12140 SW 127TH AVENUE i
ADDRESS:
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VIAS-IER PERMIT
CITY OF TIGARD PERM i T i*. . . . . . . . MST94-0165
COMMUNITY DEVELOPMENT DEPAR1tkthT DATE iSSUED: 05/06/94
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839-4171
r-'ARL-.EL: 2s 1 04AA-087mvl
_>ITE ADDRESS. . . : 121.40 SW 1,-7'rH AVE:
.3UBDIVIS1ON. . . . : BEL LWOOD 1I ZONING: R-4. 5
BL.00K. . . . . . . . . . . LOT. . . . . . . . . . . . . :9Q
----- --_--------___.--------.--•-•---__________.- BUILDING
RE I SSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 f
i.LHS'S OF WORK. :ADD BEDRMS: 1 BA'THS: 1 GARAGE. . . . . . . . . . .0 st
'-YF'E OF USE.. . . :SF FLOOR AREAS—---- REQUIRED SE 1'BACKS-•--••---------
FYPE OF CONST. :5N FIRST. . . . :596 sf LE:F'T*. . : 15 ft RIGHT. :`, ft
OCCUPANCY GRP'. : R : SECOND. . . :0 s f FRONT T. : :-'0 ft REAS. . :25 f t;
;TORIES. . . . . . . : 1 TH I RD. . . . :0 s f REQUIRED --- -_----------
i1EIGH'T. . . . . . . . : 15 ft TOTAL_- - --- :59G S SMOKE DETECTORS. :Y
LOOR LOAD. . . . :40 ps f VALUE. . . . . $ : 27416 PARE;I TVG SP'ACES. . :0
�emar-ks : ADDITION
PLLIMN I NG
:3INICU. . . . . . . . . . .0 FLOUR DRAINS. :N BACKFLOW L'REVNTRei. . :N
LAVATORIES. . . . . :t=' WATE_R HEATERo. . . :0 TRAPS. . . . . . . . . . . . . :0
TUB/SHOWERS. . . . : 1 LAUNDRY lRAYS. . . : 1 CATCH BAS .NS.
. . . . . . :0
,DATER CLOSETS. . : 1 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHE=RS. . . . :0 WATER LINT= (ft ) . :111 OT'I-IER FIXTURES. . . . . :0
;ARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :0
ivASH I NG MACH. . . : 1 SF RAIN DRAINS. . : 1
MECHANICAL _____._._______---__________._______.__. FEES
I- UEL TYPES------------ UNIT HTRS. . :0 type amor.rnt .ty date recpt
/GAS/ / / VENTS . . . . . :4 BF'RT $ 184. 00 BLT 05/06/94 .
111AX INPUT:O BTU VE::NT FANS. . :2 BF,l_C $ 119. 60 SW 04/29/94 94-25185
f"URN ( 10OR . . :0 HOODS. . . . . . .0 B5P'C $ 9. 20 BLT 05/06/94 .
1-URN ) =100K . . :0 WOODSTOVES. :0 o;F'RT $ 38. 50 BI..T 0 r5/OG/94 .
LUUH FUHN. . . . :0 CLO DPYERS. : 1 MP'L_C $ 9. 63 BLT 05/06/94 .
UOII._/CMP' ( 3HPOD OTHER LINITS.—O M5P'C $ 1. 93 DLT 05/06/94 .
GAS OUTLE.TS:O F'F'RT $ 60. 00 BLT 05/06/94 .
Owner-l: __..__._____..________.____.___....___.__..---_._P'SF'C $ 3. 00 BLT 05/06/94
JOHN BRANDES
12:140 SW 127TH AVE
TIGARD OR 972c4
f''honp it: 5917.1--6580
ontractol...
NLMODELING & MAINTENANCE SVCS
0 0 BOX 2:11061
i* f G()RD OR 97281
-'hone #1: 590-7267
leS #. . . 6699 i ----------------------------------
41L25.
