Permit V
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DEVELOPMENT SERVICES PERMIT * a MEC90-0478
y l� ;: 19125 SWtWlBlvd.,Tig OR 97223(503)639 DATE ISSUED. 10/28/98
r
.S PARCEL: 2S 1 tl3AC -05100
I TE ADDRESS...: 12775 SW 113TH PL
.;SUBDIVISION....: HUMBOLT CREEK ESTATES ZONING: R -4.5
OCK a LOT .002 JURISDICTION: URB
'CLA OF WORK. .aALT FLOOR FURN....a 0 EVAP COOLERS: 0
TYPE OF USE....: SF UNIT HEATERS.. s 0 VENT FANS... a 0
'k1CCUPANCY GRP.. :R3 VENTS W/O APPLa= VENT SYSTEMS a 0
° T O RIES a 0 BOILERS /COMPRESSORS. HOODS....... a 0
FUEL TYPES 0 -3 HP.... s 0 DOMES. INCINa 0
aGAS 3 -15 HP..... 0 COMM-. INCINs 0
..MAX INPUT: 0 BTU 15- 30'HP..... 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: 30-50 HP.... s 0 WOODSTOVES..1 0
,cAS PRESSURE...: 50 +. HP.... a 0 CLO DRYERS..: 0
t top. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
4 URN < 100K BTUs 0 On 10000 cfe: 0 M GAS OUTLETS. I
;URN > s100K BTUs 0 > 10000 cfma 0
t
' Re mark : Gmhlmn gas piping
Owner: FEES
MARK DAHLEN type amount by date recpt
"`12775 SW 113TH PL PRMT $ 25.00 JED 10/28/98 98- 310343
TIGARD OR 97223 5PCT $ 1.25 JED 10/28/98 98- 310343
Phone its
Contractor:
¢r' 'OWNER
$ 26.25 TOTAL
"` ' Phone 44:
3 Reg 41..: 000000
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Mechanical Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 181 days of issuance, or if work is suspended for mere I
than 181 days. ATTENTION: Oregon law requires you to follow rules ti
adopted by the Oregon Utility Notification Center. Those riles are
set forth in OAR 952-811 -1111 through OAR 952 -111 -4181. You may
obtain copies of these rules or direct questions to OX by calling
1513)246 -9187.
-----:* '...----
Issue ...41 Permittee Signatures --- --Y =q 4
++++++++++++++++++++++++++++++++++++++++++++++++ + + + ++ + + +++ ++ + + + + + ++ +++ + + + + ++ + ++ '
Call 639 -4175 by 7:00 p.m. for inspections needed the next business,dky �a.
++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + +++++++ +++ + ++ ++ + + +' £„
.r.ri. k - '4'01,1', ? .. • � '''
crry oF tom() Mechanical Permit Application
Rec'd By -mir
13125 SW HALL BLVD. Commercial and Residential Date Rix'. A 4/1elir
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST ____ ____
Print or Type permit # ,rf
_ Incomplete or illegible applications will not be accepted Called
Name ci Development/Protect Description
Table 1A Mechanical Code 1 Price Amt
.1
Job Street Address Suite. A) Permit Fee 10.00
1) Furrow to 100,000 BTU
Address 11,175 \/-i IA'S FT. _ Including duds & vents 6.00
MO
Cy/State ZIP 2) Furnace 100,000 BTU+
I /, o 7-1 including ducts & vents 7.50
Name (or name or business)
1.A/1 /::>,40-f 2 ..._t_ 4 .4.
3) Floor Furnace
Owner
L..—L. vent
4) Suspended heater, wad heater 6.00
Mailing Address or floor mounted heater 6.00
it 11C c 7t".- 1 IM FL, 5) Vent not included in appliance permit
City/State Zip Phone 3.00
— r - G Cll'o ,117-- ,,(9S- I t4-4 CHECK ALL *Boiler Heat Air
Name (or name or business) THAT APPLY: or Pump Cond Qty Price Amt
Comp
rAikel 7MI' t. 6) <3HP;absorb unit to
Occupant "lag Address 100K BTU 6.00
I- 7) 3-15 HP;absorb unit
City/Sta(e 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
••• .. • ...t* LA unit 1-1.75 mil BTU 22.50
Prior to permit • F.m•••• 10) >50HP; absorb unit
issuance, a copy >1.75 and BTU 37.50
of all licenses CkYistata Zip Phone 11) Air handling unit to 10,000 CFM
are required if 4.50
expired in COT Oregon cont. Cont. Board Lice Exp. Date 12) Air handling unit 10,000 CFM+
database 7.50
Architect Name 13) Non-portable evaporate cooler
4.50
or Mailing Address 14) Vent fan cfmneeS fa a single duct
3.00
15) Ventilation sy-..ta; • ..at included in
Engineer CaY/Stata Zip Phone appliance permit 4.50
16) Hood served by mechanical exhaust
— Describe work to be done: 4.50
17) Domestic incinerators
New 0 Repair 0 Replace with like kind: Yes 0 No 0 7.50
Residential Commercial 0 18) Commercial or industrial type incinerator
30.00
Additional information or description of work: 19) Repair units
20) Wood stove
4.50
Type of fuel: oil 0 natural gas LPG 0 electric 0
21) Clothes dryer, etc.
22) Other units 4.50
llo00 ,
.,,100,.
I hereby acknowledge that I have read this application, that the information 23) Gas piping one to four outlets -
given is correct, that I am the owner or authorized agent of imi ,
the owner, that plans submitted are in compliance with Oregon State laws. 24) More than 4-per outlet (each) m .,-,„.
Signature , • - . • Agent Date ';'„ TV
, l
Minimum Permit Fee $25.00 SWIM
7 ..'
.. ,
5% SURCHARit
,,,
V _ ,?:`,. •,
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
• . red for ALL commercial • , • • ...f z '..- 3.: v
N4/4474 P fv-i L-E/14 (9 s 1 44 - TOTAL
'State Contractor Boiler GNUS:IMOD ISNWind
5 . 11esidential NC requires Site Plan 4ba**14
I1
rvnechperm.doc rev 07/20/98
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