDC# APPLICA N r OR AdEN r
By
� 7 � Receipt No.
A roved _ l___— AD E 8- PHONE
DATE INSP. TYPE INSPECTION REMARKS PLUMBING
DATE
Contractor
Permit No.
FjL-L- 4nftfterzo Rough iii
P
Contractor
L
r
Um'
N
Permit
Rough ,i
Fixture
tFinal
HEATING
Contractor
Permit No.
Gas or Oil
Rouch-in
RtF
"n
a.l
S
EW
E
FinalDRIVEW
A
Y
Final
Storm Urin19p
(Rain Drain)Final
Sidewalk
CurbSteet Final
-- —CAoprowh
C- -ATE-----
FE 0-16—D k:P—T• F 1,4—AIL.. --iii�P6Riny CERTIFICATE OCCUPANCY final CERTIFICATE OCCUPANCY
Final
i
mill
BUILDING PERMIT APPLICATION TIGAP..:) DATE_______ 19
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE ..r?
LOT NO. _
OVjNEF'=3~^1``- ARf7 l-._c 1 7 JOB ADDRESS
- ARCHITECT
ENGINEER
BUILDER ADDRESS ADDRESS _-DESIGNER
STRUCTURE ❑ NEW _❑ REMODEL _❑ ADDITION ❑ REPAIR -❑ RENEWAL ❑ FIRE DA'AAGE ❑ DE?AOLITIOf,
❑ RESIDENCE ❑ G'OMM ❑ EDUCATIONAL ❑ GOWT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY - LAND USE 7.0NE BLDG.TYPE " PLAN CHECK BY
7- Aff::1I R0� / v� c G ,Yy�- or i-i< rJ'L _--
n 1 ?/C'�F>'� r"c -S4-C- 1222— G G.F.dT .JA A21'eV --
SEWER PERMIT k
OCC.LOAD _FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE T_
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFTSIDE RIGHT SIDE
Permit i. - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE EUILDING CODE,TOWN
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT TH.
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CONSWLIANC
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV
ku-!tt
otat RESTRICTIVE COVENANTS.CONTRACTOR AND SUS CONTRACTORS TO HAVE CURRENT CITY BUSINES
—0 1
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
atatd Tax lr
SOC--
Total ---
--- PDC# APPLICANT OR AGENT
By
Receipt No.�y!� � PHONE
Approved
SSDC ---
SOC
PDC
SEWER CONNECTION S
SEWER INSPECTION _S
SEWER SURCHARGE S r
WWNt
l:l I Y Ur- I IUAHU MECHANICAL PERMIT -
Permit #
Description v
City of Tigard Table 3A Mechanical Code QTY PRICE AMT
13125 S.N. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397 _-- - - —
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU -
1) incl.ducts&vents 600
Furnace 100,000 BTU 4
2) incl.ducts&vents 7.50
Name of Development —`— Floor Furnace
3) incl.vent 6.00
Job Address - - Suspended heater,wall heater
Address S ' '1 ' ( 4) or floor mounted heater 6.00
Tax Lot Map No. Vent not incl.in
Lot Block Subdivision 5) appliance permit 3.00
Name(or name of business) I 6) Repair of heating,ref rig.,
Mill le'ee / cooling,absorption unit 6.00
Mailing Address Phone Boiler or comp to 3 HP
Owner 7) absorp.unit to 100,000 BTU 6.00
city/sto zip 8) Boiler or comp to 3 HP-15 HP 11.00
7 absorp,unit to 500,000 BTU
Name 9) Boiler or comp 15-30 HP
absorp,unit 1/2-1 million 15.00
Mailing Address ph0f1e Boiler or comp to 30-50 HP
10) absorp.unit 1-1.75 million 22.50
Contractor clty'state Zip Boiler or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31.50
Efate Fleglsoat,on No. City Sue.Tax No. Air handling unit to
12f 10,000 CFM 4.50
I hereby acknowledge that I have read this application that the information given is 13) Air handling unit 7.50
correct,that I am the owner or author)ted agent of the owner,that plans submitted are in 10,000 CIM t
compliance with Stale laws,that I am registered with the State Builders'Board,that the Non portable
number given is correct (It exempt from State registration please give reason below) 14) evaporate cooler 4.50
15 Vent fan connected
to a single duct 3.00
Ventilation system not
16) Included in appliance permit 4.50
17) Hood served b
y 4.50
_ mechanical exhaust
31gnaUne(owner or agent) �— Date Domestic type
Describe work ❑ addition C7 alteration I J repair (] 18) Incinerator 7.50
to be done residential ❑ non-residential (7_— t 9) Commercial or industrial
Existing use of type incinerator 30.00
building or properly _ Other i.e.,woodstove,water —
Proposed use of — 20) heater,solar,clothes dryers,etc. 4.50
building or properly e
21) Gas piping one to r- it outlets 2.00
Type of fuel- oil I l natural ibis I ) LPG C-1 electric f) --
22) More than 4-per outlet
NQTICE -- -- —---- -- —
THIS PERMIT BECOMES NULL AVD VOID IF WORK OR CON - SUB TOTAL
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 541(3 06 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR — PLAN REVIEW 259:OF SUB-TOTAI,
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTLH --- - ------
WORK IS COMMENCED. TOTAL
Special Conditions
-- ate issued by