Permit CITY OF TIGARD MECHAN I CAL
goo/�, i,� DEVELOPMENT SERVICES PERMIT
!+� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT T # • 5/999 - 0079
DATE ISSUED: 02/25/99
04-
PARCEL: 2S1O3CD -02400
SITE ADDRESS...: 13755 SW 116TH PL /
SUBDIVISION • HOLLYTREE `F ONING: R -4.5
BLOCK • 01 LOT •008 QJRISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:R3 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 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 ?..: 30 -50 HP • 0 WOODSTOVES..: 1
GAS PRESSURE...: 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 1O0K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =1O0K BTU: 0 > 10000 cfm: 0
Remarks: Install a fireplace insert and gas piping.
Owner: FEES
JOHN R JAMES type amount by date recpt
13755 SW 116TH PLACE PRMT $ 25.00 GEO 02/25/99 99- 313243
TIGARD OR 97223 5PCT $ 1.25 GEO 02/25/99 99- 313243
Phone #: 684 -3427
Contractor:
OWNER
$ 26.25 TOTAL
Phone #:
Reg #..
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
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- 801-0810 through OAR 952- 881 -0880. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
►'
Issue By: 0 7/.— Permittee Signature:_
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Plan Check #
CITY OF TIGARD Mechanical Permit Application Rec'd By
131`25 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit#
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
J Street Address / Surte# A) Permit Fee �� , e �1 10.00
Address i S5 50 i 16* ) 1) Furnace to 100,000 BTU
including ducts & vents 6.00
Bldg# City /State Zip 2) Furnace 100,000 BTU+
including ducts & vents 7.50
Name (or name of business) 3) Floor Furnace
Owner - ...'ko, ,f -5-6./I'rj, including vent 6.00
Mailing Address 4) Suspended heater, wall heater
/ 75---s--5(k) / r0J o I or floor mounted heater 6.00
! 5) Vent not included in appliance permit
City/State Zip P hone 3.00
r T1 � o 97 - 6 ,3/3L 7 CHECK ALL *Boiler Heat Air
Name r name of business) THAT APPLY: or Pump Cond Qty Price Amt
Comp
6) <3HP;absorb unit to
Occupant Mailing Address 100K BTU 6.00
7) 3 -15 HP :absorb unit
City /State Zip Phone 100k to 500k BTU 11.00
8) 15 -30 HP; absorb
unit .5 -1 mil BTU 15.00
Contractor Name 9) 30 -50 HP; absorb
e/r ✓ --) unit 1 -1.75 mil BTU _ 22.50
Prior to permit Mailing Address ,, / 10) >50HP; absorb unit
36S
issuance, a copy / ,7' ,4
) C an voct >1.75 mil BTU 37.50
of all licenses 9tijyState tip ip Phone � 11) Air handling unit to 10,000 CFM
are required if .. tea --0 C Cf'?c, 0162- (�7'7/ O 4.50
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 12) Air handling unit 10,000 CFM+
database - '(y(e:7? 7.50
Architect Name 13) Non - portable evaporate cooler
4.50
or Mailing Address 14) Vent fan connected to a single duct
3.00
15) Ventilation system not included in
Engineer City /State Zip Phone appliance permit 4.50
16) Hood served by mechanical exhaust
Describe work to be done: 4.50
17) Domestic incinerators
7.50
NewaQ. Rep it 0 Replace with like kind: Yes 0 No 0 18) Commercial or industrial type incinerator
Residential Commercial 0 ) tyP
30.00
Additional information or description of work: 19) Repair units
4.50
� A2c��/y 20) Wood stove
4.50
/y 21) Clothes dryer, etc.
(/ 4.50
Type of fuel: oil 0 natural gas LPG 0 electric O 22) Other units
4.50
I hereby acknowledge that I have read this application, that the information 23) Gas piping one to four outlets 60
given is correct, that! am the owner of authorized agent of i 2.00
So
the ov3e ;tjx'at p s sub ' in compliance with Oregon State laws. 24) More than 4 -per outlet (each)
,sal irf ----- ',-- z.-,- x..3' 9 / 50 �7 ------ �
( J Date 7,',:.,,P;': °
C Minimum Permit Fee $25.00 SUBTOTAL , ,
/��r% //A c' n {C{r/L V6 '69 5 %SURCHARGE k, -:' as � e
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL .'
Required for ALL commercial permits only ell. *
TOTAL
*State Contractor Boiler Certification required
* *Residential A/C requires site plan showing placement of unit
l:\mechperm.doc rev 07/20/98
5/30/00 Activities for Case #: MEC99 -00079
3:13:57 PM t r
Assigned Hold Updated
p #
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MECA007 Application received 2/25/99 GEO RECD DST 2/25/99
MECA008 Create Permit 2/25/99 GEO DONE DST 2/25/99
MECA799 Final Inspection DST 2/25/99
MECA705 Gas Line Insp 2/25/99 DST 2/25/99
MECA750 Misc. Inspection 2/25/99 DST 2/25/99
MECA060 (F) Issue permit 2/25/99 GEO PASS DST 2/25/99
MECA845 Request inspection research 3/27/00 JMT DONE No Hold JMT 3/27/00
MECA880 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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