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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
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Inspection: aE'if,
Footing Susp, oiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace I
Post/Beam Stru-1. Plbg. 'fop Out Elec. Rough-in INA
Post/Beam Mech. San. Sewer Gas Lima x /�/ -Bldg.
Plbg. Underfloor Rain Drain Framing -Plum . /
Alarm Water Line ��.Insulation er,
Underflr. hisul. ShearWall `/�Gyp, Bd. Elect.
Date Requested: Time: AM PM
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Address:.. I l b'' 7 0 t4 n
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THE FOLLOWING CO CNS E REpUIRED:
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Inspector: ^---- r
Date:
APPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_Cali dor Reinsp.
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CITY OF TIGARDV.Fr'M I'
1 COMMUNITY DEVELOPMENT DEPARTMENT ;
City if I lgard M E` -AN I CAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION Permit # _fW (' 115- 01 �,�
Tigard, OR 97223
(503) 639-4171 I
Description •
Table 3A Mechanical Code QTY PRICE AMT
Job ,�O ,S i -t`� 1) Permit Fee -o- -o- 10.00
Address ,—T �p
r2) Supplemental Permit 3.00
urnace to
1) incl. ducts&vents 6.00
••' Furnace 100,000 UTU + "
Owner 2) incl. ducts&vents _ 7:50"
oor Furnance +-
3) Incl. vent 6.00
`"' " ""° "• - .5uspanded heater,wall heater —"-
4) or floor mounted heater
Occupant Vent not i in — —'
5) appliance permit 00
Zip_ apair of heating,re ng.
6) cooling,absorption unit 6.00
i firer or comp,heat pump,air con .
7) to 3 HP;absorp unit to 1OCK BTU 6.00
r Boiler or comp, heat pump, air con .
Contractor / ) S '2 8) 3.15 HP;absorp unit to 500K BTU 1 1.00
/ t T i er or comp,heat pump,air con .
9) 15.30 HP;absorp unit.5.1 mil BTU 15.00
Boiler or comp, heat pump,air cond.
10) 30.50 HP;absorp unit 1-1.75 mil BTU 22.50
hereby ackno-wleage triat I have read is application, that the Boiler or comp, heat pump,air cond.
information given is currect,that I am the owner o-authorized agent 11) > 50 HP;absorp unit 1.75 mil BTU 37.50
of the owner,that plans submitted are in compliance with State it handling unit to
laws, that I am registered with the Constn,ction Contractor's Board, 12) 10,000 CFM 4.50
that the number given is correct. (If exempt from State registration, Air handling unit
please give reason below.) 13) 10,UOO CTM+ 7.50
Ron portable
14) evaporate cooler 4.50
Vent an connected
15) to a single duct 3.00
Ventilation system not
16) included in appliance permit 4.50
Hood served y
17) mechanical exhaust 4.50
eacri e w new U a0dition U alteration repa r ommercia or in ustnaT--
to be dine residential q non-residential 0 18) type incinerator 30.00
xis ng use —
o �� b=i.e.,woodstove,wn er
building or property r 19) heater, solar, clothes dryers, etc. 450
Proposed use of 20) Gas piping one to four outlets 2.00
building or property -
Type of fuel -oil Q natural gas Q LPG Q electric(] 21) More than 4-per outlet -
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%OF SUBTOTAL
AFTER WORK IS COFAML:NCED.
TOTAL
Special Conditions -- --- --_.
Date issued by
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C I TY OF 'I I GARI) ISE t.,• :c PT PAYMENT RECEIPT NO.
CIAFCK AMOUNT
NAME* s ENERGY PLOS CASH AMOUNT 0. 00
ADVRECiS s 441210 NW ! -='7TH ST PPYMF.NT DATE y 0(, 01"-"r-
VANCO1JVF.P, WA GUTAD I V 19 ON 7
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L LIFf�CIIiE OFF'AY'ME:N'f AMOUNT PAID IIL1RrC)w+E OV PAYMC=NT nM(']i.JN"f PAl'T3
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