11925 SW SUMMER CREST DRIVE 11525 SW SUMMER CREST DRIVE
INSPE:;TION N%..I
City of Tigard Building Department
P O. Box 23397
igard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Request
ed_, rJ.'`��' f` Time—_.�. A.M._ _P.M.
Ad,ir,iss
Owner —_ Lot #
Builder — --------- --- — --— --�The following Building Code deficiencies are required to be corrected-
Presented to ._ Approved
Inspector -----.---------_��_.. Disapproved
Date
('ALL FOR REINSPECTION
[71 YES ❑ NO
CITY OF TIGARD MECHAMCAL KERMIT Receipt #
Permit
Deb,:ription
,able 3A Mechanical Code CITY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee f— 0 _0 10.00
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 1) Furnace to 100,000 BTU 6.00
incl.ducts&vents
2) Furnace 100,000 BTU 1 7.50
incl.ducts&vents _— _
r Name of Development 3) Floor Furngce 6.00
—_in0.vent
Job Address 4) Suspended heater,wall heater 6.00
Address ' or floor mounted heater
T'ax Lot Map No. 5) Vent not incl.in 3.00
Lut Block Subdivision _, appl,ance permit
Name(or name of business) — 6) Repair of heating,raft ig., 6.00
cooling,absorption unit
Matting Nddress phone Boiler or comp to 3 HP 6.00
Owner absorp.unit to 100,000 BTU
Boiler or comp to 3 HP-15 HP
city/S'ate h g 11.00
absorp.unit to 500,000 BTU — _
Name 9) Boiler or comp 15-30 HP 15.00
_ absorp.unit 1,12-1 million
Mailing Address Phon•+ �) Boiler or comp to 30-50 HP 22 50 —
absorp.unit 1 -1.75 million _
Contractor City state — zip 11) Boiler or comp to 50 HP 31.50
absorp,unit 1,750,000 BTU
State Registration No, City Bus.Tex No 12) Air handling unit to 4.50
10,000 CFM _
�
I hereby acknowledge that I have read thio applination that the,nformation given Is 13) Air handling unit 7.50 10,000 CFM +
correct,that I am the owner or authorized agent of the owner,that plans submitted aie in —
complianne with State laws,that I am regisfored with the Stale Builders'Board,that the 14) Non portable 4.50
number givdn is correct.(It exempt from State re,;. 'ration please give reason below). I 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(owner or agent) Dal"
18) Domestic type 7.50
Describe work 1-1 addition 1 I alteration f 1 repair r i __ Incinerator
to be done residential 11 non-residential l 1 19) Commercial or industrial 30.00
Existing use of — type incinerator —
building or properly _. 20) Other i.e.,woodstove,water w`0
Proposed use of heater,solar,clothes dryers,etc.
building or property— - 21) Gas piping one to four outlets 2.00
Type of!uel-- oil I_ natural gas f 1 LPG [1 electric [ 1
22) More than 4-per outlet
NOTICE 'SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- - --- —
STRUC TION: AUTHORIZED IS NOT COMMENCED WITHIN 180 4%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIF`1"25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - - -
WORK IS COMMENCED. TOTAL
Special Conditions
Date Issued_ �_by --
w
PERMIT TO CONNECT
Tigard Sanitary District
PERMIT N9 1068 DATE
PERMIT IS GIVEN TO
OF
TO CONNECT A
TO THE SYSTEM OF TIGARD SANITARY DISTRICT
AT
THIS PER14ur MUST BE POSTED ON THE DEGCRIBFD PREMISES UNTIL CON-
NECTION IS MADE AND INSPECTION OF CONNECTION HAS BEEN COM-
PLETED.
PERMIT FEE PAID $.._ ............................rIGARD SANITARY DISTRICT
Bo
CONNECTION INSPECTED AND APPRGVED
Date Superint�ndent
AddresE� !d,,l Permit No.
Name of Occupant Permit charge _
Connection fee
Paid
Date connected
Type of Building__-__..----_.----__- --_-_.-- Inspection fee__-
Service Rate---.---__________ ------T_ Paid by _ Date 12 -�2 e -6 7
Contractor Assessment Paid
Size of connection