Permit • Plan Check #
CIT4' OF TIGARD Mechanical Permit Application Rec'd By
•
e 1 125 SW HALL BLVD. Commercial and Residential ! \ V Date Recd - CV
TIGARD, OR 97223 1 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type
Permit #Oru -2 3 -
Incomplete or illegible applications will not be accepted Call
Name of Development/Project Description
/aQ(5Z Slv //e/ th ,ge Table 1A Mechanical Code Qty Price Amt
• Job Street Address Suite# A) Permit Fee 16.00
Address 1) Furnace to 100,000 BTU
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 - 'S0�Ai > including vent see footnote 1,2 9.65
L .3.--7.p. 4) Suspended heater, wall heater
Mailing Address
or floor mounted heater see footnote 1,2 9.65
/, i 3 / J / j J -6h / 5) Vent not included in appliance permit 4.75
City/State Zip Phone Check all that apply: *Boiler Heat r
7 /i J q ' 7 _ - For items 6 -10, see or Pu Cond Qty Price Amt
Name (or name of business) ° footnotes 1,2 Comp
6) <3HP;absorb unit to
100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor 2 N � ame 9) 30-50 HP; absorb
/ eh ID //e,97,N 10) 50HP mil BTU 36.00
S C� fa 10 >50HP; absorb unit
Prior to permit M iling Address ) 9 >1.75 mil BTU 60.15
issuance, a copy fr,S(2a( CiI 7 /0 7 11 Air handling unit to 10,000 CFM
of all licenses C' /State any / Ziip .� Phone 7.00
are required if / � ' 7 z fi 7 2 7 q 7 cR%C. 7 ' 3 12) Air handling unit 10,000 CFM+
. expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.85
database ' /8 C Q 7 - 10C-C 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
M ailing Address 4.75
Or 15) Ventilation system not included in
appliance permit 7.00
Engineer City /State Zip 1 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 0 No 0 18) Commercial or industrial type incinerator
Residential 0 Commercial 0 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove /gas FP /other units /clothe dryer /etc.
7.00
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 3.75
Type of fuel: oil 0 natural gas 0 LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL : 5 - 0'` 0
I hereby acknowledge that I have read this application, that the information 8% SURCHARGE 4; - °Co
given is correct, that I am the owner or authorized agent of PLAN ' • ■ 5% OF OTAL ,cam
the owner, that plans submitted are in compliance with Oregon State laws. Required for A rcia p is onl m,
TOTAL � >' 06
' ature of Owner /Awn Date
/ ' !
Other Insp and Fees:
.t
%��l� g c9e� 1. Inspections outside of normal business hours (mininum charge -two
onfacf Perso" n ame Phone hours) $50.00 per hour
2. Inspections for which no fee is specifically indicated (minimum
-/' 1,1 �✓� / " �'J 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
* *Residential A/C requires site plan showing placement of unit
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SETTING THE STANDARD FOR SERVICE EXCELLENCE
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Company: City of Tigard ?4/
Phone: (503)639 -4171
Fax: (503)598 -1960
Date: g"73 /0 6
Pages including this page: 3
COMMENTS:
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City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223
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Document * *PLEASE DELIVER THIS FAX IMMEDIATELY
SETTING THE STANDARD FOR SERVICE EXCELLENCE
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Phone: (503)639 -4171
Fax: (503)598 -1960
Date: /� /77 /a
Pages including this page: /�'
COMMENTS:
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City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223
I: \CITYWIDE\FAXCOVER.DOC ** PLEASE DELIVER THIS FAX IMMEDIATELY **
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9/27/00 Tag(s) for Parcel #: 2S103AB -06000
12:48:23 PM / aa6z ,� , // � b • .
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Use Update
Code Value Value Hold Description Notes Updated
BLDG N Hold w\ Override Building Dept Action Installed air conditioner without permit. Double fees required. This tag 8/23/00 HAP
can be removed after fees paid for mechanical permit.
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