-----------.-----------------_.4r5. 86 'TOTAL
This pewit is issued subject to the regulations contained in the ------ - REQUIRED INSPECT IONS -------
Tigard Municipal Code, State of Ore. Specialty Lodes arl all other Foot/fol.tnd Insp Fireplace Insp
applicable laws. All Fork will be done in accordance with aporoved Post/Beam Stmtct Gas Line Insp
r plans. This persit will expire if w "k is not started within 188 Post/Beam Mechan Insi.11at ion Insp
ci days of issuance, or if work is suspended for more than 180 days. P'Im/+_rndslab Insp Gyp Board Insp
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w PLM/UndPvflcor Rain drain Ins;)
-�ermxtteex Si n�'+tur e : Mechanical Insp Water Line Insp Plumb Top UUt Nppr/Sdwlk Insp
ss1_red B 4. ._..- _- --- —_ Framing Insp Mechanical Final
Call for inspection - 639-4175
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Residential Building Permit Application
City of Tigard n
13125 SW Hall Elvd. V
Tigard, CR 97223
(503) 639-4171
4 Jobslte Ad ress: Z �'`� 521 Z — ��..a..�►
�/ �/ f Office Use Only
t Subdlvislon: Qa,�/�(2� �'1 !. Lot # `;��
(//!; Plandu'Rec h �'
7, u
Valuation: � � r„n�,i��� � G�/�
v Permit # ��! ,r
%`/Owner: 101-4dd /).4fw,� 'V�. Reissue ei _ --
Address: Map & TL# �
Approvals Required
Phone: _ �7) 6$d's -- I
Planning _
Contractor: i7Hvyo�L�.li /¢w✓, n•4 ��z�-<►w-� s``'`��% -�•-Y Engineering
Address: Ifo. S� 'Z31 o � ether
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`(76-+1-f-'J. - & ` -2 L
Items Required
Phone: �iU' � 2-G �
Subcontractors
Contractor's Lh:anse # .L _
(attach copy of current Oregon license) Truss Details
Subcontractors: Other_
Plumbing: 2A►f ,,�, 'r �L' •'i i �t
r/ Mechanical: 6) (_ c+N•3iq f> 1
(attach copy of current OR Contractor's License.)
Architect/Engineee':
L.L Address:
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Phone: _
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COMMENTS: L _ `i �
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Applicant Signature & Phone number
Received b r Oate Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) Z±�vo
Plumb. Permit (PLUMB) -a,v ✓
Mech. Permit (MECM) �
State Tax (TAX) / / 3 _i`� l 3
Bldg: �D y
Plumb:
Mech: ✓
v
Plan Check (PLANCK) d2 �z 3 '
Bldg: / c'
Plumb:
Mec'): _
_ Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC) —
Storm Drainage Chg (SDSDC) _
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
n Institutional TIF (TIF-IS)
LL
un Office TIF (TIF-0) _
�- Water Quality (WOUAL)
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L Water Quantity (WOUANT)
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—' Fire District (FIRE) _
/� U r
TOTALS:
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ha-11 Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Pho e: 639-4171
yy C7 / J7
Inspection: ___
Pcoting Plbq. Underalab Mech. Rough-in Apnr/Sdwlk
/
Found. Mg. Tog Out Gas Line G ` INAL)
Post/Beam Struct. San. SewerFraming -Bldg.
Post/Beam Mech. Rain DrainInsulation -Plumb. /
Plbq. Underfloor Water Liner#k
Gyp. Bd. -Mech. �,.�
Date Requested: ime: AM PN
Address: Per�.myit
Builder: 3 ME! 6 !p v
THE FOLLOWING CORRECTIONS ARE R`(EQQUUIREDD:
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Inspector: — _—. _ Datot
APPROVED DISAPPROVED APPROVED SUBJECT 110 ABOVE
2 / / , Call For Reinsp.
INSPECTION NOTICE
CIty of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phn/P): 639-4175 Business Phone: 639-4171
Inspection:- .. _J PV6
Footing Plbg. Underalab Koch. Rough-in Appr/Sdwlk
Pound. Plbq. Top Out Gas Line FINAL:
Post/Beam struct. San. Sewer Framing -Bldg.
Poet/Beam Me-ch. Rain Drain Insulationlumb
Plbg. Underfloor Nater Line Gyp. Bd. -Hach.
