11825 SW MANZANITA STREET 11825 SW MANZANITA STREET
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IN O'-i WN NOTICE
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of InspectionDate Requested----Request�e�d�_[—___-. Time
.Address __.._J-!_LZ — 1 �, -;�� -y 1 '1 T��Permit
Owrer_._—_ .__ ^� —. _.-_ Lot _
BuilderThe following Building Code deficiencies are required to be corrected: #
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Presented to -- f`Poroved
Inspector �� —__ �- Disapproved
Date —
CALL FOR REINSPECTIM'
El YES M- NO
,•• • ••• aur+nv I r—%or AN1L;AL I LHMIT
Permit#r ` �-
w.�rlPrAa„ ----
City of Tigard Table 9A r11400*nlcul Code OTY PRICE AUT
1312.5 S.W. Rall Blvd. 1) Permit Fee -0- ,0- 10-00
P.O. Box 23397 —
'Tigard, OR 97223 2) Supplemental Permit 3,00
6s9-4175 -
F12)
Furnace to 100,000 BTU
incl.ducts&vents 6.00
-Furnace 100,000 BTU +
incl.ducts&vents 7.50
Name of t)"loa tFloor Furnace a~
3) incl.vent 6.00
Job `eea r v 4 Suspended neater,wall heater -
Address �. ) : yL ��?�t ,z t. ) or floor mounted heater 6.00
Tax Lot Map No. 5 Vent not it.cl.in
Lot Block Subdi%isfon ) appliance permit 3.00
Name(or name of buslrwss) —'— 6) Repair of heating,refrig.,
cooling,absorption unit 6
Owner Mailing AA,iresa —� Ff,ons 7) Boiler or comp to 3 HP --
`absorp.unitto 100,000 BTU 6.00
C alele — tF�--�— 8) Boiler or comp to 3 HP 15 HP
- absorp.unit to 500,000 BTU 11.00
Name Boiler or comp 15;90 HP —
_ 9) absorp,unit 1/2-t_million 15.00
M"a"o�a Phone 10) Boiler or cornp to 30-50 HP
absorp.unit 1-1.75 million 22.50
Contractor
ZIP 11) Boiler or comp to 50 lip
_ absorp.unit 1,750,0006TU 31.50
6 p''rort pM au..Tr,r nIo 12) Ar handling unit to
_ 10,000CFM 4,50
An
I htarrby. ,o,�adv.kOWI n.w reed IfW pp�cyon rrr Cie lormatlon given ,. 13) Air handling unit
oortst:l,CIA I will ft owner or MAhorl agwil of the owner,ctrl PWW wjbff*W we In 10,OCFM 4 7.50
00ml,.-0"VA%MUM I.w.,Irl I.m rrglnr"WOh the st■M&Aldsm'PAwd,Cwl M,e Non portable
rl llblir w odetiot.(C
Memo hem Slap mgbtrMbn W�gh'o mown tv bw) 14) 4.50
I evaporate cooler
— - - Vent fan connected
15) to a single duct 3.00
16) Ventilation system not
included i-n appliance permit 4.50
Hood served b
y
17
(owtwor.parNj ) mechanical exhaust 4.50
1011111111111
Donwiltictype
DeaorUs work addition[] alteration f] repair El 18) Incinerator 7.50
b be done --___ resldeatial EJ non-reeldendril ❑
Exile"use of ---- ----
Commercial or industrial
-
19) type incinerator 31.00
bulkiing of properly Other Le„wocxistove,Mrater
Propc*W use of --- �) heater,solar,6To6►es-dimers,etc. 4.50
buHg dir or property - -
- 21) Gas piping one to four outlets
Type of fuel- oil ( �--natural gas f 1 t_ 2,00PG I i electric i 1 ~-------
22) More than 4-per outlet
NOTICE -THIS PERMIT FIFCOMFS NULI AND VoILS IF WORK OR CON $US-TOTAL
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN ISO — Sjo 4%SURCUARt1E -
DAY;, OR IF CONSTRUCTION OR WORD IS SUSPENDED OR
ABANDONED FOR A PERIOD OF Iso DAYS AT ANY TiMF AFTER ------P�RE���'��'T��
WORK IS COMMENC*r"J `-
TOTAL
Special Conditions
-- 2_Ae issued . 10/rr-7--
Permit No.-- ,/40.27
Name of Occupant__ Per rnitc'IOTge
Connection fee
Paid by-
------ Date connected.
Type of Building
Inspection fee--/
Service Bale Paid by Date__
Contractor
Size of connection
� s �
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N° t027 DATE
PERMIT IS GIVEN TO --- -
OF �:-- ✓ -__ _ __ -
TO CONNECT A,
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
ATTHIS PERMIT MUST BE POSTED ON THE DERCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID g_... ............................TIGARD SANITARY DISTRICT
By
CONNECTION INSPECTED AND APPROIWED