Loading...
11665 SW SHEFFIELD CIRCLE 11665 SW SHEFFIELD CIRCLE w 1 I Wl r"1 J N U ,b Q1 W N 3 V) U) 0 �O INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Gregon 97223 Phone: 639-4175 Typa of Inspectioit Det Requested_— --7 Time x A.M.—P.M. AddresL� r= Permit s Owner . ------ —------- _ Lot — Builder The following Build':--, Code dericiencies are required to be corrected: Presentcd to Approved Inspector T— - — L1 Disapproved Date % L CUL FOR REINSPECTION 0 YES ❑ NO 4MECIAANICAI PE AM I T C17Y OF TWA RD = �LRD PEIRMIT NO. ME811131'423 %,;OMrOtJNITY DEVELOPMENT DEPARTMENT DA*1'1-'.: ISSUED: '7/19/NET 13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223,(503)639-4175 PAJM. PMT.NO. 881423 JUL4 ADDRESS .1.1.665 SW 15FIEFFAAH'I 1) C I P "I AX MAP/I..01 SUET : I T : BK : L AND USE LOT S1:71.*. : ITEM : NO : NO: WUPK CLASiS : 141.. IV,41ATION FLJWNACF:: 0.00K AIP HANOLP <1 0 USE. IYPIE : SINGI L". F-AMT11 Y F*UPNACA_:: 1001<+ A114 11-11ANDII-P 10K CONSI VN F-1.00141 FURNACE EVAP .COOLER UCCUIP Gpi:" . : 113 HE A TE 14 VENT FON VF:'N1 VENT . SYSTEM F.",1—1.1 C 0 M P <'311--Ip HOOD NO . !-)'T'OA1E;.5 : UL.P COMP 3-11-511"IP TNCINE:PA'TOP(DOM DWI;.;.:i L. .UNITS : 13L.P/CoMil" 1.5-3011-41', I NC INEPATOR(CON IJI::.I. TYPE WOOD DI-P/COMP 30-501-11P PI;J)A".I:P UNITF MAX . INPUT 1;1L.A/COM1---' 504.1--lP 011-11R.:14 ITPING OUTL.E.TS I UW PRESS7 PEMAPI(S Gam-Fr.ir,t. 011.50 in c4xitit'ing 111fd ci I u n 1:A-"PMVT $1.0 00 0 f;) W 11.1665 lim LAN VILVII.-i'M N t'it tJ I IXTUPIES E Jin.r. R r)HUNE (50*.1) 6Z49-6796 I AT11]: TAX 0 i-liz:A C 0 N T R A C T TOTAL : *15 P-*..s 0 PEOMIPT NO. 3 F?6 9 1. This permit is I35LJe'J subject to the regulations contained ri Title 14 of the TMC. State of Oregon specialty Co les.zoning regLJIRUGIIS and all other applicable codes and ordinances, and it Is hereby agreed that the work will be done in accordance with the plans and OTI-11ER111111 specifications and in compliance with all applicable codes and ordinances The issuance of this permit does not waive reoictive covenants Contractor aiw subcontractors shall have current city business tax permits This permit will expire and become null and void if work Is not started within 180 days,or It work is suspendld or abandoned for A period of 190 days any time after work has commenced It shall be the responsibility of the pei mittee to ass�jre all required Inspections are requested and approved (I V\5 Penn t r e r-*OP INSPECTION 639-4175 Issued By SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE COF OCC�'AlC -ISO-1 T CE1 CITY OF TIGARD OREGON Pine T_ee ndusir_.es No. 6784 Owner: Permit o. 24300 SW Rosa Rd__iii1 r OR 97123 , Building Address: _11665 s]Q£f iQ j A r-; rc le — ✓t R12PD 5N Occupancy: R3 .:anc. Use Zone: Bldg. Type Comments iot 39, �3rittany Square 2 ' Certificate is ereby given this 2nd day of May , 19 ` �., =' ! that said building may be occupied and that it complies with all ', 1j = _ requirements of the Building Code for the Ci of Tigard. as aPPrLedty r_ by the Tiga-d City Council. 