Data Requested: Time: AM PH
Address: � `1- Permit
Builder:
THE FOLLOWING 001VECTIONS ARE REQUIRED:
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Inspec'to/r- _ _ _ Data:/_�_7_��_
�( APPROVED DISAPPROVEn APPROVED 'SUBJECT TO ABOVE
-- -Call For Relnsp.
LNSPECTJ�R NOTICE
City of Tigard Building Departawant
13125 BW Hall Blvd. Tigard, Oregon 97223
Inspection Li a (Roc-O-Phone)s 639-4175 Busi.nean Phones C39-4171
Inspections"
Fontinq Plbq. Underslab Mach. Rough-in Aplr/Sdwlk
Found. Plbq. Top Out Gas Line F'1`NALt�
Poet/Beam :tract. San. Sewer Framing -Bldq.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Nater ine Gyp. ed. -
C
Oita Requ-js'tods_ Times G AM/\ PH
Addrese: L /`al—C.L� ���J ✓ � Permlt rs! v '
Builder:_
T'HR FOLLONING CORRECTIONS PAR REQUIRED:
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Inspector: Data: Z
PROVED DISAPPROVED APPRovRD aUSJilCT To ABOVE
/� Call For Painsp.
INSPECTION NOTICE -
City of Tigard Building Departaeent
13125 Sit Hall Blvd. Tigard, Oregon 97223
Inspection Line (Roc--O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plb,. Top Out Can Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Boam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Hater Line (-Gyp. Bd. -Hoch.
---
Date Requested: CJ � - 1"7/� �TLms G�r I AM�/�-�PH
hddres" I -to t` /`C�- Pa"i" t. 1`1 - a I
Builders . i, V' V�
THE FOL.IAMINC CORRECTIONS ARE REQUIRED:
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Inspec : _ _ _ Date: _- „
APPROVED DLSAPPRovxr) A,.�ROVICD SUFUNCT TO ABOVE
Call For Reinap.
tLNSPECTION NO':I4E -
�.
City of 'Tigard Building Departaent
13125 b-M Hall Blvd.. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:__
Footing Plbq. Underelab sC�Rouqh-in Appr/Sdwlk
Pound. Plbq. Top Out as _ FINAL:
Poet/Beam Struct. San. Sewer Framing -- ' -Bldg.
Poet/Beam Hoch. Rain Drain naulation -Plumb.
Plbq. Underfloor Water Lina QOyp. Bd. -Hach.
Date Requested, i Ll `\ Time,, �_AH PJ!
Addrese,� Z,1 A 0L,, �� u / t V Permyit q7-9L1.---0) �n
Builder, �/"1 ''A 1
THE FOLLOWING CORRECTIONS ARE REQUIRM
1&4
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Inspector Date, Z221
APPROVED DISAPPROVED V APPROVED AOsisCT TO ADM
Call For Reinep.
INSPECTION N07. �y
City of Tigard Buildinq repartment
13125 Sit Ball Blvd. "'Lyard, Oregon 97:v23
Inspection Line (Rec-O-Phor• ;. 639-4175 Buaiaeesee Phone: 639-4171
Inspect ion: \ `
Footing (; Plbq. Underslab k, Hoch. Rough-in Appr/Sdwlk
Pound. O P1 Gas Line FINAL:
Pont/Beam Struct. San. Sewer in -Bldg.
Post:/Beam Mach. Rain Drain Inaulatior -Plumb.
Plbg. Underfloor Water)Line Gyp. Rd. -Hoch.
Date Request^eed:` [ - . (-,----- 9 L( Times -1-Z.-AM PM
Address: I DL 1 Lt 0 ' Permits_ -LL4- (0 1 (05
Builders A M f2e-[-1. 9 Le - Ll to -7`„
THE FOLLOWING CORRECTIONS An MUIREDs
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pct) � —
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l17_2�. --e-✓1
AIL
Inspectors_ U ,tee
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
L( , Call For Reinsp.
INSPECTION NlYTICE
City of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
'nspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection:_
Foctinq Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Lino FINAL:
Past/Beam Scruct S.An. Sewer Framing -Bldg.
I'out/Beam Mech. Rain Drain Insulation -Plumb.
