12122 SW SCHOLLS FERRY ROAD-1 12122 SW SCHOLLS FERRY ROAD
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INSPECTION NOTICE
4Cco 19 Z Y City of Tigard Building DApartment
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested----_.-:=, Time A.M. P.M.
:�
Address _2 Z'
2,/j? Permit #
—
Owner Lot #
Builder Alt-44
The following Building Code deficiencies are required to be corrected:
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Presented to Approved
Inspector LI Dimpprovod
Date
CALL FOR REINSPECTION
DYE$ ONO
INSPECTION NOTICE
City of Tigard uuilding Department
P J. Box 23397
Tigard, Oregon 97223
Phone. 639-4175
Type of Inspection _
Date Requester' _. � 1) _ Time A.M. P.M.
Address Permit #
Owner--_-. Lot #
Builder
The following Building Code deficiencies are required to be corrected:
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Presented to _
— — ""T ApprovedJ�
Insprctor –�'�s%4 _
� I Disapproved
Date _ o" 7
CALL FOR REINSPECTION
❑ YES ❑ NO
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PLUMBINU., PERM11'
CITY OF T'VA RDM*►r� PEAMI I' NO .
CIT'YOFMA11111111
COMMUNITY DEVELOPMENT DEPARTMENT oleo*"
13125 S.W.Hall Blvd..P.O.Box 23397.Tigard,Oregon 97223.(503)6394175 DATE ISSAJED: 1.5/1.3 a8
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This permit is issued subject to the regulations contained In I ttlr 14 1:11: CI I P T NO
of the TMC, State of Oregon Specialty Codes,zoning regulations . ......
and all other applicable codes and ordinances. and It is hereb%p
agreed that the work will be done In accordance with the plans and I f F BEAM
specifications and in compliance with All applicable codes ano ITN
ordinances The issuance of this permit does not waive restrictive I I H 001
covenants Contractor And subcontractors shall have current city
business tax permits This permit will expire and become null and .1.Nr*)I,
void if work is not started within 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 assure
all required inspections are requested and approved.
lerinitleu re
Issued '1'3y'�4
7--7T
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
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FIRE PREVENTION E31JREAU
OFFICE OF' FIRE MARSHAL
INSPECTION NOTICE
OWNER. – DATE . --- ---- _—
OCCUPANT �-� I � � �� OCCUPANCY
LOC A T I C.IV l� `�j ���. ��4t✓1-t I- <-rc:'f °���, — -----
j YOUR Alit'NT16N 19 CALLED TO THE FOLLOWING FIRE SAFETY DEFICIENCIElI
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FAILURE TO CORRECT THE ABOVE CONDITIONS WI r.aINl � OAYS WILL MAKE YO I'' TOM!?.PECU 10N !-+DULL' r'AE
RESULT FROM SUC-I CONDITION! 'SOU MAY BE LIABLE FOR DAMAGES TO PERlO LE P 006ERTY N�FVR PROVISION! OF
OR! 479 IGD
WASHINGTON COUNTY FIRE DISTRICT#1 RsJAL
20665 S.W. BLANTON STREET PR TEC TOS
ALOHA,OREGON X17006 6498577
FORM 900 40
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CITY OF T'GA RDG��::1-1M:['1' NO : MV.81130825
(MY.OF TWA ROD I)AIE'. ISSUED- 5 1 19/SO
COMMUNITY DEVELOPMENT DEPARTMENT PRIM . P14T .140 , 88082.5
13125 S.W.Hall Blvd..P.O.Box 23391,Tigaid.Oregon 97223,(W3)b39-4175
,.OH AL)PIESS : S14 !A',H01-A-5 FEAPY P10
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This permit is issued Subject to the regulations contained in Title 14PIE'EQUIPLA7 1:NSF'E,:J.,'11C)N!Fj
of the TMC. State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances. and it is hereby GA45 L TNE
agreed that the work will be done in accordance with the plans and c.;Y r� nnoPn
specifications and in compliance with all applicable codes and MIKCHAN(A.. . SYS tr-.:M
ordinances The issuance of this permit does not waive restrictive F:J NAL.
