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INSPECTION NOTICE
City of T;gard Building D^partmc nt
P O. Box 23397
Tigard, Oregon 97223
///�y Phone: 639-4175
Type of Inspection _ JLw ' r --
Date Requested---__:_.__� � Time P.M.
Address � 7`�� ��� `r ' L �o�s1 Permit
Owner �— ' _ Lot
BuilderThe following Building Code •,feficiencies are required to be corrected:
Presented to t l Approved
Inspector — ( Disapproved
Date _-• —
CALL FOR REINSPECTION
M YES 0 NO
WJKMRXrAFAM
Permit No: ----------__-�-- _
Address:
r Z' Issued by: - - - Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
w!*lo are not registered with the Construction Contractors Board to sign the
fokowing statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
1- �] I own, reside in, or will reside in the completed structure.
2. A. [—= My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. E-;k4 I will be my own general contractor.
if I hire subcontractors, I will hire or'y subcontractors registered with the
Construction Contractors Board. If I change my mind and do hire a general
contractor, I will contract with a contractor who is registered with '.he
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certifv that the above 10ormation is correct and that I have read and understand
the Informatien No0co to Property Owners about Construction Responsibilities on the
reverse side of this form.
-,gnature of Permit Applicant Date /
CONSTRUCTION CONTRACTORS BOARD
0244) VY24/89
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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CITYOF TIFARD
GITYOF nGARD
COMMUNITY DEVELOPMENT DEPARTMENT oaEGOMC NICAL
131,25 SW Hall Blvd. P.O.Box 23397,rgard,Orogon 97223(503)639-1175
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639-4171 PRIM. PERMIT . : MEC90-0021
DATE ISSUED: 02/01/90
ITE ADDRESS. . . : 11575 SW FAIRVIEW LN PARCEL: 2SI03CD-00800
UBDIVISION. . . . : HOLLYTREE ZONING: R-4.5
LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :3
LASS OF WORK. . :ADD FLOOR FURN. . . .'---------- ----•---._-.----------------
EVAP COOLERS:
YPE OF USE. . . . :SF UNIT HEATERS. . : VENT PANS. . . :
CCUPANCY GRP. . :R3 VENTS W/O APPL: VENT SYSTEMS:
TORIES. . . . . . . . : BOILERS/COMPRESSORS HOODS. . . . . . . .
UEL TYPES------------- 0-3 HP. . . . . DOMES. INCIN:
`WOD/ / / 3-15 HP. . . . : COMML. INCIN:
X INPUT: BTU 15-30 HP. . . . : REPAIR UNITS:
IRE :CAMPERS?. . : 30-50 HP. . . . . WOODSTOV 'S. . :1
nS PRESSURE. . . : 50+ rip. . . . : CLO DRYERS. . :
O. OF UNI'.^S---------- AIR HANDLING UNITS OTHER UNITS. :
JRN < 100K BTU: <= 10000 cf_m: GAS OUTLETS. :
URN >=;OuK BTU: > 10000 cfm:
emarks: Woodstove permit
wner: -----------------------------•----- ----------- ---•-- FEES -----------•--
-
ATRICIA DUNCAN type amount by date recpt
1575 SW FAIRVIEW LN PRMT $ '4.50
5PCT $ 0.73 r /
IGARD OR 97223 PAYM $ 15.23 JLH 02/01/90
Phone /:
Contractor: ------------------------•-----
OWNER/CONTRACTOR
--------------------------------------
-` --------------•----
Phone #:
Reg $ 15.23 TOTAL
g V . : OWNER
-------- REQUIRED INSPECTIONS --•----his permit is issued subject to the regulations contained in the Final Inspection
igard Municipal Code, State of ore. Specialty Codes and all oche -
pplicable laws. All work 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 more
han 180 days. ---- -
L*mittee Signatures
saued Bv: -_-- ---- --
Call for inspec^_icn - 639-4175 —
CITY OF TWARD RECEIFT OF PAYMENT REG NOt 00107196
CHEGF, AMOUNT s i 5. ::'
NAME. PATRICIA DUNCAN CASH AMOUNT .00
PAYMENT VATE s 02-01-90
ITGARD, OR P71223 HLOD' NO/Alkk:
115-15 SW FAIPVIEW LN
PURPOSE OF PAYMENT AMOUNT PAID PUPPOSE OF PAYMENT AMOUNT PAID
MECHANICAL PEFM (90-0021) 14.50 STA,ru Buit..D PFpmm TAX (s%
TOTAL AMOUNT FAID
0F 0
CITY OF TIGARD Cy
OREGON
Owner:. Qu.#sdr.ant.-Corp.e ......... Permit Na.73-15
Building Address . .
