11865 SW SUMMER CREST DRIVE i
VALUE FEE
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" :=UM:.r,le-rres� Dri e
LOCATION OW'vr.Fc_ `d w i n Gill
JOB MAP if LOT # TYPE
PFS..- Fri-!T-T 1: -
_ � --�
:EVFR PERMIT m - FEE S MECTJOICAL PERMIT
DATE I ( 3Y D.&TE
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EXCd:VATIOTI/FILL AIR CONDI'TIOKM rn
FOOT--r,IG FOU:MATIO;i "MITILATIONEn
v'
; FORMS j SFRI2*CLER SYSTEM
— I SLABS M9SU Y FIS c
RE=1 0RCIX FIRE �''(IORS m=5
_t TRUCT'Ja-a.L STEEL GARAGE FLOCEL
_ E PUDGM i R.i. DRIB;WAY n�
—�ROOF F:.ASHIX SEWEE rn
FRAME STORM DRAIN
WALL30ARD PAPICM
HE OG _ FENS. SCREEN ,
WATER HEATER FINAL
i
W rw jrjw t A
MMqTiOi NOTICE
City of Tiqard Building Department
13125 SN %all Blvd. Tigard, Oregon 9722.3
Inspection Line (Rec-o-Phone):JJ639--,.175 Business Phone: 639-4271
InspsctIon:. —
Foot+ng plbg. Underslah Mech. Rough-in Appr/Sdwlk
g•
Found.
Ylb Top Out Cas Line FINALS
Poet/Beam Struct, San. Sewer
Framtnq -Bldg.
Post/Beam Moch. Rein Drain
Insulation -plumb.
Plbg. Underfloor Water Lina cyp. Bd.
-Hoch.
Date Requested: Time:
PH
Permit
Addressy �/� J ✓t'��///Yi�/Yyf. ?�/s)y��'
v
Duilder:
THE FOLLOWING WRRRCTIONS ARE REQUIRED:
i�
inspector: �/ _ Dater
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITYrOFTIGARD -
MECHANICAL
COMMUNITY DEVELOPMENT' DEPARTMENT Cr111
PERMIT
moon � r�E.RMT'r #. . . . . „ . : 14EC91-O2O6
19125 SW HWI Blvd, P.0 Box 23307,Tayud,Onpon 07723(603)830.4176
SITE ADDRESS. . . : 11865 SW SUMMER CREST DR PARCEL: 1 S 1 34CD•--O8500
SUBDIVISION. . . . : BURLIAOOD NO. 4 ZONING-, R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :35
CLASS CF WORK. . :ADD FLOOD TURN. . . . : EVAP CC'OLERS;
TYPE OF USE. . . . :SF UNIT HEATERS. . - VENT FANS. . . :
OCCUPANCY GRP. . : R3 VENTS W/O APDL.: VENT SYSTEMS:
STORIES. . . . . . . . : SOTLER /COMPRESSORS HOODS. . . . . . . :
FUF.I_ TYPES -- - -- -- - -- 0-3 HC'. . . . : DOMES. INC:IN:
: /WOD/ / / 3-15 HP. . . . : COMML. INCIN:
MAX INPUT: BTU 1.5-30 HP. . . , REPAIR UNITS:
F IRE DAMF'El:;!S'?. . : �
+ 0.__50 F1F. . . „ : WOODaTOVES. . : 1
GAS PRESSUF"!E. . . : 50+ HP. . . . CLO DRYEV=,. . :
NO. OF UN I1"S•___._______ AIR IPNDL I NG UN I T'S OTHER UNITS. :
FURN ( 100K BTU: <= 10000 c f m : GAS OUTLETS. :
177URN ) =I 00K BTU: ) 10000 c f m :
RV,nal-ks : EXISTING W:JODSTOVE.
Owner,: _.___._________________________ _.__._.__.__ __..__. FEES -------____-----
EDWARD & ROSE SAJA type amoo-int by date recpt
11865 UW SUMMERCRES'i DR PRMT f 25. 00 JL.H 09/26/91 -
1' IGARU OR ",7223 SPCT f 1- 25 JLH 09/126/91 -
Phone #: 6`1-3848
C:ontt-actor:
C:ONTRAC.TOR NOT ON FILE
___----.-___-----
w6. 25 TOTAL.
REQUIRED INSPECTIONS --- —This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This per•3it will expi^e if work is not started — — ��—
within 190 days of issuance, or if work is suspended for more
than 18.0 days. -----
r-'e r m i t t e e Sir)„gat tar-e :
Issi.ted By :
Call for- inspection - 639-4175
CITY OF TIGARD RECEIPT OF PAYMENT RECEIPT 140. 191-217950
CHECK A*,IOUNT - 26.25
NAME WA, ROSE CASH AMOUNT : 0.00
ADDRESS 11865 SW SLIMMERCREST DR PAYMENT DATE : 09/26/41
SUBDIVISION :
TIGARD, OR 97223-
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
MECHANICAL. --------P-E ST. BUILD PER
WOODGTOVC PERMIT
TOTAL AMOUNT PAID 215
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inst fiction .. - — I
- --
Date Requester Time _ _ A.M. P.M.
