Permit ��
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CITY OF TIGAR �� n MECHANICAL •
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DEVELOPMENT SERVICES PERM IT
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.-.4, � � 13125 SW Hall Blvd., Tigard, KSO�������
- '=-- `---~ DATE ISSUED: 08/04/97
PARCEL: 2S101AA-09800
SITE ADDRESS...: 12570 SW 69TH AVE #104
SUBDIVISION....: MLP95-0013 ZONING: MUE
BLOCK..........: LOT.... ..... ....:0Q1 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
:GAS 3-15 HP : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP....: 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30-50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: 50+ HP....: 0 CLO DRYERS..: 0
NO. OF UNITS-- -- AIR HANDLING UNITS OTHER UNITS.: 7
FURN ( 100K BTU: 0 (= 10000 cfm: 0 GAS OUTLETS. 0
FURN >=100K BTU: 0 > 106900 cfm: 0
Remarks : Tenant improvement: Dellanca Ent.
Owner: ------- - ----- FEES -------
J T ROTH JR type amount by date recpt
12600 SW 72ND STE 200 PRMT $ 41.50 B 08/04/97 97-297922
TIGARD OR 97223 PLCK $ 10.38 B 08/04/97 97-297922
5PCT $ 2.08 B 08/04/97 97-297922
Phone #:
Contractor: ---- -
TRI-COUNTY TEMP CONTROL/HEATNG
13651 SE AMBLER RD ------ -
$ 53.96 TOTAL
CLACKAMAS OR 97015
Phone #: 654-3115
Reg #..: 000007
REQUIRED INSPECTIONS --
This permit is issued subject to the regulations contained in the Duct Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspect ion
applicable laws. All work will be done in accordance with _
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-001-0810 through OAR. 952-001-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246-9187. ___
' ----
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Issue 8y: 371A ~����---~��ermittee Signature /17,:i iv, '
•
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 p.m. for inspections needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Plan Check # (.O ( " - la
CITY G
OF TIGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd 0
TIGARD; OR 97223 Date to P.E.
(503) 639 -4171, x304 - erg Date to DST 4
( q.7" .-o ' Print or Type Permit # ,� c �1 ` � -o
Caned - 4,+( ° r 7 / / ti
Incomplete or illegible applications will not be accepted e_, r , .1 - e,C S
Name of Development/Project Description
R#1. L ..s.LaL-.......7 Table 1A Mechanical Code OTY- PRICE AMT
Job Street Address Suite# A) Permit Fee -0- -0- 10.00
Address /0 5 C7 / o y to
Bldg# City /State rp 1.) Fumace to 100,000 BTU 6.00
TT" CPA /7271 including ducts 8 vents
Name (or name business) 2.) Furnace 100,000 BTU+ 7.50
Owner v 7. qq, . including ducts & vents
Mailing Address 3.) Floor Furnace 6.00
4000 SGv 72 Zoo including vent
City /State zip I Phone Suspended heater, wall heater 6.00
7 C2 97 2/x - 2435 or floor mounted heater
Name n of business) 5.) Vent not included in appliance permit 3.00
- t�pr/'
Occupant Mailing Address 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorb unit to 100K BUT"
City/State Zip Phone 7.) Boiler or comp, heat pump, air cond. 11.00
3-15 HP; absorb unit to 500K BTU".
Contractor NNamee 8.) Boiler or comp, heat pump, air cond. 15.00
/7�.�
(Prior to (c . %kit Cat f e7 / 15-30 HP; absorb units -1 mil BTU"
issuance Mailing Address p / 9.) Boiler or comp, heat pump, air cond. 22.50
applicant / 3 45/ SE „air." , 30-50 HP; absorb unit 1- 1.75mi1 BTU"
must provide all C lState Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
contractor j((gq,1 012 97025 45e1 34 i > 50 HP; absorb unit 1.75 mil BTU"
license Oregon Const Cont. Board Licit Expp D _ � G) S 11.) Air handling unit to 10,000 CFM 4.50
rm
infoation 72 623 r
for COT COT Bussbss Tax or Metro # oats 12.) Air handling unit 10,000 CFM 7.50
database).
Architect Nam° p ea 4%. 13.) Non - portable evaporate cooler 4.50
or Mailing Address 14.) Vent fan connected to a single duct 3.00
Engineer Ci h f / , Z I P _ �/` 15.) Ventilation system not included in 4.50
(lt,I�j J appliance permit
Describe work New b Addition 0 Alteration 0 Repair 0 16.) Hood served by mechanical exhaust 4.50
to be done Residential 0 Non - residential 0
Additional Description of work - 77.-•%,".."1 2 .,o/avcw44+c/}' 17.) Domestic incinerators 7.50
d-o% C die d i.cL y 0w.G4 crr Lis le
r S rJ 18 Commercial or industrial type 30.00
Incinerator
Existing use of 19.) Repair units 4.50
building or property "✓u✓ Caw 7i s (C i -'
20.) Wood stove 4.50
•
Proposed use of /►/ ` 21.) Clothes dryer, etc. 4.50
building or property 0 7 4 2 C v►4 ( L a ., _
22.) Other units / 4.50
H VC'
Type of fuel - oil 0 natural gas e LPG 0 electric 0 23.) Gas piping one to four outlets 2.00
I hereby acknowledge that I have read this application, that the 24.) More than 4 -per outlets (each) .50
information given is cored, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
Sigma re o riAgent Date 0/97 •SUBTOTAL !d % f ,�
t,r. r 45' 3 //S 5 % SURCHARGE n
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL ,In V 3g
TOTAL /
:�dstlmechpmtdoc (re'v 9 'Minimum permit fee is S25 + 5% surcharge I \
- Residential NC requires site plan showing placement of unit.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: q-/0-9 7 / A.M. P.M. MST:
Location: 1 n�, 5 7 () S -( (� 6 cr ., BUP:
Tenant: ,, Suite: /t c107-- / Bldg: MEC: do /�
Contractor: (. �-y� / / 0 Phone: / W' et 3 9- off-(3 PLM:
Owner: Phone: ELC:
ELR:
1 SIT:
BUILDING BLDG (con't) PLUMBING ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
O Call for reinspection 0 Reinspection fee of $ ( required before next inspection 0 Unable to inspect
Inspector: �� •i Date: I /� V 7 Page of