covenants Contractor and 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 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 assure
all required inspections are requested and approved
Permittee q i
cm. I.. r'on T.wli t.-rTON 6*319-41 71
Issued By:
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
HUTILMING VIERM11'
CITY OF T167A RD1* [1411`1111' NO. : SIA38082Z
DA'I'E.' ISSUED: 5/ 9/We
COMMUNITY DEVELOPMENT DEPARTMENT P111M . PMT .NO. BF3O823
13125 S.W.Hall Blvd.P.O.Box 23397,Tigard.Oregon 97223,(503)6394175
1.0]0 ADDPL.'V.i 12.A2E2 SW AD
TAX MAP/101' FAM: OPEE::NWAY TOWN CEN11--:11 1...1 BK :
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This permit Is Issued subject to the regulations contained in Title 14 r4I:%QLJ1I:4I;A) 1N!:iPE.CT10N!i
of the TMC. State of Oregon Specialty Codes,zoning regulations
--if 3/c/t/-5—
and all other applicable codes and ordinances. and it Is hereby
agreed that the work will be done in accordance with the plans and 1.WiIJI-A1 10N
specifications and in compliance with all applicable codes and G Y P . 1311:1110111:1r)
ordinances. The issuance of this permit does not waive restrictive 4`4.145"Pf.;*.ND .CU.11- 1:N1:3
covenants Contractor and subcontractors shall have current city P't NAI..
business tax permits This permit will expire and become null and
void If work is not started within 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 permitlee to assure
all required inspections are requested and approved
Permittee Signature
CAL I 1: OW 1N5PF('.1T10N
Issued By
tSEPARETEPE ITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
M 'CHANIt:A I... PEPKE'T
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CITY OF TWA
CITYOFTNA c 10111YTE: ISSUED: 5/ 9/88
COMMUNITY DEVELOPMENT DEPAR-rMENT o"GoN PRIM , 1:.,M'T*.NO , ou 082 3
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard.Orpgon 97223.(503)6394175
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This permit is issued subject to the regulations contained In Title 14 14:141,la.PED INSIA.A.;I ]AINS
of the TMC, State of Oregon Specialty Codes.zoning regulations (gin`" 1—INE:
arid all other applicable codes And ordinances, and it is hereby
agreed that the work will be done in accordance with the plans and (3 Y P 1A)AND
specifications and in compliance with all applicable codes and MEXI-16M.A... . SYSIT.-'M
ordinances. The issuance of this permit does not waive restrictive VTNA!
covenants. Contractor and subcontractors shall have current city
business tax permits This permit wall expire and become null and
vola if work Is not started within 180 days,or if work is suspended or
abandoned fo, a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
Pet mittee1 k ig 4natt r-4 1'.N5 V,E C' :f.(.IN 6 39- -1 1
Issued 13Y ----— -- Lt —1t.-
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Washington County Fire District No. 1
City of Beaverton Fire Department
r! Tualatin, Rural Fire Protection District ,...�e
May 9, 1985
Steve Fehlman
Fire Extinguisher Service Center
12870 S.W, First
Beaverton, Oregon 97005
RE: Scotty's
12122 S.W. Scholls Ferry Road
Tigard, Oregon 97223
Dear Steve:
A fire and life safety plan review was conducted on the above-
captioned project, for compliance with the 1985 editions of the
Uniform Building Code (UBC), Uniform Mechanical Code (UMC) , and the
Uniform Fire Code (UFC) as amended by Washington County Eire
District No. 1's Ordinance 86-1 .
Plans are conditionally approved subject to the following:
1. Nozzle Height: Nozzle height shall be installed in
accordance with installation manual.
2. Pull StF .ion: Manual pull station shall be located along the
path of egress.
3. Trip Test: After installation has been completed,
appointment shall be made with this office. Contact person
Boli Ray to witness trip tests of the system. Please give 24
hour notification prior to anticipated tett.
4. Hood and Duct: This office has not received detailed
construction diawings of hood and duct system and shaft for
the hood and duct system. Would you please relay this on to
general contractor and hood and duct constructor And
installer.
Steve Fehlman
May 9, 1988
Page 2
If ' can be of any further assistance to yeti, pl.e;i.,fv fcel five < <:
call me at 649-8577.