Address !f Permit
Owner Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented to _ _-- (`- proved
Inspector ❑ Disapproved
Date -
CALL FOR REINSPECTION
0 YE9 l=7 NO
,.a
%A i Y ` r I IUMMU 1V11=ko"A1' II,.HL VCHIVII I Permit � l
Description
Tsbie 3A Mechanical Code _ _ OTV PRICE AMT
City of Tigard 1) Permit Fee -0- -0- 10.00
13125 S.W. Hall Blvd.
P.O. Box 23397 2) Supplemental Permit 3.00
Tigard, OR 97,023 - .
639-4175 1) Furnace to 100,000 9TU 600
incl.ducts&vents
Furnace 100,000 BTU +
2 incl.ducts&vents 7.50
Name of Uavelopmonl 3) Floor Furnace 600
incl.vent
Job Address 4 Suspended heater,wall heater 6 00
Address ) or f.,or mounted heater
/
Tax Lot Map No )` S Vont not incl.in 300
Lot Mock Subdivision jpliance permit
Name(or name of business) 6) Repair of heating,refr ig., 600
40 cooling,absorption unit
Mailing Address pitons _ 7) Boiler or comp to 3 HP 600
Owner 1VW,-f-S,n 1. 6-?tm absorp.unit to 100,000 BTU
oty/slate Zip 8) Boiler or comp to 3 HP-15 HP 1100
T7KAeb �,Z 3 absorp,unit to 500,000 BTU
-�- Name 9) Boller or comp 15-30 HP 1500
_ absorp.unit 1/2-1 million
Mailing Address phos. 10) Boiler or comp to 30-50 HP 22,50
absorp.unit 1 -1.75 million
Contractor Cltyrstate zip 11) Doiler or comp to 50 HP - 31.50
absorp.unit 1,750,i)006TU
State Registration No City Bus.Tax No. 12) Air handling unit to 4 50
10,000 CFM
I arx Air handling unit
eby �owbdgs that 1 haus reed this appkcauon that ets Information given is 13) 7 50
correct,that I am the owner or Authorized agent of the owner,that pians submitted are M 10,,000000 CFCF M— ++ --- ^—
cornpbance with State laws,that I am registered with the State tjuithtrs'Board,that the 14) Non portable 4.50
number given is correct.(N exempt from State registration phase gwe(enson below) evaporate Cooler
- ---- -=Q �` ---- 15) Vent fan connected ;'00
to R single duct
Ventilation system not
16) included In appliance pennit 4'50
--- , —� �17) Hood served by 4.50
mechanical exhaust _
sada(ewrtw or Agatha) 4 18) Domestic type 7.50
Describe work C7 addition O alteration Cil. repair El _ htdnerator _
to be done residential ❑ non-residential Ll _ 19) Crmmerciai or Industrial X00
Existing use of type Incinerator
building or property__1<W610 _ �) Other I.e.,woodstove,water
heater,solar,clothes d'yers,eta
Proposed use of
building or property_ -- — 21) Gas piping one to four outlets - 2.00
Type of fuel- oil [Inatural gas LPG C ^1 electric 1 I
-- -- — 22) More then 4-per outlet
NOTICE SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- -- ----
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S 06 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF BUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER -------
WORK IS COMMENCED. TOTAL
Date issued_ Q__ _by _
City of Tigard
INSPECTION REQUEST
for
Fi , C - E--
INSPECTION TIME: �v PERMIT NO. :
DATE: A-1- 1Z- _DATE ISSUED :_ .—!—
OWNERS NAME ; --
A DD R E S S: l `a1,�'1l— mirJ�RCAST-
CONTRACTOR :
,rt.I
CONTRACTOR :
TEST : Air ❑, Water❑ , Visual , , Laboratory ❑
I
RESULT' Dian ,��. .4 ..� ^ , »Pending ❑
SKETCH:
i
I
I
I
I
- I
D :E I
I
l
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :_��'3y _ PERMIT NO. : --.
DATE DATE ISSUED:-
OWNERS NAME
ADDRESS
CONTRACTOR :__ - ----- -- - --- -- _ --- ---
1
J
TEST: Air ❑, water ❑ , Visual, Laboratory ❑
RESULT: Approve , Disapproved ❑ , Pending U
SKETCH* �'D 7
44 Jill 7�1
INSPECTOR DATE
[NOTE : Attach supplemental test date heret]
r �
CITY OF TIGARD
G
12420 S. W. Main Street
TIGARD, OREGON 97222
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING DATE ISSUEDBUILDING PERMIT
DATE RECEIVED BUILDING FEE $ S: O 0 No.
