Permit ��
CITY OF TIGARD n����• ; ►�t����' �
�w�,,:�,,, �� � DEVELOPMENT SERVICES `•'- '� "'' -'-
�_ r.. , ..
����'����� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 T `� =�t�1 I T� ��.. � T ... � I���� ^,� - -�}� i ��
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Contract or o ____.__.
WIL_Lt= tNiE'TTE E-IVAC SERL "ICE
c (E�JJ ;a�.J �..F�'LLY LIV
hl I LL5E�0 ^0 0;� 77 t:�;�
r'hono �e E,�t3-- C,C�`�I.
-- - -• - -- REC?U? RED I h!SF'EC - f I Oi'JS ---- - - - - --
This per�it is issued sub,;ECt to the regulations cortaint:d in the Gas L? n e I n s p _ _
?igard "unicipal Code, State of Ore. 5peciaity Codes and all other I�ieci�ain i cai I ,� s � __
dy7}71iCa5;E laws. All �{ork will bE done in accordance with, Coo •! i n g Un•� I n= �
appravec� plans. This perait will Expire if :pork is r:ct started D�_►ct T. o� v Fr�c�L i. on _ _ ._
within 18lr days of issuance, or if work is suspended fer �orE F i. na 1. I n c, pecL i o ►i ,_
than 18Z days. AT � "JT;Ctd: CrEgon iac� r "E�lires you to fol'.c� rlc. _____ _ —, ___.,__ —_
adorted 5y the QrE�on Ltility Notificatior CEnter. Those rules re -- _
set Forth in CAR 5�P-;�1 -@010 through Ot;R 952- �31-OCtz2, You gay ._.__^ __ _
obtain capiES of these rules or direct questions i;o i:11+iC Ey ' =allin •�
t5tD3)245 -318 ?.
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/ Plan Chedc # Q 6 -
CITY OF TIGARD Mechanical Permit Application �'�� Recd B C�-
13125 SW HALL BLVD. Commercial and Residential �'' �� Date Recd - 9-�
TIGARD, OR 97223 Date to P.E. �-
(503) 639 -4171, X304 � �t� Date to DST �
�� t Permit # ��- ® ��j
Print or Type Called � -1u -O I
. Incomplete or illegible applications will not be accepted
Name of Develo ent/Projett /_ Description
/YIe ��OSK� Table to Mechanical Code oT`� PRICE AMT
Job Street Address �,. suae# A) Permit Fee -0- -0- 10.00
Address lz 4 y� .sL1�q p l� Y
eidg# �iState vp � 1.) Furnace to 100,000 BTU 6.00 � pC
l /,9�rp � 7�'� � induding duds 8� vents 3
Name (or name of business) 2.) Furnace 100,000 BTU+ 7.50
Oyyner � (-� � �C �J � (� induding duds 8 vent.
Mafling Address. � 3.) Floor Furnace � 6.00
I� .J g D y��� r {�� j� �/ � / induding vent
' � /State � ZJp Phone ry 4.) Suspended heater, wall heater 6.00
V�rC�i L. �sL4,)� t� . ®2.• _ tj�,��J- S�J 8 or floor mounted heater
Name (or name of business) 5.) Vent not included in appliance permit 3.00
Occupant Mailing Address 6.) Boiler or comp, heat pump, 6.00 / o U
to 3 HP; absorb unit to 100K = UT" � / �'
cnyisrate zp Pnone 7.) Boiler or comp, heat pump, air cond. 11.00
3.15 HP; absorb unit to 500K BTU'•
ContreCtor Na"'e 8.) Boiler or comp, heat pump, air cond. 15.00
Gy���.��t �/�� 15-30 HP; absorb unit.5 -1 mil BTU'•
Prior to permit Mailing Address [ / i ,, 9.) Boiler or comp, heat pump, air cond. 22.50
issuance, a copy 2-7G �SS'w L.-!� PL� �� 30-50 HP; absorb unit 1- 1.75mi1 BTU"
of all licenses c estate zlp Phone 10.) Boiler or comp, heat pump, air cond. 37.50
are naquin:d if �rLL1' � Q/��/23 � � G�7(/ > 50 HP; absorb unit 1.75 mil BTU"
expired in COT Oregon Co st. o�n. Board Lic.# . E�x '.� ate 11.) Air handling unit to 10,000 CFM 4.50
database '� ���� � /,Z /pd'
Architect Nan'8 j 12.) Air handling unit 7.50
10,000 CTM+
or Mailing Address 13.) Non - portable evaporate cooler 4.50
Engineer ciiyistace zlp - Pnone 14.) Vent fan connected to a single dud 3.00
Describe work New� Addition O Alteration O Repair O 15.) Ventilation system not included 4.50
to be done Residential O Non - residential O in appliance permit
Additional De cription of work: p 16.) Hood served by mechanical exhaust 4.50
� 7 f. � � /' QO�vfi� S�.S'��'y'r� 17.) Domestic indnerators 7.50
Existing use of 18.) Commerdal or industrial 30.00
building or property type indnerator
19.) Repair units 4.50
Proposed use of 20.) Wood stove 4.50
building or property
21.) Clothes dryer, etc. 4.50
Type of fuel - oil O natural gas lPG -O electric O 22.) Other units 4.50
t hereby acknowledge that 1 have read this application, that the information 23.) Gas piping one to four outlets � 2.00 / . G d
given is tarred, that I am the owner or authorized agent of (/
the o�p�s subm' are in co pliance w'r��0 o laws. 24.) More than 4 -per outlet (each) .50
ature of owner/ gent���� �t� •SUBTOTAL �;�..�'�� �_
�� rZSb�
5 %SURCHARGE �'.'�~�� �#'�� �'' °
Contact Person Name Phone PIAN REVIEW 25 /o OF SUBTOTAL �: -��3= 2
Required for all commerdal permits only. �r"�Ar � ����, I � � 1 J .
TOTAL ^',, �a ��"'e� s � /- ([ llY
:�s�,�` ��5 Ft � 10 D
'Minimum permit fee is 525 + 5 °k surcharge
••Residential A/C requires site plan showing placement of unit.
I:�rnechprtnt.doc rev 4/15/98