41 t Fire Dept. Building Inspeeto Building Official N -00 N. $a Post Certificate in Conspicuous Place �r 1��' � ~4. -a��^� - / ♦.� - rico - _ �' _ �t�` i INSPECTION NOTICE City of Tigard Buildin, Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested Time k' __ A.M._ P.M. Address F'/tee- -�—_ Permit Owner _ —— Lot # __ Builder the following Building Code deficiencies are required to be corrected: 4 c,�► �U c l�� vd„a�J al ►. ;, �c�,�,� sou��--_-_ =jai L e. Presented to _.. n Approved Inspector �/ (V I %� Disapproved late CALL FOR REIASPECTION ❑ NO t IBM INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 �--� Type of Inspe `on Date Requested —_—__ ____ _L ---- ��m�� -�---_A.M. P.M. c� Address l -— Permit --- Cil Owner 1��—a-.r _ Lot # ._ __ - Builder The following Building Code deficiencies are required to be corrected: V --- -. Presented to — ❑ approved Inspectcn __ _—._.. ❑ Disapproved Date — CALL FOR REINSPECTION YES ❑ NO g-_-�.. 8 BUILDING PERMIT APPLICATION � DATE ---- - - - --' THE U�'DERSIGNED HEPEBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATE? BUILheR P'AONE 6 -�-- ON AS�;HOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. 1007 VINER PHONE �=� JOBADDRESS 116Fs�L'`W�hA , F- Cla OWNER lei T - ARCHITECT S-07 24300 SW R0541 F'.(' ENGINEER A. 1w1ascor d 2.11)8 BUILDER 53YTl x0030440 ADDRESS _ _ –Q1023 DFSiGNER _ STRUCTURE Q(NEW ❑ REMODEL ❑ ADDITION ElREPAIR ❑ RENEWAL ❑ FIRE DAMAGE 1-1 DEMOLITION RESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑_CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE – =_--— – OCCUPANCY LAND USE ZONE BLDG.TYPE _— FIRE ZONE�—PLAN CHECK BY ------HEAT–.,–,--- �:�n:;� xuc t atnq.le fatniZ ctw I, ng W a nrl L (jar:age,-IjZT pe i3p Subject tzs $5 �„cxle. Subject to AmnrC 1#5n.00 sewer �urchar.c��. 33465 ( ]-dc>I) 2 batTi6$trans . rtayTBr- SEWER PERMIT# .-- OCC.LOAD *$ FLOOR LOAD 4 n HEIGHT 20± NO.STORIES 2 AREA 13 3 3 NO.BEDROOMS _3 VALUE BUILDING DEPARTMENTSET BACKS FRONT 20 REAR 3P LEFT SIDE –].0 RIGHT SIDE – 6 Permit -)NS 6 t 00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULA111' �7NTAlItED IN THE BUILDING CODE,ZONING 2 05 /�r A(0 REGULATIONS A190 ALI. APPLICABLE CODES AND ORDINI NOES, AND IT IS HEREBY AGREED THAT THE . Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANE AND SPECIFICATIONS AND IN CCRAPI_IAI•N WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WNIVE Sub-total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS LICENSE.SEPARaTE,F8RMITS REQUIRED FOR SEWER,PLUMBING AND HEATING. State Tax 12 .64 - — — soC— 60b.0p Total 534 .04 -- PDC# PPLICANT OR AGENT BY dg . t(10.00 _ T. 150.00 Approved tam 434.04 Receipt No. ADDRESS DATE IN'SP. r YPE INSPECTION REMARKS PLUMBING wq nATE Cont actor Permit No. J4-X. RoLgh-ln T Fixture 7 / !7 _ - kt Final - /-e7 J pCtA cL�ap HEATING Contactor•0 �t-0 3.tZ •• 7 �,�� � v� ,eA.,d - Permit No. l Gas or Oil [ _ ✓�'}„� Rough-Inv - - 71 ____- Final SEWER i - -7 _ DC7 ���� _ Final �j ._"=�-+� `�,4+C/� �J� - - DRIVEWAY -- ` •� - of/hl�a oN Se led G