Sincerely,
WASHINGTON CO TY FI&15TRCT NO. 1
Gene Birchill
Plans Examiner
1.0665 S.W. Blanton Street
GB:kw
cc: City of Tigard
Jim Murphy
Inspector Ray
Washington County Fire District No. 1
City of Beaverton Fire Department
Tualatin Rural Fire Protection District
May 9. 1988
Jim Murphy
12122 S.W. Scholls Ferry Road
Tigard, Oregon 97223
RE: Scotty's Pizza Place
12122 S.W. Scholls Ferry Road
Dear Mr. Murphy:
A fire and life safety plan review was conducted on the above-
captioned project for compliance with the 1985 editions of the
Uniform Building Code (UBC) , Uniform Mechani(_al Code (UMC), and the
Uniform Fire Code (UFC) as amended by Washington County Fire
District No. 1's Ordinance 86-1 .
Plans are conditionally approved subject to the following items:
1. Doors: Doors shall swing in the direction of egress where 50
or more occupants are located in assembly occupancies. UBC
Sec. 3304(b) UBC Sec. 3318
2. Exterior Exit Door: Hardware for the exte.ior doors and key-
operated deadlocks may be permitted where there is a sign
posted on or over the door reading, "THIS DOOR MUST REMAIN
UNLOCKED DURING BUSINESS HOURS" in letters not less than
one inch in height on a contrasting background.
(UBC Sec. 3304)
NOTE: This item applies to the main exit only.
NOTE: Side exit shall be equipped with panic hardware.
UBC Sec. 3318
3. Mechanical Plans Required: Plans referred to and examined by
;Itis office contained no plans for heating or air condition-
ing systems. Unless electric baseboard heat is employed,
complete mechanical. system plans for the HVAC equipment and
duct work must be submitted to and approved by this office
prior to installation. (UMC Sec. 302)
t
Jim Murphy
May 9, 1988
Page 2
NOTE: Pizza ovens shall be provided with Type 11 hood and
duct. Flans submitted du not si.ow details of this
hood and duct system. Please submit for review and
approval by this department and City of Tigard.
Also submit for review and approval the Type I hood
and duct system being installed.
4. Mechanical Equipment Apprvvi�l: All heat producing and
electrical equipment and appliances installed in conjunc-
tion with the construction or occupancy of this project
must be approved by Underwriters Latorat.ories, Inc. or
other nationally recognized testing agency and installers
in accordance with the testin.L agency's specifications.
(UMC Sec. 502)
5. Automatic Sprinkler Plans: Plans referred to and examined
by this office contain no provisions for the alteration or
installation of automatic sprinkler system. Not less than
three sets of plans for the installation shall be submitted
to this office for approval. prior to install.:atiort.
(UBC 302(10)
NOTE: if this building is not sprinklered, please
disregard this item,
6. Occupancy Loral: This occupancy shrill be rusted at 132. UBC
Sec. 3302(c)
?'OTE: A posting card will be provided for you upon final
inspection for occupancy by this department.
7. Seating and Table Diagram: Seating anti table diagram shrill
be made up and readily available for inspecbnrs upon entiy
and request for inspections,
S. Aisles: Aisles serving one side of seating and tables shall
n,)t be less than 36-in-hes in width and nislvs serving 2
sidc-s of seating and tables shall not be less than 44-inches
in width. UFC Sec. 25. 107 Aisles shall he maintained at :all
times. UFC Sec. 12. 103
9. Approved Plans on Job Site: One set of approved plans bear-
ing the stamps of the Washington County Building Department
and this office must be maintained oti the Project site
throughout all phases of construction :and must be made avail-
able to building ,and fire inspectors fuc reference during
required coustauction inspections. (UBC Sec. 303)
Jim Murphy
May 9, 1988
Page 3
10. Inspections Required: Inspection kind approval of construc-
ti•an by a representative of this office is required: (a)
prior to the cover of any new framing elementL following the
installation of all utility runs which will be concealed
within wall and partition cavities; (b) upon cumpletion of
construction and prior to occupancy of the tenant space.
(UBC Sec. 305)
11. Cer.tifiente of Occupancy Required: Prior to the use anti
occupancy of the project (space), a certificate of occu-
pancy or other written instrument of approval must be
obtained from the City of Tigard Building Department.
(UBC Sec. 307)
If I can be of any further assistance to you, please feel free to
call me nt 649-8577.
Sincerely,
WASHINGTON COUNTY FII Di?,rRICT NO. 1
Gene Birchill
Plans Examiner
20665 S.W. Blanton Stry spt
GB:kw
cc: City of Tigard
Inspector Ray
SPECIAL NOTE TO INSPECTOR:
This is a remodel, of .an existing area appruximarely, 3,000 square
feet in size. It is an A-3 occupancy.