Pltq. Underfloor slater Line_ Gyp. Bd. -Mech.
Date Requested: ��1E'
7 ^LS _C314 Time: _ —AM
Addresses 4 1 L� ! Permit 1611'-I\
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
J
A 11 �-
TZ
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Insper"toFi Data:
APPROVED V/DIBAPPROVRD APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Dep rtsent
13125 GW Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 9usiness Phone: 639-4171
Inspection: - --
Footing Plbg. Dnderalab Mech. Rough-in Appr/Sdwlk
Found.
Plbg- Top Outs Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain
Insulation -Plumb.
Plbg. Underfloor water Line) /Gyp. Bd. -Nech.
Date Requested:_
6 Time: __QJAM PN
Addr -Z �,A 6 � Permit :�� 4 - o c S
ess: -
Builder:
TILE FOLLOWING ODRRECTIONS ARE REQUIRED:
CL -
0:
1-
F-
J
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0
W --
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Date:
Insor
RpRppyED - DISAPPROVED APPROVED SUBJECT TO ABOVE
Call ►or Reinep.
INSPECTION NOTICE
City of Tigard Buildiuq Department
1'125 SA Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175/ Business Phone: 639-4171
Inspection: --__ ('( �)�! I I i C iZ ! ✓�J f�P_ L- --- —
Footing Plbg. Underrlab Mech. Rou h-in Appr/Sdwlk
1! _
round. Plbg. Top Out ash- � FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Plat/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line / Gyp. Bd. -Mech.
Date Requ.ssteds - �/ TLmas _G AM /PQM
Address: 7 C� / 1 Per/mit�ls
Builders ly/�l 71 !Ji nl )lea d
THI: FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Dates—
t./ APPROVED _ DISAPPROVED APPROVED SURJRrT TO ABOVE
__Call
For Reinsp.
j!N,PECPION NOTICE '/ 51
City of Tigard Building Department
13125 SU Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Eusinesa Phone: 639-4171
Inspection:_______
Footing Plba. Underalab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out G:-.—L
ine> iHAL:
Post/Beam Struct. San. Sewer Framing -Aldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hech.
Date Requested: 6 ri0- /�/ Times AM __��pN
/ )1 /^')f
Address:_!/< )/L�� OJ V�) Permit V.
Builder: l ) /L [ 11 ) V!L` // f"' !� C/ cJ
r,
THE rmwwING CORRECTIONS ARE REQUIRED:
-ms's Ll r / _1
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Inspector Date: 6_q
APPROViLD ✓ DISAPPROVED APPROVED SUBJECT TO ABOVE
/—Call For Reinsp.
INSPECTXON NOTICE
City of Tigard Building Department
13125 8W Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspections ---
rooting
-_rooting Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
lbg. Underfl r ) Water. Line Gyp. Bd. Mech.
Date Roquesteedyt„ 7 -�Timat AM - PM
Address:
Builder-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
CL - -- - ----- -
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Inspectors_
APPROVED DISAPPROVED APPROVM SUBJECT M ABOVE
-Call For Reinsp.
INSPECTION NOTICE U%,City of Tigard Building Departmen'-
13125 aw Ball Blvd. Tigard, Oregon 91223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Foot+ng Plbg. Underalab Mech. Rough-In Appr/Sdwlk
Frn:nd. Plbg. Top Out Gas Line FINAL:
Pont/Bean gf-riat San. Sewer Framing -Bldg.
MEt/seas McOh / Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line t�d Gyp. Rd. -Mach.
Date Requested:,_ i' / Tine:
Aidroee: Permit #:�/-1f!
B,.ilder:_
fBE FOLLOWING CORRECTIONS ARER-{EQUIRED:
CL
Un
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CO
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Inspector: `� ^- Date.
APPROVED DISAPPROVRD -- AAPPROVED SUBJECT TO ABOVE
�( Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Hall. Blvd_ Tigard, Orogon 97223
Innpection Line (Hec-O-Phone)t 639-•4175 Business Phone: 639-4171
Inspections
Rooting Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. ` San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Pibg. Underfloor Hatter Line Q / Gyp. ad. -Mach.