C d_j d t s C [Final Storm Drainage (Rain Drain)Final �----- [Sidewalk Curb&Street Final Approach BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY OCCUPANCY Flnel CERTIFICATE -_ Landreepir Zuniny Final P.O.soot 233W CITY OF TIGARD PLUMBING JU25,cW WU IU%fl Applicants must hold t)reg(n pegistration to corntucl a plum'Ang PERMIT business or must be properly owner/operator rx)t hiring outside h.al hal �(I 1 NadCir w _ Numbeint Permit No. I,,? - � // MS c 1�%t",��(�AddrouC�./ - ORS S 81 21-610__ QUAN. Pi�K'E T_ Job Tax Lot Map.No. "'idrsse (FIXTURES _ -- C Nod, ScbdMslonShk - ------ � 7.5� Sa _ ---- r __ �s� 7.50 ��- V arta(OfAWM� �+� 7.50- � ,/L C �� C �-/U/►�� ) Tub or TuWShowdr Corral. I ,'�'G�- "� Shower Oniy 750 %rU �• /J/J( 1`",U / - 7.50 5< Water Cbsel Owner City/. . Z� -— ---- 7.5o I1. Dishwasher ---- -� --,, -- Phone Garbage Disposal _ - 7.50 - _-_ Washing Machine / 7.50 arta -- 7.50 Fbor Drain - 1�ailKig mess - -Phone 50 Water Heater _ - Laundry Ro)m Tray Occupant Gt/ISlaie zip 7.50 Urinal - -- ---_- Other FKtxea(Specify) 7.50- -- - - E� --- 7.So i;ontraclor WSCELI NEOUS ( > Sewer tai 1W 30.00 r 8.,..;....Ad&.100 15.00 -3T�o�_- -3Z■`ii erste- -�Wa - .� 20.0020.00 ( a1) ter Sonfice 1t 10 a0' - I hereby adwv*Mdga ODM I Mk Mrs rend OAP 2W :aSM that I* wabr Sarvloe a&Ad*X0' 16.00 gN«+is con M nal I&,,fegWiv#J wi1h Die State 9t*dar'e Soerd.r. *0 Storm&PAMn Drain td.100__ -- hew a Stell Pkmt*lg-o tt o the rteimbere 0~are oonsd.tho ally.,�m fl PMit Orafn AddM.100' 43.00 pkarbirq work wN be daa x In orwm% e with a V&*bie pr N%k)ow of Ort _- _ - --- wn Revised SU*Aae C*wwfm"Ni aril a:h erg ePPikM� ea e oodand tl+at hlaYNe�, 25.00 no help w1 to errlldoyt d u>Mwa Wxneed kinder ORS 693- (If emonvi tram —�- -- - Staw rookwWoon,phrase give reason bakw). Bade Flow *42okon 7.60 WmeoVIRam-1 hush)'ram*Oral I tn►Oa owner of M property de ��e or Ar1wPo2tAlan Uerioe --- aattad Aboaa.11111~ha-ha I prop0ot110 malar a pMrr+bMlp ktasararon lrx Airy Trop or weele Not 7.60 tali t>Astt tlss all OIU propery M nal MMIO eonaln+died star a11e.ieass Dir rent Qwvooled to a Rxlass _ C4*:h chain ?so r�..... -- kwo.of Eidet.PwRoft^�- 40.00 Per Fir. Pit Mr - _ Alla.of Pkwb"nwllldn or 161ft A,idlMan WlMl tf►tr�_ c)C4NX"work rww I[] oddg0ft[] 4"0800n❑ fOPSw❑ EXW ,tnw Of IlLodk Or PmtwtY Ley—, 4►_._...______*Y110� _._.__.. _ L �t�111bI0�111wow �,ll IM�tM116111�1. DGW wu.d CLAN Oir_t t\ NU, for inspections call 679--4115 PERMIT NO. �i' rS ` MY OF TIGARD 639-4171 DATE BUILDING P��,MIT s__e��-,L P.O. or 2 97, 'Tigard OR 97223 TAX MAP _______„_,LOT NO. EusaVl><S wN OWNER •/I, �. -� 1? N �� h ;i�. JOB ADDRESS BUILDER STATE REQ.NO. BUILDER'S PHONE ARCHITECT. tAA f," (,a, PHONE OTHER STRUCTURE I.NEW O REMODEL. Q ADDITION ❑ REPAIR 0 MOVE ❑ OIItER t7 DEMOLITIO'l C, RESIDEW;E ❑ COMM 0 EDUCATION Q IND O RELIGIOUS, ❑-ACCESSONY ❑ GARAGE ❑OTHER ❑ FENCF OOMPANCY ,�=LAND USE ZONE BLDG.TYPE .iti ~' FIRE WNEr....1,l.AN CHECK BY L I,*AT Construct single family dwel l ina wLU'a�aa�ana--=] I ppc a4iµra'fad P! mQ6 -- --- qnhiprt Lo 85 code, A SEWERPEAWTI, .j_�y4 `� '(Idu) baths. ' tr �aarayC_a_Lr-a_. OCC.I nA0 FLOOR LOAO� HEIGHT NO.STORIES AREA NO.BEDROOMS BUILDING DEPARTMENT REAR 'K LEFT SIDE RIGHT SIDE SET BA��FRONT � IN mth - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE WILDING (:ODE. ZONIMG REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES,,AND IT IS HEREBY AGREED THAT THI FUn Check C S. 5l WOVIK WILL BE DONE IN ACCORDANCE WITH THE►LANG AND SPECIFICATIONS AND IN COMPLIANC( WITH ALL APPLICABLE CODES AND ORDINANCES. T14E ISSUANCE OF THtS PERMIT DOES NO( WAIVI PL CIL Fki RrSTRICM COVENANTS.WNTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS TAX PERMTTA SrPARATE PERMITS RFOUIRED FOR SEWER,PLUMBING AI10 HEATIN(L Slate Tu /,;t . SSOC SDC— ( �� � , Lo C,�(c5 ..-- roufj ,�[ ,6_�L APPOCANTOAAGF.NT PIX:1 Pf*pd. "L, ,5 c-,c, .)U__� J'>-o S A W,,cslpt No ADOR SS t^N NI Igmuc4oy_ -..-----._Approv*dBy SSDC - S - sor. - f RECEIPT POC_ - L_. - DATE PD. \ 5CWER CONNECTION AMOUNT PD.� SEWER INSPECTION S ��. .. —, A"V SEWER SURCHARGE 5 �:_ ammenta� OWN ������ CITY OF TGARD BUT NG DEPARTMENT PLAN CHECK NO. : PLAN CHECK APPLICATION LATE RECEIVED: P.O. Bax 23397, Tigard OR 97223 P/C DEPOSIT PAID: This is to certify that the attached sets of plans have been submitted for plan check pursuant to the Oregon Structural Code and Fire & Life Safety Code, -�5' edition. °ROPERTY OWNER: L��! ��-- OWNER'S ADDRESS: _ CONTRACTOR: �G=-�7t-�'�,� _ TELEPHONE: U JOB ADDRESS: fes/ ;�yCcGf'� LOT NO. & MAP: x,0221 DESCRIPTION OF WORK: "�12.t�✓' � Arovals Required SPECIAL NOTES OPlanning Depe. O Reissue O Engineering Dept. 0 Flood Plain/Sensitive Lands OFire District 0 Sewer Availability 0 Other 0 Other Items Required �1 0 List of subcontractors OBusiness Tax Ll Calculations Truss Details 0 Parking Plan 0 Landscape Plau 0 Other COM?%NTS: City of Tiprd Building Depa:taent BYt BUILDING PERMIT APPLICATION TIGARD DATE _MaY 2S 19 d!) _ 5390 THE UNDERSIGNED HEREBY APPLIES Fr)R.A PERMIT FOR THE WORK HEREIN 114DICATED BUILDER PHONE 644-2762 _ OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS �tAND PEC FICA TIONS. OWNER PHONE_ OWNER L;ertury 41 JOB ADDRESS '" r "�'e LOTN�O. _ Tualatin 'i7Ufi� wr RCHITECT NGINEER BUILDER Seats ADDRESS 7160 SW Haulf:rlo Rd. DESIGNER STRUCTURE D NEW ❑ REMODEL Cl ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION 13 RESIDENCE Cl COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE OCCUPANCY _ �-3 LAND USE ZONE K"20 SLDG.1'YPE 5tV FIRE ZONE_ _ PLAN CHECK BY L1GR_____HEAT construct aigg?e family dwelling W attaehed &&rage 3 Bidroom 2 Bathroom 5aty'ect 'co 150.00 lemn Height 6 36U.00 Amer tlWedgewood Sever Surctiarge SEWER PERMIT(# 2$431 JA, Garage 396 _OCC.LOAD FLOOR LOAD 40 HEIGHT y-17' NO.STORIES 2 AREA 1856 NO.BEDRL As 3 VALUE 65,500• BUILDING DEPARTMENT SETBACKS FRONT REAR 26 LEFTSIDE RIGHT SIDE Permit 331.00 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED 1N THE BUILDING CODE, ZONING REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE Plan ChecY. ?15. 