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PLAN CHECK H _ �
CITYOFT117ARD PERMI I #
COMMUNITY DEkl,..LOPMENT DEPARTMENT ORFOON DATE ISSUED
13125 SW-fall Btvd. P O.Box .397,Tigard.Oregon 97223(5031639-4175,.
JOB ADDRE'SS: �;_> ( 2: _ �Ull TAN MAP/LOT
SUB: LOT LANJ USE:
OWNER Va 164 V, -50 0, 0 0 SPECIAL NOTES
NAME:
AV-A REISSUE OF
1W I
ADDRESS: '-j LAST REISSUE:
FLOOD PLAIN/
SENSITIVE LAND:
PHONE:
APPROVALS REQUIRED
G,ONTRACTQR PLANNING:
NAME : N ENGINEERING:
ADDRESS.___ FIRE DEPT
OTHER:
PHONE: 17 ITEMS LE-9UIRED
LIST/SUBCONTRACTORS:
ARCH/ENGINEER BUS TAX:
NAME: CALCULAT16N,,
ADDRESS' TRUSS DETAILS:
PARKING PLAN:
LANDSCAPE PLAN:
PHONE: OTHER:
COMMENTS:
e7%
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD, BAL. DW
j"i-0 j 10--432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
10--431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mech
-
10-433 00 Plans Check Te o 6,5(2
Building
Plumbing
Mech
30443 00 Sewer- Connection (20%) .........._
,%%L, e 30--202 00 Sewer Connection (80%)
30-444 00 Sewer- Inspection
51--449 00 Str-oot System Dev Chat-go (SDC)
52--449 01 Parks I System Dov Char-ge, (PDC)
52 449 02 Parks II System Dov Char-go (PDC)
31-450 00 Storm Drainage Sy5t. Dov Chrg (SSDQ .......
10--230 09 TRFD (95%) ------
10--435 00 TRFD (5%)
10--230 06 Washington County Firo HI (95%)
10435 00 Washington County Fire #1 (5%)
10-220 00 Amar-t/Wedgewood TOTAL
6REC #
6KPLIC.04T STGAATURF
Received BY ; Date Roceived:
ht/3587P
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CRY OF TIFA RD PLAN CHECK AI'PLICA ],UN��
PLAN CHECK N
COMMUNITY DEVELOPMENT DEPARTMENT CI11fo��RD PERMIT N _
DATE ISSUED
18125 SW Hall Blvd. P.O.Boa 23397,Tigard,Oregon 97223(5s09)839-4175
JOB ADDRESS: ` I Z-2- '��-' X_41g���'�_�ti �k�� TAX MAP/LOT
SUB: _ LOT: _ LAND USE:
OWNER VG/Ue: 500, 00 _
SPECIAL NOTES
NAME; _ ,� ��u` o:�l�.' __ _ _ REISSUE OF':
ADDRESS: C'YVw LAST REISSUE:
---�-- FLOOD PLAIN/ —
PHONE:
- n - —
SENSITIVE LAND:
APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME:--� __ _ ENGINEERING: _
ADDRESS: ,_ FIRE DEPT
OTHER:
PHONE: ITEMS REQUIRED
LIST/SUBCONTRACTORS: _
ARCH/ENGINEER BUS TAX: _
NAME: CALCULATIONS: _
ADDRESS: _ RUSS DETAILS:
PARKING PLAN:
__ _ LANDSCAPE PLAN
PHONE: OTHER: �—
COMMENTS:
PERMIT N ACCTN DESCPIPTION AMOUNT AMOUNT PD. BAL. DUE.
10--432 00 Building Permit Fees -�f1•D(7
10-431 00 Plumbing Permit: Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mech
10--433 00 Plans Check Fee 6t0
8ui1dirig
Plumbing
Mech
30-443 00 Sewer Connection (20%) _
30--202 00 Sewer Connection (RO%)
30-444 00 Sewer Inspection
51--448 00 Street System Dev Charge (SDC)
52--449 01 Parks I System Dev Charge (PDO)
52--449 02 Parks II System Dov Charge (PDC)
31-450 00 Storm Drainage Syst. Dev Chrg (SSDC)
10-230 09 TRFD (95%) 11f . p
10--435 00 TRFD (5%) --
10-23006 Washington County Fire Ill (95%)
10-435 00 Washington County Fire N1 (5%) _—
10-220 00 Amart:/Wedgewood _
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� i C\ RECN _-
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OPPLICOAT SIG ATURF
Received By: Date Received:
ht/1587P
CITY OF TIGARD No. 31362-1
13125 S.W. HALL BLVD. '
P.O. BOX 23397 Date
TIGARD, OR 97223
Name
Address j
Lot Block/Map
S b ivlSlQnlAddress
Permit ff's Bld� Plumb W SN
Cash Cbec�s-
Sewer Other y,ybc Other Rec.,8
_ Description -- --------- Am nt
Acct. No.
