Permit CITY OF T MECHANICAL
,i6 PERMIT
^ .. 71N A l i
DEVELOPMENT S RVI� PERMIT
IS 01 • M E98 7 -0492
PARCEL: 1S136DA -00100
SITE ADDRESS...: 11308 SW 68TH PKWY
SUBDIVISION • ZONING: MUE
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B VENTS W/O APPL: 0 VENT SYSTEMS: 0
STORIES • 2 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP : 0 DOMES. INCIN: 0
: 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: Y 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS. :7O
FURN < 1O0K BTU: 0 <= 10000 cfm: 2 GAS OUTLETS.: 0
FURN > =1O0K BTU: 0 ) 10000 cfm: 0
Remarks : Tenant improvement to an existing office building.
Owner: FEES
PROVIDENCE HEALTH SYSTEMS type amount by date recpt
4805 NE GLISAN PRMT $ 334.00 GEO 01/27/98 98- 302841
PORTLAND OR PLCK $ 83.50 GEO 01/27/98 98- 302841
SPCT $ 16.70 GEO 01/27/98 98- 302841
Phone #:
Contractor:
FULLMAN SERVICE CO LLC
5805 SW HOOD AVE
$ 434.20 TOTAL
PORTLAND OR 97201 -3716
Phone #: 224 -5221
Reg #..: 122310
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Duct Inspect i o n
applicable laws. All work will be done in accordance with Fire Damper Insp
approved plans. This permit will expire if work is not started S. D. Shut—down
within 188 days of issuance, or if work is suspended for more Final Inspection
than 188 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-001-0818 through OAR 952-881-0888. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9181.
Issue By: ' I L /. . !
Permittee Signature: _' /_'L,4 � '
/ .,. /
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
I
Plan Check # 'Z ' C
CITY OF TIGARD Mechanical Permit Application Recd By t .2 - a y- 7
13125 SW HALL BLVD. Commercial and Residential DateRecd A
TIGARD., OR 97223 i,i,� �j P�u^ gk✓1,/ e z- .;- 91.30 Eq`� �? Date to P I2 - ?
(501) 639 -4171, x304 t , ✓ Date to DST z. 41 C
Print or Type Permit # V . 0 ' D '
Incomplete or illegible applications will not be accepted called
Na of Develop envPro(ect Description
(-,+yu /dei1C-e 90. t CS," f Cr Table 1A Mechanical Code QTY PRICE AMT
Job SGGeet Address C Sinter, A) Permit Fee -0- -0- 10.00
Address // 3 O E. S? 6(F
etagr, i tState O Zip B) Supplemental Permit 3.00
Name name of business&/ 1 h 1.) Furnace to 100,000 BTU 6.00
Owner T�`� (Al��. c tt ,C4 /f1.,Ss` incl. ducts 8 vents
Mailing Address / 2. Furnace 100,000 BTU + 7.50
ii �S�iM ' 1 incl. ducts 8 vents
City/State - / Zip Phone 3.) Floor Furnace 6.00
gl r /T G- a( er P1 S -P fir!?- incl. vent
"'e (or name of busunes l 4.) Suspended heater, wall heater 6.00
! (bli tie / /t ' $ -efr • or floor mounted heater
Occupant Mailing Address /„ 5 Vent not incl. in 3.00
4 (POS )J C, I i ✓ appliance permit -
C ate i Zip Phone 6.) Boiler or comp, heat pump, air cond. 6.00
r11C.naOr P1 S ) to 3 HP: absorp unit to 100K BTU '
Contractor Name 7.) Boiler or comp, heat pump, air cond. 11.00
(Prior to 1G l / /144 A - ) SCr^Vt`!,c... 3-15 HP; absorp unit to 500K BTU
issuance Marling Address 8.) Boiler or comp, heat pump, air cond. 15.00
applicant Z g� 5 ._( iv d 15-30 HP; absorp unit .5-1 mil BTU
must provide all C /State zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
contractor x /..•1 d j 0 2P-1-5 30-50 HP; absorp unit 1 -1.75 mil BTU
license 0 egon Const. Cont. Board Licit Exp. ate 10.) Boiler or comp, heat pump, air cond. 37.50
information 12 Z 0 U vi i L > 50 HP; absorp unit 1.75 mil BTU
for COT COT Business Tax or Metro r, Exp. Date 11.) Air handling unit to 4.50 C
database). 1 (/ 1 On fl U) 10.000 CFM f,
Architect Name
/'�( / ,/ F r/& 12.) Air handling unit
10.000 CTM + 7.50
/ "t
or Mailing Address
�'at>? ft tk� / 13.) Non portable 4.50
evaporate cooler
Engineer c state Zip - Phone 14.) Vent fan connected 3.00 ,
/� O/,, l.'7? if 2 3 (f-aPf to a single duct
Describe work New 0 Addition 0 Alteration Repair 0 15.) Ventilation system not 4.50
to be done Residential 0 Non - residential O included in appliance permit
Additional Description of work 16.) Hood served by mechanical exhaust 4.50
e C O 4: Q fr P.4 i iT )1i. I !. 17) .Domestic incinerators 7.50
Existing use of 18.) Commercial or industrialtype 30.00 Gf
y per--Pc-
building or properC.. � ?c, - incinerator
19.) Repair units 7 Q 4.50 3 I S;
Proposed use of /},/.�.� 20) Woodstove 4.50
building or property Pc3. tc. irc
21) Clothes dryer. etc. 4.50
Type of fuel - oil 0 natural ga( LPG 0 electric 0 22) Other units 4.50
1 hereby acknowledge that I have read this application, that the 23) Gas piping one to four outlets 2.00 C
information given is correct. that I am the owner or authorized agent of l
the owner, that plans submitted a in mpliance with Oregon State 24) More than 4 -per outlet (each) .50
laws. 7E4re K , I y�� 7
Signature of Owner /Agent Dtit / QTY.SUBTOTAL •
/ -re., #414.4 vat'(-5-?.y) 'SUBTOTA 31-1
Contact Person Name Phone 5% SURCHARGE
11/
PLAN REVIEW 25% OF SUBTOTAL
43
TOTAL
l i:'\dstlrmechpmt.doc (rev 7/96) l 'Minimum permit fee is 525 + 5% surcharg