Date Requnctedf �/! l (D ✓la- / (/ _Timer [� /AM/� PH
Address:_ 17(/ /o� / i-~ l�P • Pefrmit/1s / LI- CJ/
Builder: y e r Y'l rJ '726, - /((p 73
nip FOLLOWING CORRECTIONS ARE REQUIRED:
ma
0.CIDw
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Inspector ,r 0
APPROVED _� DISAPPROVED - hPPH0vr.b SUBJErT TrJ ABOVF.
_/ Cali Por Reinsp.
\fes.
INSPECTION NOTICE
City of Tigard Building Department
13125 SN Ball Blvd. Tigard, Oregon 97223
Inspectto� Line
�((Rec�-)rO-Phoone)s 639-4175 Business Phone: 639-4171
Inspection: — ---
•ootiriq� Plbg. Dndernlab Mach. Rough-in Appr/Sdwlk
rVund� Plbg. Top Out Gas Line FINALt
Post/Beam 1ltruct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plctq. Underfloor Water Line Gyp. Bd. -Mech.
Datn Requestad/t_i ,J C�- 9-"/ Timet AM / —PM
ndataeas ��1 I,��
Builders1rlill �--
THE FOLLOWING CDRRRCTIONS ARE REQOIREM
LL
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vp
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Date
.nspector•—
APPROVED DISAPPROM VJ;PROVSD 89wacP TO Ram
CJ Wil Per FALnop.
MECHnNICnL
CITY CSF TIGARD T--�E.R M I T
COMMUNITY DEVELOPMENT DEPARTMENT 'r"ERXIT #. . . . . . . : 1?EC94---0J.C,0
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)830-4171 DA"'L ISSUED,., 06/17/9,4
fl PARCEL: 2SI04AA - 08700
ADDRESS. 12140, SW 127TI-; FAVL
RF[.LWOOD T T ZONTKIG- R-4. 5
1?Lf2CX. . LOT. . . . . . . . . . . . . :98
CL-qSS 01' WORK. . z nDD FLOOR FURN. . . . EVAP COOLERS-.
rZ OF USE. . . . ;SF UNIT HEATERS. . . VENT FANG. . . .
7;r.0 P A N C Y G 13 1P. . i;R3 VENTS W/O ADPL: VENT SYSTEMS
-'RIES. . . . . . . . C1 BOILERS/COMPRESSORS HOODS. . . . . . . :
FIFFL 0-3 HP. . . DOMES. INCIN.
� /SAq/ELE/ 3-15 HP. . . COMML. INCTN-
M,".,X IN-"'UT- BTU 1.5-71A fip'. . . REPAIR UNITS:
r- T'RE- DAMPERS?. 30- 50 !-Ir. . . . : WOODSTOVE S. . :
GnS PRESSURE. . . ., 50+ 1 IP. . . . : CLO DRYEPS. . :
Njr. Or UNITS- AIR HANDLING UNITS OTHER UNITS. :
rURN ( 100'rl% BTU: 1 10000 c-Fn, : OAS OUTLETS. . 1
"'_!'2N- N ) =100K DT,J-. 10000 cfll; :
— ahs i`ktB . GAC FURNACE. & AIR CONDITIONER
Owner; -------- FFES
JOHN BRANDC'-, type 'qM011ni- her Hate rpc-nt
4
1?140 SW 127TH AVE PRMT $ 25. 00, JG 06/17/94
.' - - r) OR r--,PCT $ 1. 25 JG 06/17/94
. ,.cnR
590... C'3 11-0
t
Ck C
OLUMBIP. HEr-)TING
3-300 SY'4' BURNHAM
-11 lZ
OR
#� $ ?'6« 25 TOTAL
Ron 76359
-------- RFULITRED INSPECTIONS
71-i's pe-rit is Issued Subject to the regulations contained in the (3a:3 Line Itisp
.' -xv,:c I:pal Code, State of 0,-e. Specialty Codes And 81111 other MechaniLal :T15P
L0 a laws. A:: work will be done in accordance with Final. rnr'pectimn
d plans. This permit will expire if wr-k -� not started
18? days of issuance, or V work is suspprdtd for sore
n i t t e Cigna t-.,t i-e
C Ll r,
a i rLir inspection E,31) 175
u I 'r 1.11 I I04-11d) i4k('I. )1--' 1 lIf• I,'HYMI W1 1;1 ('I_ Jill Nil, Qyy
1 I It t a: AM1)II4
