Permit CITY TI GARD MECHANICAL PERMIT
1
�• I i 4 ' DEVELOPMENT SERVICES PERMIT #: MEC1999 -01001
c�l DATE ISSUED: 6/16/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 39 -4171
PARCEL: 2S112CD -02000
SITE ADDRESS: 15630 SW 79TH AVE
SUBDIVISION: DURHAM ACRES �l ZONING: R -12
BLOCK:
LOT: URISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Installation of gas insert and associated gas piping.
Owner: FEES
JOHN MALLINSON Type By Date Amount Receipt
15630 SW 79TH AVE PRMT DEB 6/16/99 $50.00 99- 316159
TIGARD, OR 97224 5PCT DEB 6/16/99 $2.50 99- 316159
Total $52.50
Phone: 624 -8231
Contractor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other 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 in the Oregon
Utility icatr3n Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 -001 -0080.
You y obtain copies of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue 1
Permittee Signature:
Call (503) .39 -4175 by 7:00 P.M. for inspections needed the next business day
Plan
CITY OF TIGARD Mechanical Permit Application Rec'd :.y . •.
13125 SW HALL BLVD. Commercial and Residential Date Rec'd ' -
TIGARE?,, OR 97223 Date to P.E.
(5(23) 639 -4171, x304 Date to DST
Print or Type Permit# Meg_ )999 -0lcc /
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
Job Street Address Suite# A) Permit Fee 16.00
. 1) Furnace to 100,000 BTU
Address including ducts & vents see footnote 1,2 9.65
Bldg# City /State Zip 2) Furnace 100,000 BTU+
,including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace -
Owner m h.ti ,p/ o� L(.1. 6 5 . r including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
/ b - i D , ,j .7_ 9,'F h c,,,,e_ or floor mounted heater see footnote 1,2 9.65
5) Vent not included in appliance permit _ 4.75
City /State Zip Phone Check all that apply: *Boiler Heat Air
r-Q e(Z, QZ (,, 1-•t g Q) (_ For items 6 -10, see or Pump Cond Qty Price Amt
Name'or name of business) footnotes 1.,2 Comp **
J D VAQLt l i h 5 CND 6) .3 HP;absorb unit to
100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit
5 / � 56U 2Qi � av 100k to 500k BTU 17.65
City/State Zip Phone ' 8) 15 -30 HP; absorb
Tt -4 U /. � 7,1..14-/ c ,g'/ g,- - unit .5 -1 mil BTU 24.15
Contractor Nam 9) 30-50 HP; absorb
( � � � G ^ unit 1-1.75 mil BTU 36.00
Lr(.- 10),>50HP; absorb unit
Prior to permit Mailing Address >1.75 mil BTU 60.15
issuance, a copy 11 Air handling unit to 10,000 CFM
of all licenses City /State Zip Phone 7.00
are required if 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const: Cont. Board Lic.# Exp. Date 11.75
database 13)''Non- portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or Mailing Address 4.75
15)Ventilation system not included in
appliance permit 7.00
Engineer city /state Zip Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17)'Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes O No O 18) Commercial or industrial type incinerator .
Residential qe Commercial 0 48.25
19) 'Repair units'
Additional information or description of work: 8.40
?Wood stov: /m•ther units /clothe dryer /etc. 7, 0
, � , ek4 op- , -f -- 7.00
'ly /
NOTE: For Commercial projects only; Units over 400 lbs. require 'Gas piping one to four outlets -7 5
structural gas calcs. See footnote 1 3.75 J
Type of fuel: oil 0 natural gas, I' LPG 0 electric O 22)'More than 4 -per outlet (eac .75
Minimum Permit Fee $50.00 SUBTOTAL ,r
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE ''',4. i
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL 5ml:5
Signature of Owner /Agent Date -; $ .
fr' ak-ekt..,(Lr.A.A.a..n-- 6`/ SI 4 1 Other Inspections and Fees:
1. Inspections outside of normal business hours (mininum charge -two
Contact Person Name Phone hours) $50.00 per hour
LAN. vt/\C?.A : S 67 p g7--.51 2. Inspections for which no fee is specifically indicated (minimum
charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge- one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. *State Contractor Boiler Certification required
,n
**Residential A/C requires site plan showing placement of unit
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