1,5 _ WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH ALL APPLICABLE CODES AND ORDINANCES. THE iSSUANCE OF THIS PEF.`�!T DOES NOT WAIVE Sub-total 54b.15 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING. State Tax 13.24 fl.-,U.(.10 Total 559.39 SDC- 5(1).00 PDC# J j 150.00 ,__ NT OR AGENT By �U -- I �,-�,.- � Receipt No. r _ . r,•+r. /, 1 _ � � " i. 'cf_�`,,�,. �i- Approved scl ADD ES$ PHONE TDATEa INSP. TYPE INSPECTION REMARKS II PLCiMO1NG _— DATE - �L✓�__..___111Q–SYO1l.�___1�� s l*----�":r croy`.—__+�__ `� Fixture I — ---^--•-•-•----- Final _— Contractor permit No. __– ..__ Get or 011 Final ^I Final DRIVrWAY ^— _ (Rain Drain)Final Sidewalk -- Curb&Stroet F,nal --}� Approach EILDG. CEPT. FINAL TEMPORARY CERTIFICA'iE OCCUPANCY CEPFIFICATEMICUPAN Y I if Final –�–Y-- Iil Landscaping Zoning Final -- BUILDING PERMI i APPLICATION TIGARD DATE -- - ---- 19-- C/ THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INOICATEO 9UILDER P•HONE412a2 OT SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE OY/r1E ' JOB ADORE.SS ` � -- i !.ICHI TELT �-- �NCINEER / DESIGNER BUILDER ADDRESS /rc'd S, – STRUCTURE g NEW – ❑ REMOOF-L ❑ AOOITI(,N 7 REPAI ❑ RENEWAL ❑ FIRE OAIAAGE ❑ OEr,fOLll RESIDENCE ❑ com.m ❑ EDUCATIONAL ❑ GOV-T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT C] CARAGE G STORAGE ❑ SLAB❑ FE C7;�i1i'ANCY _--LANO USEZONE ._-._-. r BLDG.TYPE FIRE ZONE PLAN CHECK BY HEAT= I. ,l SEWER PERMIT M J OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VtJ_UE BUILDING DEPARTMENT SET DACKS FRONT REAR LEFT SIDE RIGHT SIDE Ptxrrttt THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS 0'ONTAINEG IN THE BUILDING CODE,ZOO REGULATIONS AND ALL APPLICABLE CODES AND ORDINAtICES, AND IT IS HEREBY AGREED TFAT P11 an Check WORD WILL BE DONE IN ACCORDANCE WITH THE FLANS AND SPECIFICATIONS AND IN COIAPLIA WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT W Su"o_fal RESTRICTIVE COVENANTS,CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSIA LICENSE SEPARATE PERMITS REOUIREr FOR SEWER.PLUM '.rlG AND HEATING. ;Stats Tax — Total PDC R APPI CANT OR AGENT By _.-- – Recolpf No. Approved ADDRESS —--- -- -- "tNti -----_–_ SDC POC — � SEWER CONNEC'IION b SEWER INSPECTION $ SEWER SUFCHARGE S �•- /yam / �� , C� 1N AIL 3 2 u O /.Z c�0 2xG — i2 /.2 7 D i,2 74 o - i _3 7 ,see GS_Pi � OOP' t,l'PEit' - SNING(.CS Z• Z N-r - s qh, '` G Ertl/vt� i r'. C",Ao Ps r S o / / A Building Permit No. I_ocat ion _� 66 " Oat v - - "— Certification of Registration With the Builders Board doing business as (dba) , am registered under the provisions of ORS Chapter 101 Oregon Nomebuilders Law) . My Builders Board Registration Number is My registration is in full force and effect and expires on C � 1 ig ature BUILDING RECEIPT NAME: ,C c�I DATE: _ ACCT. N DESCRIPTION AMOUNT 10-432 Building Permit Foes 10--431-600 Plumbing Permit Fees s 10-431-601 Mechanical Permit Fees 10-230-�►01 State Building Tax 10-433 Plans Check Fee s _30-443 Sewer Sewer Connection (20X) 30-202 Sewer C nnection (80X) 