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(apJ)W. ISI t 8900 sw HIMN104111 full ff 1. 1 i1 I't)YMk NI JWJII t Of
T 11.y�1TiI'), Clf�1 '�IJFlI',I:f.V I'�i 11.IPl
PIA10-' WA. OF PAYMENTNM(1l.)N7 Pw f.) PtJRI•'1AA'-. (IF NOWNl flmtWIN't
ME1.44ANICAI.. PF ME 1:194- 1A16fA 0171 ST. FAWII.D V11-44
t,t lW GW WITH
1 i I) i ti Of�1111 1pd 1 i'!•I!1[) .-� �.. > ,'t. � ,
i
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Hall Blvd. APPLICATION Permit #
Tigard, OR 97223
(503) 639-4171
— F7av—To1^wil.�m..� /�- — SCflphnn f
fable 3A Mechanical Code 011 PRICE AMT
Job �- 1) Permit Fee 0- -0- 10.00
Address I ZI t-!
W 2) Supplemental Permit 3.00
urnace o
l Cld1c 7 11 incl.duds 8 vents 6.00
�.h
um
ace f6ai5b�87U+
2) incl.duds&vents 7.50
Owner I?f`-> !`'I<) / u Floor umance t
3) incl.vent 6.00
buspGrided heate,,wall seater
�- 4) or floor mounted heater 600 �
Vent not incl.to
Occupant 5) appliance permit 3.00 _
Repair of heating,re ng.
6) cooling,absorption unit 6.00
Boiler or comp, eat pump,air conn. i
7) to 3 HP;absorp unit to 100K BTU 6,00
C cl a►n 1.1��� rC / —
,a �err or comp, eat pump,au conn
�l/ Q,�x .�. `�� C — 8) 3.15 HP;absorp unit to 500K BTU — 11.00
Contractorlr/ T� c12
boiler or comp, seat pump,air con;
6-3 ���j1 9) 15-30 HP;absorp unit .5.1 mil BTU_ _ 1500
„. „�,, i er or comp,Feat pump, air cora,
-7 10) 3050 HP;absorp unit 1-1.75 mil BTU 22.50
fTioy—ere- ac T5w( gea ave rea tis application,tis eBoiler or comp,heat pump, air coFc—
information given is correct,that I am die owner or authorized agent 11) >50 HP;absorp unit 1.75 mil BTU — 37.50
of the owner,that plans submitted are in compliance with State Air han tng unit to
l ws.that I am registered with the Construction Contractors Board, 12) 10,000 CFM _ -- 4.50
that the number given is correct. (If exempt from State registration, it handling unn
please give reason below.) 13) 10,000 CTM+ 750
Non porta e
14) evaporate cooler 4 50 `
ent an connec
15) to a single duct 300
— —
Ventilation system not
— I
16) included in appliance permit 4.50
o serv. y
17) mechanical exhaust 4.50
--&stnammeraor to
DescribewoiT( a ttton i rao �repair T 30.00
to be done residential Q non residential Q 18) type incinerator
Existing use o Cer i.e.,woodstove.water
building or proerty - l p 4— _ _ 19) heater,solar, clothes dryers,etc. 4.50
Proposed use of20) Gas piping one to four outlets ' 2.qO -,
l�
LL building or property '2 1 t >" ' _- -
,,,,� � 21) More than 4 per outlet —
Type of fuel-oil p natural gas. LPG Q electric Q
Q�
Minimum Fee$25 00 SUBTOTAL _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
c AUTHORIZED IS NOT COMMENCEG WITHIN 180 DAYS,OR 5%SURCHARGE L�
IF CONSTRUCTION OR WORK IS SUSPENDED CR
ABANDONED FOR A PERIOD 01= 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL
AFTER WORK IS COMMENCED
TOTAL
Special Conditions
Date issued by
\�MEC'MP1AT