Certificate is hereby given this..Ath....(lay of-..Na!!e.mber .........1 19_71.
that ,aid building may be occupied and
that it complies with all requirements of
the Building Code for the City of Tigard,
as approved by the TigArd City Council.
f
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...............
iuilding Inspector
o......, ",-IN u e A.
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City of Tigard
INSPECTION PEOUEST
for
i
INSPECTION TIME : 07 PERMIT NO. . .
i DATE: X0!1!/73 ,)ArE ISSUED'--./'--i'—
OWNERS NAME *
ADDRESS :
# C-)N1 RACTUR :
TF:S I La
RESULT sgpr;j�e4 �k rpproveO 1
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INSPECTOR DATE
NOTE: Attach supplemental test .:afr.
naret 1
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amity of Tigard
INSPECTION REQUEST
for
INSPECTION TIME . _ _ ° PERMIT NC. .
UAT E : 9 &�7"-72' DATE ISSUED
OWNERS NAI ,E : _��
A D D R E S S: _ k��I� 3_
EST h�ter[J `v' . :c; '.ub-rq+')r�".j
RESUL' ' sip_rove suppr-,ed G eidi�t; I.j
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NSPECTOR )ATE
COTE: Attarn supplemental test uuta icer -tul
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;�ity of Tigard
1
INSPECTION REQUEST
far
i.NSPECTION TIME . PE(?MI"1- NC
DATE . :� ' �DATE ISSUED
OWNERS NAME
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A r)D R E S S: -1._2_�
r;O N T R A " r n R
;,EST ' . h tar V' . c:• '] . '.ab-rct•)rI 7j
R,ESUL." �p rcvad uppr).tad G
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INSPECTOR DATE
50TE: Attaci supe emental test uuta fieri toJ
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Address 11575 S.W. Fairview Lang Permit No.
4865
—...... Permit charge
Owner Connection fee ZMASXx 425
Paid by Quaeirant f'orjy_
Type re building residence Date connected
Service rate _ 3.00 per monthInspection fee ?5
Contractor quadrant uiro. Paid by _ same date
Size of connection 3 411
_ Assessment paid
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. '. .
DATE1,471 ;7'; DATE ISSUED'_LL
OWNERS NAME : ex d6l
ADDRESS : L3 '� - -----
CONTRACTOR
TEST \ i ,J, Wnter 1,1 , Visi-GI 0 , La', .rotor; P
RESULT. Approved [ Disepprovod _l F'Nnding LJ
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INSPECTOR DATE
COTE : Attach supplemental fest d afo heret]
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City of Tigard
INSPECTION REQUEST
I for
s —
INSPECTION TIME ' ll�V_�1w7 PERMIT NO. : . Ilff
DATE : _S-149-1�- DATE I SSUED'�—
UWNERS NAME '. ----
A D DR E S S : JJL ;-5= s,
I G0NTRACT0R :._b,-.L- 3-
•s��.cf
1"EST .a r ;J, Water 5(l, v+ 1�, La•• ,ratan (.1
RESULT: Approved , Disapproved 1 Pynding 3
I{ SKETCH:
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INSPECTOR DATE
IOTE : Attach supplemental test iota heret,
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CITY OF TIGARD MECHANICAL PERMIT
DATE_4 yPERM-T NO. ! 3 i' �>> �. ,
� ._ � .t RECEIPT N()� _ILL)
c
BY
i-"-=ern:1t
FEE shall be obtained prior to commencement of installatijn.
