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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 2339"
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection ----
Date Requested_
` �7-----. Time.---- A.M. P.M.
Address � � rY.��-t/L^�"� Permit
Owner - --- _-- ----- --- Lot -
BiAder - - ...- - ---__ ---- ----—The following Building Code deficiencies are required to be corrected:
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Presented to -- --'-- -_--------�- approved --
Inspector / Disapprvved
Date —_1 ' �La" f2/
CALL FOR REINSPECTION
❑ YES 0 NO
CITY OF TIGARD PLUMBING 1.12-5 ;-W Ia11 lu"1•
11gud CR 9722-3
Applicants must hold Oregon Registration to condud a plumbing PERMIT 639.4175
business or must be property ownerloperator not hiring outside help.
Name of Development Plumbin8 Permit No. �� -?: r"�
A Description
Jt>U OAS 614.21-010 CHUAN PRICE AIAT
Tax Lot Map.No.
Address FIXTURES
Ld Bkrck Subeivttlon
Sink - -- -
Asm4 o neaa Laval" 7.50 _ Z 50
�, —
'1. ob or TubiShower Comb 7.50 _ ���
— / -750
-Z-
Mail" rest ShowarOrtly -- -- - L__ _ ---- _
Wolof Closet Z 7.50
~
Owner C'�ty �ete .. Tip _-------- _
Dishwasher750
--- Phw,e -- Garbage Disposal
-
Nemo, Washing Machine / �_50
- - - -
Flow Drain _ 150
Using M,Ires,s Ptw)ne Water Heater 750 JJ�
Laundry Room Tra1 7 50
Occupant /Slate Zip - .
Urinal ._ --- - 7 50
-- ame --- -Other Fixtuiss(Specify) - — - 7_50
e—A *t - ___ 7.50
Address �--
Corttrtticto► 'CHy%;t►to--- --Zip �- 750
MISCELLANEOUS __...
- -- City Hue Tex No e•41wK 11111100' 3000
ule a ar v ---Ute P�, s s Sevwr aa.AddH.100' 15.00
(Residential) WaterServioe 1st 101) - _- 20.00 p
1 hereby acknowledge Viol 1 have reed this appllcatlon•tial the Inlormatlon Water Servioe ea.Addi1.200'- � -- 15.00
given is ocmed,Thal I am rogisiwed with the State Builder's Board,and also Skim 3 Rain Drain 1 at.100' 30.00
have a Stolt-i PksnbkV"rise that to numbers given are nomad•that all
r*tmit ng work will be dome in socordanoe with oppilcable provisions of Ore- 51a►m t Pyrt pram AddN.100' 15.00 -
gon Revised Statutes Chaplers 4,17 and 693 and"IcA bis codes and that Mobile Home Spam 2500
no help will be employed unless Moaned tn"w ORS 683 (11 exempt from — —
State registration,please give reason below) Back Flow Prevention+
HOMEOWNERS- 1 hereby cerwy that I am the owner of the property de- DevioearAn&F'olkAionDev" 750
sutod above,N which focatton 1 propose W snake a plumbing hataNistim Par Any Trap or Waste Not 7.50
my own use and this property Is not hosing ocw"Mi.•led for tale,tease or rent Connedood loa R NIo _- _-
Catch Basin _ 7.50
k".of Elm.Plum" 40,00 Per Hr
--- -
-
SpeciallyRaquaaled Inapaayor►t 40.00 Per He
of Pltr"Alft veld
an EttlsMrq Bldg 13.(10 min
AtENORL&IJ SIGNATUAE - Date New Bldg.of Bulli.AddlUon _ M-00 min _
Fain L2Li-gle Gwil _--
UattirX#A wak. new(_) addition alienation❑ repair(7 dwell_ inti.
be dorm residential( � own resldtrnnal -
Eadittklp use of _+
or prwerty 'TAt j
PfqpNedtqe 01 11k Kl1 1!