10-432 BuildingPermit Fees
10-431.600 Plumbing Permit Fees---
10-431-601 Mechanical Permit Fees _-
10-230-501 State Bldg. Tax
10.433 Plans Check Fee
30.443 Sewer Connection --
30.444 Sewer Inspection
51 448 Street Syst. Dev. Charge _
52-449-610 Parks 1 Syat. Dev`Charge —
52.449.620 _ Parks II Syst. Dev. Charge _ —__-
31.450 StorDrainage Syst`Dev. Charge
10.430 Business Tax _ — —�-
10.4;14� Alarm Permit
10-227 Ball _ -
10-455- Fines •TrafficlMisdlParking —�--_
10.230• CPTH TrafficlMisdlVlc. Asst. _-
10.456 Indigent Defense
3-01 2F2-.401 Sewer ServicelUSA
30.12?.402 Sewer Service/City 30%
30.123 Sewer SevicelCity Maint_�,�
30.1 5-5 Unmatched
31-124 — Storm Drainage 1
40--47N— Bancroft Prin. Pymt.
40.471 Bancroft Int. Pymt.
__ --- TOTAL
DEPT.
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P.O.Boot 23317
CITY OF TIGARD PLUMBING 13125SW1 11 Blvd.
Applicants must hold Oregon Registration to conduct a plumbing PERMIT 7Yr� CR 97�
business or must be owner/ t�175
_ property operator not hiring outside help.
Name d De"lopnmenl ✓ �/
Plumbing Permit
AddrM -
L .Z �° ��• OR 14-21-610 QUAN. PRICE AMT
Job Tax Lot Map.No. --
Addrssa
FIXTURES
Lot fllock Subdivislon -------
Sink
Or Lavatory 7.50
Tub or Tub/Shower Comb. 7.50
r Shower Only
— 7.50
Owner 0ty/State .$ Water Closet 7.50 _
J,11 Distw ether - -- 7.50_
Phone Garbage Disposal - 7.50
�e W uhing Machine �— - 7.50
k 1 l Flax Drain -- - - -- 7.50
Address -- Wattr Healer — 7.50
Yy\ Laurvy Room Tray --� _-- - - - 7.50
Occupant City/State Ip ---- - - ---
Urinal
Name ` Other Fix,ures(Spe ity) 7.50
77_50
7.50
Cofltractor Cliy/State - Zip - - ai -- --- -- - 7.50
--•M_- MISCELLANEOUS
City Bus.Tax No. Sewer 1 st 100'_ 30.00
.Mite s. ar ,T tate rr�i iers Bus I _SowK•f+a.Addit.1 W — -- 15.00
(Residential) Water Service 1st 1O0' 20.00 _
1 ho eby acknowledge Mut I have read this oppllcatlon.Mut the Irdom►attan Water Servios ea Addit."' -- 15.00
given is owed.that I am reglefered with the State Builder's Board,and also Storm&Rain Drain 1 of 100' -! "woo _
have a State PkmftV license Mut the numbers gtwn ars correct,Mut to _---- --
pkxnbing work%Ati be dory in aacc,donoe with appscable provision of Ore- Storm&P Jn Drain Addll 100' 15.00
gon Revived Statutes Chapters 447 and W3 and appkel 40 codes and that Mobile Boma Space -- - 25.00
no heip wunless 1N be ernployed uess licensed urxfer QRS F413.(If exempt from --- --- -- ---
State►eglstratlon,please S11ve reason below) Batik Flow Prrlvt+ntion
HOMEOWNERS-1 OwlosorAnti•r+e!! NAce - 7.50
hereby pertly Mut I am the ov,ger d M+s properly ds- _ •^� ___-- --
scribed show.at which lo,.,.y._t pappose tomaka o r,r: - 11^n krtaMatlon far Any T �.A
fny ovn use and ll ris lxopxtq w rKA1_j--V t"mru«..t 1ks Dei .+...,.v.-.- ...eFixhre 7.50
rralCh Basin -- --- - 7.50
kW.of Exist.Pkn**V---- 40.00 Per Ht.
