Permit •
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Plan Check # -2._C_.,
CITY OF TIGARD Mechanical Permit Application Recd By .g)
13125 SW HALL BLVD. Commercial and Residential Date Rec'd 4-is 17
TIGARD, OR 97223 Date to P.E. % - S --9
(503) 639 -4171, x304 Date to DST - ���
Permit # 7 7fa
Print or.Type
Called //TD 3 'I' cc ,F1
Incomplete or illegible applications will not be accepted Cji,i le/c---
Name of Development/Project Description
I2rr >E A 1 p Table 1A Mechanical Code QTY PRICE AMT
Job Street Address p j Surtee A) Permit Fee -0- -0- 10.00
Address ( 2240 SW Stt w.u.spy
Bldg* City/State Zip 1.) Furnace to 100,000 BTU 6.00
T1 Ga. Gp %I)/ 22. r5 Including ducts & vents
Name (or name of business) 2.) Furnace 100,000 BTU+ 7.50
Owner GrotQ-i t...sero r including ducts & vents A.
Mailing Address 3.) Floor Furnace 6.00
71 S \Y Fit Lae Sr (00 including vent
City/State Zip P hone 4.) Suspended heater, wall heater ...... I. 6.00
1
Tj &p 5)-7 % # I 86 or floor mounted heater
Name (or name of business) 5.) Vent not included in appliance permit 3.00
'I-r - AI o .►4QA'i0vy
Occupant !Wading Address 6.) Boiler or comp, heat pump, air cond. 6.00
° 5 2 7 6 S ( Pei r7 m is, to 3 HP; absorb unit to 100K BUT
City /State Zip Phone 7.) Boiler or comp, heat pump, air cond. 11.00
WIC-1100V1 e. 6 5707 Ce $15'C,Orc 3-15 HP; absorb unit to 500K BTU"
Contractor Name - 8.) Boiler or comp, heat pump, air cond. 15.00
•
(Prior to -rev IaC. t3, A 15-30 HP; absorb units -1 mil BTU**
issuance Mailing Address 9.) Boiler or comp, heat pump, air cond. 22.50
applicant 30-50 HP: absorb unit 1- 1.75mi1 BTU"
must provide all . City /State Zip Phone 10.) Boiler or comp, heat pump, air cond. 37.50
contractor > 50 HP; absorb unit 1.75 mil BTU"
license Oregon Const Cont. Board Licit Exp. Date 11.) Air handling unit to 10,000 CFM 4.50 -
information if
expired in
COT COT Business Tax or Metro 0 Exp. Date 12.) Air handling unit 10,000 CFM 7.50
database). .
Architect Name 13.) Non - portable evaporate cooler 4.50
ESQ Acceitriscre, seLassar5
or Mailing Address 14.) Vent fan connected to a single duct 3.00
C7 ? +6 SW ((1TN V'.. -2.--- Engineer City /State zip Phone 15.) Ventilation system not included in 4.50
- dMt`ai'Ls1Q 451 4 G4' appliance permit
Describe work New 0 Addition 0 Alterati5TV Repair 0 16.) Hood served by mechanical exhaust 4.50
to be done Residential 0 Non- residentia
Additional Description of work 17.) Domestic incinerators 7.50
18.) Commercial or industrial type 30.00
Incinerator .
Existing use of 19.) Repair units 4.50'
building or property 'l�Y44 t/.,_ ,
20.) Wood stove 4.50
•
Proposed use of Q 21.) Clothes dryer, etc. 4.50
building or property 4 C?1.6tt `^
22.) Other units 4.50
Type of fuel - oil 0 natural gaa� LPG 0 electric 0 23.) Gas piping one to four outlets 2.00
I hereby acknowledge that I have read this application, that the 24.) More than 4 -per outlets (each) .50
information given is correct. that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
Signature of Owner /Agent Date 'SUBTOTAL n g
a �
/ ii/r / �� /� 5 % SURCHARGE �a �(
ontact Person N j7/ Pone PLAN REVIEW 25% OF SUBTOTAL 5
K E-- G 4„4- 4-e.22_1 �A TOTAL I 21 i:last\mechpmtdoc (rev 9 'Minimum permit fee is S25 + 5% surcharge `
"Residential A/C requires site plan showing placement of unit. '