30-444 Sewer InsFertion 51-448 Street System Dev. Charge (SDC) s L/ 52-449-610 52-449-610 Parks I System Dev. Charge (PDQ 52-449-620 Parks II System Dev. Charge (PDC) 31--450 Storm Drainage System Dev . Chrg (SSDC) 10-230-505 TRFD (95X) 10-470 TRFD (5X) 10--230-506 Washington County Fire N1 (95X) 10-478 Washington County Fire N1 (5X) 10-220 Amart/Wedgewood TOTAL =. (bs/1214P) CITY OF TIOARD .MECHANICAL PERMIT Receipt M _ Permit#. oescriptlort - Table 7A Mechanleal Code QTY Pf"CE A&T City of Tigard 13125 S.W. Hall Blvd. 1) PermitFee -0- -0- 10.00 P.O. Box 23397 - Tigard, OR 97223 2) Supplemental Permit 3.00 539-4175 Furnace to 100,000 BTU - 1) incl.ducts 8 vents 6.00 Furnace 100,000 BTU + 2) incl ducts&vents 7.50 Name of Development -- � Floor Fumac e 3) incl.vent 6.00 Job Address � ) 6.004 Suznerkted heater,wall heater — Address v° , -t v��f1 P �� C�A or floor mounted heater _ I Tau Lot Map No. Vent riot incl.in Lot Block Subdivision 5) appliance permit 3.00 Name(or name of business), Repair of heating,refrig., k '(. 6) cooling,absorption unit 6.00 Mailing phptw Boller or comp to 3 HP Owner �) absorp.unit to 100,000 BTU 6.00 cnyistate ZIP 8) Boiler or comp to 3 HP-15 HP 1100 absorp.unit to 500,000 BTU Name 9) Boilor or comp 15-30 HP 15.00 - absorp.unit 1/2-1 million Mailing Address Ph(M10) Boiler or comp to 30-50 HP absorp.unit 1-1.75 million 22.50 Contractor City/Stale Zip 11 Boiler or comp to 50 HP absorp.unit 1,750,000 BTII 31.50 state 14eg+a(1800n No. -` City Bus.Tex No. Air handling unit to 12) 10,000 CFM 4.50 1 hereby acknowledge trial I have read this appl+catbn that the information given Is 13) Air rtandling unit V 10,000 CFM + 7'50 correct,that I am the owner or authorized agent of the owner,that plans submitted are in — — compliance with State laws,that I am regisierwi with the State Builders'Board,that the 14 N)f,1, table num4er given Is correct.(if exempt from State registration please give reason below). ) f,vaporate cooler 4.50 — _` Veot fan connected ��f 4 - 15) to at ingle duct ------------ 3.00 - e,tt 2.�of / - - Ventilation system not — 15)) included in appliance permit 4.50 H("1 ser.,A by 1�) mechanical exhaust 4.50 Signature(owner or agent) Date -i Domestic type i--- - --- - Describe work El addition ❑ alteration E7 repair [-I8) incinerator 7.50 to be done__ residential ❑ non-residential ❑ Commercial or industrial Existing use of 19) type incinerator _ -- 30.00 building or properly _ Other i.e.,woc Jstove,water Proposed use of 20) heater,solar,clothes dryers,etc. 4.50 _ hulloing or property___,------_ 21) Gas piping one to four outlets 2.00 Type of fuel- oil [.I natural gas 11 LPG [I electric n J -- 22) More than 4 p,-r outlet. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- ----- - SUB-TOTAL -- STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 _ 5�;� 446 SURCHARGE DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL ABANDONED FOR A PE 1IOD OF 180 DAYS AT ANY TIME AFTER -- -- -- WORK IS COMMENCED TOTAL Special Conditions Date issued by