_— -- SpelsMy Requested Inspections --- - 40.00 Per Hr - - -
-----— After.of Plumbing within ---- --- --
11 an ExW*V Bldg _ 15.00 min.
A O SIQNATWF -- u- DoH New Bldg.of BuNd.Addition------ 26.00 min.
Pt s' a fewil
[Describe work rtew[) addition) � alteration ] repair f7 dlling15.W on-reside
be dorm rosidential nrltlel) i - --
l 1.-._ _.__
E.xistklp use of —
btAkOog air property-, ---- - - -- -- NA•TQTAL !/
"" .5a1 W wllalAME
HaTICE
Tale permft becomes mA and wid fit work or aonstruoMon outhortzed Is not oom
merxf W MA W 100 domer M oenelnrollon or work M suapermfed or dwxk rwd lot 50
a P~of 110 days ar eny time MW wok is oonwMnoed
- - -- --- - Date Issued - ------ by ---
/CITY OF TIGARD MECHANICAL PERMIT Permit t IHi S
Description
City of Tigard
Table 3A Mechanical Code OTY PRICE AMT
- -----�
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397 --+--- --
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents_ 6
�C
_ Furnace 100,000 BTU +
rLV Hol. •��il �) incl.ducts&vents 7'50
Name of Development (1 oo pp Floor Fumace -
3) incl.vent _ 6.00
Job Adcaess r Suspended heater,wall heater
Address _ 4) or floor mounted healer 6.00
Tax i-ot Map No. Vent not incl.In — -
')
Lot Bappliance permit 3.00Block SubdiNafat
Nene(or name ql business) Repair of heating,refr Ig.,6 6.00
cooling,absorptlnn unit
J
MaUldress ft"
Ad - Boiler or comp to 3 HP
Owner h 7) absoro.unit to 100,000BTU_ 6.00
city/State 7Jp 8) Boiler os comp to 3 HP-15 HP 11.00
_absorp.unit to 500,000 BTU
Nan" t - 9) Boller or comp 15-30 HP - -
Vy.\t t absorp.unit tfa-1 million 15.00
Mailing Address phq�- Boiler or comp to 30-50 HP
Contractor - 10) absorp.unit 1-1.75 million 22.50
ciryiste to 7ip Boller or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31 j
State Registration No. City Bus.Tex No. 12) Air handling unit to
_ 10,000 CFM a-50
I hereby a(*nowbdge that I have read this application that the infrxmstlon given is 13) Air handling unit
7.50
corned,that I am the owner or authorized agent of the owner,that plans submNted are in 10,000 CFM 4-
oomplianoe with Stat,laws,that I am registered with the State Builders'Eloard,that thet 4 Non portable
number given is crx.ect.(If exempt from State registration please give reason below), ) evaporate cooler 4.50
- -- 15) Vent fan connected
-�J-- ------ - `--- ---- - to a single duct 3.00
_.__�___- ---- _----- - 16) Ventilation system riot - -- A.50
included in appliance permit - -
• 17) Hood served by
mechanical exhaust .a0
age
Sipnalure( or agent) --
----� l ' f, 5Ll
--- -- _.---- Dais __Domestic type — - --
Describe*or* O addition [] alteration,e4; pair F-118)_incinerator 7.50
to be done residential ❑ -- nonresidential 1_ 19) Commercial or industrial
incinerator
Existing use of � type30.00
building of properly Other i.e.,woodstove,water
Proposed use of 20) heater,solar,clothes dryers,etc. 4.50
building or property _ _�__.- -- — -----
----- --�-- 21) Gas piping one to four outlets 2.00
Type of fuel-- oil 1 I natural gas LPG CI electric Cl --- - - - - --
-' 22) More than 4-per outlet
NOTICE ---- -- -- -- -.- _
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- SUB-TOTAL ,
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 5% 406 SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL -
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER - -
WORK IS COMMENCED. TOTAL Z 4 S
Special Conditions /`� 'efae� �-f� 0
-- --- Date issued by --