2. Permit shall be obtained for all appliances which are to become
a fixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct Mork require permits.
4. All work to be concealed must be inspected before cover up.
New Installation [ I Replace ❑ Relocation ❑ Addition ❑ Alteration ❑
CONTR. OUApgANT GQ PQ2AT QN OWNER QUADRANT
ADDRESS 1150 5 E Skyline Blvd WORK ADDRESS 11575 5 W Fi;view Lane
_ ynrr lalld circ-g,w _ U2., L APPLICANT — imperial Plbci. & ;iear__1 ,, in
TELEPHONE NO. _ 777-3801
FURNACE - MANUFACTT^.'.LR c E TELEPHONE NO,, M16-1161
HEAT Input rating (Btu Per Hour) 100.000 Vent Size 5 Flue .size
rr6
FUEL OIL U GAS 0 ELECT l__J OTHER
TOTAL SQ. FT. Top Floor h Main Floor1561 Basement
GENERAL
ITEM NO. FEE ITEM NO, FEE
For Issuance of Permit .00 Boilers Over 50 Hu
New - Under 100 000 Btu 4.00 AirHandlin 10,000 CFM
ew - •ver u xxxx "- it f.an in er 10.000 C
Floor Furnace 4. a orative Cooler
Wall - moor - bus ien e . Fen an - _ •
Installens m
Ne- air —f.eat & Cooling- + 00 flood -
Boilers n erpmesticc ' nuc vera .,o�--r "0
�� ers o > Gomm. nc nera or 20.0
Boilers 15 to 10.55 - er Not--Li-sT3-
o ers to 50 Hp_
INSPECTOR'S COMMENTS
APPROVED BY �L DATE a 1 SSTBY
mi pafrj a 1 in Heat R, Inc.
00
Sign a'ture of Applicant
Heating Supervisor
PLUMBING PERMIT APPLICATION
Jurisdiction of TKARD
No. Type of Fixture Fee Permit No. 1743- 111i-C'
Permit feeLV
2 Water Clobets (Loiletsi Permit Issuedi-?
Bath Tubs Approved by
avato Wash Basin) Building Perm t
Shower Receipt No. J(eo-_
in s Dishwa_.hin w_
inks Citchen
I Sinks Ordinary Location of Building
Sinks, a; 11575 SM FI,
Sinks Slop
Automatic Dishwasher
Disposal
Laundry Trays Name & Address cf Owner,
Drains Floor _ IYADRANT COR? —
rains Area __ 1750 SM SKYLINE QLVD
Drains Re r•ii erator BLAND OREGON
Rain Drains
Name � Address
is Addressof Pliimber
Automa her
oto atns r e �n fMPERIAL PLUMBING & HEATINGANC-
Fountains soda ___ P 0 BOX 806327
Hot
Fountains,
Tan PORTLAND OEGON 97206
Water Service Size
Urinals Buildin Old or New) (Alter, Repair, or
Catch-Basins - Yard
Lawn Sprink er a stem
Swimmin P-0-o UTer
S rin '- pr System
This permit becomes null and void if work or construction authorized is not
-ommenced within 60 days, or if construction or work is su�,pend(-d or abandoned
f,jr a period of 120 days at any time after work .is co�mmer-'Ced
A1.1 plumbing firms must be licensed by the City of Tigard and post a $1,000 bond.
I hereby certify that I have road and examined this application and know the same
to be true and correct. All provisions of laws and ordinr.nces governing this typ
of work will be complied with whether specified herein or riot, the granting of e
permit does not presume to give authority k) violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
IMPERIAL PLUMBING a HEAITNG, INC,
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Si ture of Applicant P SUPV.
