11815 SW SUMMER CREST DRIVE 11815 SW SUMMER CREST DRIVE
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CONIMUNITY DEVELOPMENT DEPARTMENT
1352,SW Hall Blvd-P.O.Box 23397,Tlqarc,Oregon 97223.(.903)3394175 DA1 L. /J. C-39
11.181.5 ISW OMMEA (: PEST' DP
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DIAILI. [ . 1241 f!:I RLA/COMP
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1 11 10 11 . I !�)03) 6349 to l ')7I l I (AX III tab
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ThiF permit is Issued subject to the regulations contained in Title 14 NO . /6)09 7
....................... .........
of the TMC State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances. and it Is hereby D :1:NSP14-1,11014S.'
agreed that the work will be done in accordance with the plans and I.NI'-
specifications and in compliance with all applicable codes and 1:10iii I' & Iia):FAM
ordinances The issuance of this permit does not waive restrictive it H.411- -1.N
covenants Contractor and subcontractors shall have current ci,y
business tax permits This permit will expire and become null and
void it work is not started w!thin 180 days.or if work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to ISSUre
all required inspections are requested and approved
Permittee Sign;.ttjrt,
Issued By 77,1 1 1 1 In W-1—V --, -3
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
�.Immw=
CITY OF TIGARD MECHANICAL. PERMIT Receipt#�n
Permit #
Description -- — —�
` 'fable 3A Mechanical Code _ QTY PRICE_ AMT
City of Tigard 1) Permit Fee -0- 0- 10.00
13125 S.W. Flail Blvd. _
P.O. BOO 23397
Tigard, OR 97223 �2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
incl.ducts&vents 6'00 J0
Furnace 100,000 BTU +
RESIDENTIAL FURNACE 82,000 2) incl.ducts&vents 7.50
Name of Development ) Floor Furnace 6.00
GLADYS DAVIS 3 incl,vent _
Job Address 4) Suspended heater,wall heater 6.00
Address 11815 SW SUMMER_CREST or floor mounted heater
Tax Lot Map No. 5) Vent not incl.in 3.00
.-Of Block Subdivision _ appliance permit ^
Name(or name of business) _6) Repair of heating,refr Ig., 6.00
CLADYS DAVIScooling,absorption unit - -
Mailing Address — PhoneBoller or comp to 3 HP
Owner 11815 SW SUMMERCREST 639 8157 7) a`isorp.unit to 100,000 BTU 6,00
City'state Zip 8) Boiler or comp to 3 HP-15 HP 11.00
TIGARD OR 97 22 3 absorp.unit to 500,000 BTU
Name Boiler or comp 15-30 HP
AAA HEATING_ & COOLING INC. t3) absorp,unit'/z 1 million 15.00
-- -'--�- Boiler or con to 30-'30 HP
Marling Address Phone 10) p 22.50
2915 NE UNION AVE 284 2173 absorp.unit 1 -1.75 million -
Contractor City State — Zip 11 Boller or comp to 50 HP 31.50
absorp.unit 1,750,000 BTL_I
P�RTLAIIfD, OREGON__9721 __ Air handling unit to
State Registration Nr City Bus.Tax No 12) 10,000 CFM 4.50
222 1184 --
I hereby acknowledge that I have read this application that'.no handling unitne information given is 13) 10,000 CFM � 7.50
correct,that I em the owner or authorized agent of the owner,that plana submitted ere in
compliance with State laws,that I am registered with the State Bi lldersBoard.that the 14 Non portable 4,50
number given Is correct (If exempt from Sta.: egistration please give reason below). ) evaporate cooler
15) Vent fan connected 3.00
_- to a_single duct _
-- ----------------
-- 16) Ventilation system not 4.50
included in appliance permit
- 17) Hood served by 4.50
mechanical exhaust
Signature(ow ter or t) OHN $p�f,A �9 Date 16) Domestic type 7.50
Describe work [-I addition 11 alteration 1 1 repair 11 Incinerator -
to be done _ residantial A _ non-residenAl I I _ Commercial or industrial
Existing use of 19) type incinerator _ 30.00
building or properly INSTL NEW CAS FURNACE _ 20) Other i.e.,woodstove,water 4.50
Proposed use of heater,solar,clothes dryers_,etc_
building or property- RESIDENCE
21) Gas piping one to four outlets 2.00
Typo offuel- oil I 1 natural gas ! LPG electric F1
22) More than 4-per outlet
NOTICE SUB-TOTAL 1.6,00
THIS PERMIT BECOMES NULL AND,VOID IF WORK OR CON- - -- --
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 _ 52 4%SURCHARGE X80
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REV" v..'25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER --- -- - --
WORK IS COMMENCED. TOTAL 16,80
Special Conditions
Date issued
I,
459
BUILDING PERMIT ArPLICATION TIGARD DATE-_--.�� '`3— 19---
z��i-c,axo
THE LINCEnSIGNED HFiiCBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INnICATED BUILDER PHONE 238
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. LOT O PHONE
OVr'NER Ila _�I�►Via JOBADDRESS 11,` 15 S4?5uw;utrGrest - ARCHITECT — —
Ymc'i f is Fire b ,u,,oke _ ENGINEER
BUILD
ADDRESS ESC 1 1 :'}'. Orron St _ DESIGNER
ER —
STRUCTURE L.1 NEW ❑ REMODEL Ll ADDITION ❑ REPAIR ❑ RENEWAL ED FI FIE DAMAGE _ ❑ DEMOLITION
};RESIDENCE G7 COMM ❑ EDUCATIONAL f, GOVT C] RELIGIOUS ❑ PATIO Fl CAR?ORT ❑ GARAGE ❑ STCRAGE ❑ SLAB❑ FENCE
� _ti 1=IRE�ut.E PLAN CHECK BY HEAT
OCCUPANCY �._LAND USE ZONE i -• BLDG.TYPE _.—_ --—
hepai.r fire da:jai;e to N iT�'Jf` [a_}ily dwell in#.
