Permit A CITY OF T MECHANICAL
,,,, .,, A, DEVELOPMENT SERVICES PERMIT
PERMIT # • MEC96 -0402
'1 _ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/96
PARCEL: -04200
SITE ADDRESS...: .14051 SW LIDEN DR
SUBDIVISION.:...: CASTLE HILL ZONING: R -12 PD
BLOCK • LOT .025
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/O APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 0 DOMES. INCIN: 0
: /GAS/ / / . 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..: 0
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: Installing gas piping
Owner: FEES
ELAINE OBRIEN type amount by date recpt
14051 SW LIDEN PRMT $ 25.00 B 11/18/96 96- 286661
SPCT $ 1.25 B 11/18/96 96- 286661
TIGARD OR 97224
Phone #: 590 -4012
Contractor:
HOLMES INSTALLATION SERVICE
RAYMOND FLANDERS
5200 SW 141ST AVE #55
BEAVERTON OR 97005
Phone #: $ 26.25 TOTAL
Reg #.. : 102473
REQUIRED 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 . F i n a l Ins Inspection
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.
Permittee Si tore: atwrii/
Issued By: ' 1_ V ��
Call for inspection - 639 -4175
•
CITY b . IGARD Mechanical Permit Application Recd By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit s h Pc it - 01-0.-.
Incomplete or illegible applications will not be accepted Called
Marne of Development/Project Description
Table 1A Mechanical Code QTY PRICE AMT
Job Street Address Suaes A) Permit Fee -0- -0- 10.00
Address 1 LOS" ( I WA / ,vpeft:
Bides CityrState Zip B) Supplemental Permit 3.00
719 Avi) oVe.
Name or name or Cwness) ► 1.) Furnace to 100,000 BTU 6.00
Owner I`(a t h e. 0 131x\ e 4u ind. ducts & vents
Aiming A dee s S w J t 2.) Furnace 100.000 BTU + 7.50
-- h inci ducts a vents
y o Q /�� ,� 3.) Floor furnace 6.00 .
L
•
�V O "�lo!'L ind. vent
Name tar nave a 4.) Suspended heater, wall heater 6.00
C a wit- A (4-j l� or floor mounted heater
Occupant u 4 Address 5.) Vent not ind, in 3.00
avoidance vend
CityrStste Zip Phone 6.) Boiler or comp. heat pump, air cond. 6.00
_ - to 3 HP: absorp unit to 100K BTU
N �, rd / e � + 7.) Boiler or comp. heat pump. air cond. 11.00
I ' V ` e I S t ( Se ; 3-15 HP: ateorp unk to 500K BTU
Contractor moiling mss 5-5- 8.) Boiler or comp. heat pump. air cond. 15.00
. 5 Lid Y 1 S / 15-30 HP, absorp un8.5 -1 and BTU
Attach copy of Zip Phone licenses f G�Je 1r7 O'•'J one_ /-4 8 1 9.) Boxer or comp, absorp heat pump. air it BT 2250
30-50 I.P. absorp unit 1-1.75 mil BTU
Oregon Cons° Cont. Boas Lacs Esp. 0 10.) Boiler or comp. heat pump, air cond. 37.50
O Z LI 7 3 / 0 > 50 HP: absorp unit 1.75 mil BTU
e
COT herss Tas or Metro S €a 11.) Air
LI ( 7 L L- ' / 1 7 10 . t urd to 4.50
Nan. 10 ( 12.) Air handing unit 7.50 '
10.000 CTM +
or M ar i " 9 Address 13.) Non portable 4.50
evaporate cooler
Engineer "Ste Zip I Phone 14.) Vent fan connected 3.00
to Describe wort New 0 Addition Repair 0 15.) Ventilation Alteration 0 duck
to be done Residential 0 Non- residential 0 d a single n e 4.50 system not
permit
Additional Description of work 16.) Hood served by
medtanical exhaust 4.50
` 17) Domestic incinerators 7.50
Existing use of 18.) Commercial or industrial 30.00
budding or property type incinerator
19.) Clothes dryers. etc. 4.50
Proposed use of 20) Other units - 4.50
building or property •
Type of fuel - oil 0 natural gas LPG 0 electric 0 • 0 Gas piping one to four outlets 2.00
I hereoy acknowledge that I have read this application, that the 22) More than 4-per outlet (each) .50
information given is correct that I am the owner or authorized agent of
the � li owner�gtat plans aqe c4o pjgnce // t n at OTY. SUBTOTAL
laws. ��
Signature of erfAgent D SUBTOTAL 2
in d int•c 0 13 1-‘€_A' O-yorZ 5% SURCHARGE '. 2 tj
Contact Person Name Phone PLAN REVIEW 25% OF SUBTOTAL
TOTAL
24 -2-r
cldsttrnechpmt.doc 'l1tInimum permit fee is 525 + 5% surcharge
Rev 7/96
•