PLAN CHECK $ i Ste_ -/
BY ovaa //'A 577M, VALUATION $4000,
TOTAL $ 7. 5 S RECEIPT No. 9g i,q
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N MAP k CENSUS TRACT JOB N
Architect or Engineer
Address Phone
Owner
C
Address
Builder
Address Phone _
BUILDING USE Single Res. 1K Multi Res. ❑ Comm._ ❑ Industrial❑
OCCUPANCY GROUP No. of Stories Total HeightArea of Lot
Type of Construction I II III IV V Floor Area B.---- 1___--_____ 2
Set tacks: Front Back L.Side __ R.Side
Private Sewer Pipe Size Sewer Septic Tank ❑
i
Water Service Pipe Size _ Storm Sewer ❑ Ditch ❑ Drywell❑
I
Str^et and Curb Requirements
i
Driveway Width_ _, - No. of Parking Spaces`_^
SEPARATE PERMIT& REQUIRED FOR SEWER ANT) PLUMBING
SPECIAL INFORMATION
°C . _
ADDRESS ASSIGNED
FIELD CHECK BY DATE
PERMIT APPROVED 4$T71�.r9d'.
It is understood that all work i.ill conform with applicable codes a"d o-dinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occ�ncy has. been issued by thy. City of
Tigard Building Inspector. -�
Si a ure of Applicant
w
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT 1175 DATE
PERMiT 1S GIVEN TO
OF
TO CONNECT A
TO THE EYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PERMIT MUST BE POSTED ON THE De:SCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEF. PAID $....................... ...........TIGARD SANFTARY DISTRICT
By
CONNECTION INSPECTED AND API'ROVF.D
Date Superintendent
Address_1/g ts,S`.f be! -���se•.ns►c.rtT p ,p Permit No.- // Z,,� - - --
Permit charge .2 --
Owner Connection fee 7 AV
Paid by
Type of BuildingDate connected / - 2
Service Rate Inspection fee /o —
Contractor Paid by Date
Size of connection - s Assessment —Paid
- daim N - --
City of Tigard MECHANICAL PERMIT Planck/Rec. # `_ _
13125 sw Hall Blvd. APPLICATION Permit #
PCS Box 23397 ('
Tigard, OFA 97223 17� P�
(503) 639.4171Description
Toole 3A Mechanical Goole OTY PRICE AMT
Job !) Permit Fee '0- -0- 10.00
Address _a7_0"
2) Supplemental Permit 3.00
.m. Furnace to 1`60 b5BT
See_ jr�( I incl. ducats& voids 600
«. furnace 100,000 BTU + —
Owner
�(�� �,� ka0JP9, 2) incl duds&vents 7.50
� 3) inccl.l. vent
6.00 1
-- _ Suspended eater,wall eater
4) or floor mounted heater 6.00
M.J.V ••• Vent not incl. in
Occupant 5) appliance permit 3 00
�r e• -- ^��— Repair of heating.re ng.
6) cooling,absorption unit 11.00
------ .» — _ Boiler or comp, heat pump,ai–r–c'370.
7) to 3 HP absorp unit to 100K BTU 600
M,A
.c •.• —� oder or comp, Neat pump,arr cor
8) 3 15 HP absorp unit to 500K BTU 11 00
Contractor ,,,. i er or comp,meat pump, err ca
9) 15 30 HP absorp unit.5-1 mil BTU 15.00
tel.n4oa . Coy Fi T.NO Boiler or comp,heat pump,air cond.
10) 3050 HP absorp unit 1 1.75 mil BTU 22.50
era y acknowledge that I have read is app kation,t a^� iter- Boiler or comp, ieat-F pump,au co
infomtation given is corree.,that I am the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
of the owner,that plans submitted are in compliance with State Air handling unit to
laws,that I am registered with the Construction Contractor's Board, 12) 10,000 t't M 4.50
that the number given is correct. (If exempt from State registration, Air handiiing unit
please give reason below.) 13) 10,000 CT M 4 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected
15) to a single dud 3.00
Ventilation system not _
16) included in appliance permit 4.50
u...«.4P.M HoodsprveJ by — — -
17) mechanical exhaust 4.50
Describe work new addition Commercial or industrial
anW
to be done residential O non-residential O 18) type incinerator 30.00
Existing use o tier re,woodslove,water —
building or property _ 19) heater, solar,clothes dryers,etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property --
21) More than 4-per outlet
Type of fuel-oil 0 natural gas O LPG Q electric Q
NOTICE
Minimum Fee$25.00 SUBTOTAL _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%Or SUBTCTAL
AFTER WORK IS COMMENCED. --"- "
TOTAL
Special Conditions
-- Date issued by
►.r.�[a+war
radeenaMv