TSL
NO flCE
This pilnrtM Will! e- null ane twig M work a aontMuOron suthorued ht not oom
Ow ad 00 A 100 days tar I millovotion or work to suopentlsd or Ibandoned for
a period d 180 6"of any Qme artiN work is i1nrIMMrKfad
Doli lnw.d •''�3i / M
t tu�uiNi • _
CITY OF TIGARD MECHANICAL PERMIT Permit t/ c ��
Description
rales U raearantoel code uy M11Ca AMY
City of Tigard 1) Permit Fee -0- -0- 11.00
13125 S.W. Hall Blvd. ------ ----------- -
P.O. Box 23397 2) Supplemental Permit 3.00
Tigard, OR 97223 -----
639-4175Furnace to 100,000 BTU
1) incl.ducts&vents t•t'
2) Fumacc 100,000 BTU +_ 7.50
Incl.ducts&vents_
Name of Dove( nt - 3) Floor Furnace 600
/ Incl,vent
rf� �rtdress L 2 C { J 4) Suspended heater,wall heater 6.00
Job or floor mounted heater
Address ;' l i' J �" i/•/c . _( _
- Vent not Incl.in
Tax Lot Map No 5) 300
� appliance permit
Lot Block Subdivision —
Name(or Repair 01 healing,re}rig., ti
name of business) 6)
___cooling,absorption unit
(c ' Boller or comp to 3 HP
Mailing Address Phoney7) ti 00
Owner absorp.unit to 100,000 BTU
city/state Zip e) Boiler or comp to 3 HP-15 HP 111.00
absorp.unit to 500,000 BTU
Boiler or comp 16.30 HP 1500
9) absorp.unit 1/t-1 million
Mailing Address Pitons 10 Boller or comp to 30-50 HP 22.50
absorp.unit 1-1.75 million
Contractor Gty�state Zi — 11) Boller or comp to 50 HP 31.50
absorp.unit 1,750,000 BTU
State Registration No City Bus Tax No Air handling unit to 4,50
12) 10,000 CFM__
13) Air handling unit -- 7 50
I hereby W*ncwbdge (hal I have read this application that the information given is 10,000 CFM + _
correct,that i am the owner or authorized agent of the owner,that plane submined are in -
compNerce with state laws,that 1 am registered with it*state Bulhfers'aoerd,that ft 14) Non portable 4.50
number given is correct.(H exempt from State registration please give reason below) evaporate cooler
15) Vent fan connected 3.00
to a single duct --� --
- 16) Ventilation system not 4.50
Inclided in eppli_ancys permit
• `- --- - Hood served by
�.-_- 17) 4.50
mechanical exhaust
(tin
of orliq Date18) u0mostic type 750
O
Describe workaddition ❑ alteration ❑ repair CJ Incinerator _
to be done residential a non-residential O 19) Commercial or Industrial 00
type incinerator
Existing use of
) Other i.e.,woodstove,water
building u properly
- -_ - - 20 heater,solar,clot s dr)-ors,etc. 4.
50
Proposed use of --'�—�
building or property_._._._ _ _ 21) Gas piping one to four outlets I ton '
Type of fuel- oil ( 1 natural gats-jisk� LPG i ) 61wric 42
22) More than 4-per outlet
K4IlUE SUN-TOTAL _
THIS PERMIT BECOMES NULL. AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 a_ _
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUt&-TOTAL l
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER -" TOTAL'-
WORK IS COMMENCED, L
Special CondMons
fla'r ;surnl •' by
BUILDING PERMIT APPLICATION 4=1111111M DATE ` + _' 19 `a L OP782
97
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE 245-44
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE�B __
LOT NO. — _
OWNEROB ADDRESS 13�l1S l� ncic�n Ci . 1S13CD-�
t�S 722 9-11-87 ARCHITECT Came
219 ';W 1.9th Pt.1.nd ENGINEER
BUILDER ;.ame ADDRESS • DESIGNER
STRUCTURE EXNEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
IR RESIDENCE CI COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY R' LAND USE;ONE _ BLDG.TYPE . FIRE ZONE_.PLAN CHECK BY HEAT '
Construct single family dwelling w/attached garage, all per annrovad plans.- -
>u -ject to 85 code. KE3'RZVXX@jXX. Sttbject tp AWAwt $360 **R12 setbacks.
Pty NOT_PALCE; FOUINDATTON ON FII.J., DO NOT ENCROACH ON EASEMENTS.
SEWER PERMIT k 33404 ( 1(b)) 2 bath 9 trans glmr:aga 440
OCC.LOAD FLOOR LOAD 40 HEIGHT t NO.STORIES - z AREA 1,41 R NO.BEDROOMS 7 VALUE 629171n
BUILDING DEPARTMENT SETBACKS FRONT 20 REAR LEFT SIDE ! RIGHTSID_E _ 7
Permit .1119..00 _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
- REGULATIONS AND ALL. APPLICABLE CODES AND ORDINANCES, AND IT IS 14EREBY AGREED THAT THE
Plan Check 207.35 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 DGI:S NOT WAIVE
Sub-total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 1.3 . 7 2 .... . ,;
SDC— Gf10»O(► O,,
Total 39-6.4 .,
PDC# APPLICANT OR AGEN1
BY -lew -24 40.00 150.00
FTduqSx Receipt No. AS S
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractors f3
N
Permit o.
S3s2..
RoughAN,
—
�� z Fixture
Final --_
HEATING
Contractor
Permit No.
Rough-in
Final
--- — SEWER
------ -- -- Final 11 T~ -.2=,*J
— DRIVEWAY
Final
Storm Drainage
(Rein Drain),Final
-- Sidewalk, i lyd
Curb&Street Final
Approach
M.DG. DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
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