City of Tigard
INSPECTION REQUEST
for
I' ,SPECTION TIME : _��-/,�f� PERMIT NO. :
DATE ; ,' 7 DATE ISSUED :
OWNERS NAME : .� �
ADDRESS: --./m 7-_ -` --- •r'yr_-__.�_______
CONTRACTO R : ---- ----- ----- --------- - -_-
1 EST V.-uaiy(, I-aboretory r
RESULT ' _ );suppr nad G , Pendi_iq
SKETCH:
INSPECTOR 7DATE
NOTE: Attach supplemental test data heret0j
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city 9 of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO.: --
i DATE. s> -' -:�– DATE ISSUED:---L�
IOWNERS NAME : -----
ADDRESS : ----
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CONTRACTOR :—.-------------
TEST .
ONTRACTOR :—.-----TEST. Air O, Water u , Visual ❑ , Laboratory ❑
IRESULT: Approved ) , Disapproved ❑ F'andinq I]
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NSPECTOR DATE
COTE : Attach supplemental test data heret:01
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UNIFIED SEWERAGE AGENCY NO
WASHINGTON COUNTY LATE _it
CITY OF_- T i pard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNr R: _____ I,uadt'ant. wil_Cprporation—
OWNER'S ADDRESS: ._ _-- ---_1�yQ_5•J.f.--:Ilsylinl�_Hlvd.. -
p STREET
_ CITYi�--- -- -- --ST� - ---
- ZIP _ -
BUILDING SITE: LOT-- - j BLOCK ADDITION iluI I,ytree
TAX LOT N0. _ _..._.___ TYPE OF OCCUPANCY he�-iderrce
ADDRESS - --11j jam;;.W. Fairview Lege
DWELLING UNITS_ ___.1_.__ ._____ _ FIXTURE UNITS _
SURCHARGE IF APPLICABLE .._ -- -5O-LQQ tv derr4_ggkjL•.__ _
-904 FEE __ ____ INSPECTION FEE 2:) _ TOTAL DEPOSITED
((NEW) '(EXI,TING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and re ul ions of the Unified Sewerag(�,Agency.
APPLI
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SEWER'" PERMIT
THIS PERMIT AI.IrHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE INSTALLER X duaciraut C:ort'•
RECEIVED 13ti tt-.jj,,��
1 Nc1yA IT AGENT)
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COMMENTS
This Almlwation and hermit expires in ninety (90) clay- The amus nt paid will he fcxrr.lted
should expiration occur.
CITY OF TIGARD
11440 S. W. Main Stroo
TIGARD, OREGON 97443
APPLICATION FOR BUILDING PERMIT
New Construction L••J Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING 1;_y DATE ISSUED BUILDING PERMIT
BUILDING FEE $ �, No.
DATE RECEIVED ,•� � `���� 1�� -1'15BY t'�LAN CHECK $ 4uUJ
VALUATION $21,f jU. li
ts
OTHER
TOTAL $ 12U.UU RECEIPT No. .2"3_s
i L• _'l /'7
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
L01' # 3—` MAP # 291 3C CENSUS TRACT JOB #
Architect or EngineerJ3uy Wuur,r,an & Ac;;,aciatea
Address be,.,.vue, 6 ,gin _ --Phone---
Owner ;Auaarant
—Phone--_Owner4uuuraut c ". _---
Address Phone
Builder- ,;arae
Address _ Phone
BUILII-'NG USE Single Res. ❑ Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP 1: No. of Stories__.L_ Total Height _-_ Area of Lot
Type of Construction *XXXkk(xEWx)oM V Floor Area B 1 ,4;. - 2
Set Backs: Front a`— Back_IN�,)L.Side / R.Side,_,__
Private Sewer Pipe Size `- Sewer uzu Tear, Septic Tank ❑
Water Service Pipe Size_ Storm Sewer 1� Ditch ❑ Drywe11 ❑
SI-reet and Curb Requirements kxi•,Llrag
riveway Width____,_, _No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED 1W) ;}.W. Fairview lane
FIELD CHECK BY 2C DATE.
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PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
no: be occupied until a Certificate of,q� pancy has bee�ied'by the City of
Tilard B•iilding Inspector. ��/ /'i i /1 c� <
`S gnature of Ap icant