I
(attached �"arw,'e — 1
SEWER PERMIT M ------
OCC.LOAD FLOOR LOAD _ HEIGHT N(; 'JOHIES__ AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR
LEFTSIDE RIGHT SIDE
— --
Permit ri 116.w THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLI= CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check —+ — WORK WILL BE DONE IN ACCORDA14CE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
-- WITH ALL APPLICABLE CODES ANI) ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal
r •' it RESIRICTIVE COVENANTS. CONTRACTOR AND SUBCONTRACTORS IO HAVE CURRENT CITY BLI31NESS
� LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax SDC— Y' "�,�' .•,
I '
Total PDC# rnrl 1( near nn nGFNT
By
-- Receipt No. PHONE
Approved ADOREl38
- 1-- I - -
DATE INSP. TYPE INSPECTION REMARKS I PLUMBING DATE
Contractor
Permit No. -
- -------�._..
Rough-in --
-- Flwture
Finul
HEATING
Contractor
Permit fro.
Gas or Oil
Roullh•in
-- Fine
SEWER._ ._
DRIVEWAY
_ _�_�. �.•- � Final
Storm Drainage
(Raln Drain)Final
Sidewalk
rT— Curb&Stract Final
f _ Approach
BLDG.DEPT.FIINAL �� TEMPORARY CERTIFICATE OCCUPANCY final
�1?RTIFIC ATE OCCUPANCY -
i ILandscaping
Zoning Final
f
BUILDING PERMIT APPLICATION 'nGAFtO DATE
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE kXOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE •=- +%i
�L,7 xtr-170 j LOT NO.
OWNER _.•`� I JOB ADDRESS
ARCHITECT
_ t ENGINEER
BUILDER ADDRESS '� -�� •DESIGNER Y
STRUCTURE ❑ NEW ❑ REMO_0_5L ❑ ADDITION 0 REPAIR ❑ RENEWAL _ Q FIRE DAMAGE ❑ DEMOLITION
Q RESIDENCE ❑ COKIM ❑ EDUCATIONAL Cl GOVT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ G;RAGE ❑ STORAGE ❑ 81-AB❑ FENCE
OCCUPANCY - _ LAND USE ZONE �_BLDG.TYPE – FIRE ZONE PLAN CHECK BY _ HEAT-` _
_ may /.e �_ gs; _ _AJ c _f• _—
j -
SL=WER PERMIT M
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUF- # '
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit THIS PERMIT IS ISSUED SUBJECT TO THE REGUI ATIONS CONTAINED IN THE BUILDING CODE,ZOK!N;
REGULATIONS AND ALL APPLICABLE CODES ANA ORDINANCES,AND IT IS HERESY AGREED THAT THE
Plan Check - WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINIANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV3
Sub-total RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
Stata Tax
SIK_
Total —.--.--.__-.-_-
PDCA APPLICANT OR AGENT
BY .
–' Receipt No.
Appmv� ADDRESS PHONE
SDC _._ -
PDC
SEWER CONNECTION 9
SEWER INSPECTION S
SEWER SURCHARGE S _ _
PERN,�T TO COINFECT
Tigard Sanitary District
PERMIT N9 t t 85 AAT6
PFR311T IS GWEN TO l -c,�a,jjcjEo�d��_
OF
�r
TO CONNECT A
TO THE SYSTEM OFTIGARD SANITARY DISTRICT
AT dad 4-
THIS PERMIT MUST HE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $,i` ..........................
TIGARD NITART DIST ICT
fO /
2, By
ij
a�wwn
CONNECTION INSPECTED AND APPP,({VED
Date — -- Superintendent
I
1161
Address �-,jPermit No.
Permit charge —
Owner �� b �. � — Connection fee A,:r4? -
Paid by
'type of Building__ _ Date con,iected /-x_4o e,.r
Service Rate Inspection fee /0
Contractor — _- -v� Paid by 4 _ _ Date-�
Size of connection_`, —� Assessment Paid
II
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