Permit / -/
MECHANICAL I C_AL '�/
CITY OF TIGARD PE RMIT M......l. MEC96 -0260
.COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/01/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL.: 1S133DA -01400
SITE ADDRESS...: 11095 SW SUMMER LAKE DR
SUBDIVISION • AMART SUUMMER LAKE ZONING: R -7
BLOCK • LOT •36
CLASS OF WORK..:ADD FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •SF UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:(1 VENTS W/O APPL: O 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...: M 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS - -- -- AIR HANDLING UNITS OTHER UNITS. : 1
FURN < 100K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =100K BTU: 0 > 10000 cfm: 0
Remarks: GAS PIPING FOR ZERO CLEARANCE GAS FIREPLACE
Owner: FEES
BOB MILLER type amount by date recpt
11095 SW SUMMER LAKE DR PRMT $ 25.00 JMH 08/01/96 96- 262405
5PCT $ 1.25 JMH 08/01/96 96- 282405
TIGARD OR 97223
Phone #:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 26.25 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the F i n a l Ins • ect ion
Tigard Municipal Code, State of Ore. Specialty Codes and all other /
applicable laws. All work will be done in accordance with i ' _
/ , �i.� / ____
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more 4 7 - ht - el — ______
than 180 days.
(J1 _____
11111 11111 /
Permittee Signatur .. i ` c f; / 4 1
_ -+ _____
Issued Lay: — - - -‘ ' ' . -- --
Call for inspection — 639 -4175
Plan Check #
CITY OF TIGARD Mechanical Permit Application Recd By 7
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 # 1E1% -O>bb
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code QTY PRICE AMT
Job Street Address S(.PK Suite# A) Permit Fee -0- -0- 10.00
Address 0 /C) 7S� 5i.�) ( ,. e
Bldg# - City/State Zip B) Supplemental Permit 3.00
C
t 1 C Aa.D Otte_
Name or name of business) 1.) Furnace to 100,000 BTU 6.00
Owner \A L ,s2_■/ incl. ducts 8 vents
Mailing Ca / r - 2.) Furnace 100,000 BTU + 7.50
I l 0�/ S $Ll) , ,1•vL(,t /r?y� ( Lc_
ind. ducts 8 vents
Comte Zip Phone 3.) Floor Furnace 6.00
(< G�Ct QRc � yo - ''S incl. vent
Name (or name of business) 4.) Suspended heater, wall heater 6.00
or floor mounted heater
Occupant Mailing Address 5.) Vent not incl. in 3.00
appliance permit
City/State Zip Phone 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorp unit to 100K BTU
Name 7.) Boiler or comp, heat pump, air cond. 11.00
L . a r--1 Jr01jt) i L � _TN (. 3-15 HP; absorp unit to 500K BTU
Contractor I Address 8.) Boiler or comp, heat pump, air cond. 15.00
l [� Z , KIC`- (.[•C. G 15-30 HP; absorp unit .5-1 mil BTU
Attach copy of a /St Zip Phone D 9.) Boiler or comp, heat pump, air cond. 22.50
Current Licenses 2ti( �'OUvek 40 '6n_ 737 ^q ( 19 30-50 HP; absorp unit 1 -1.75 mil BTU
Oregon Const. Cont. Board Lic.# Exp. Date 10.) Boiler or comp, heat pump, air cond. 37.50
�' o"T Q [� > 50 HP; absorp unit 1.75 mil BTU
COT Business ax o rF 0 Exp. ate 11.) Air handling unit to 4.50
Architect Name �r�.11(�lltron/ 12.) Air handling unit 7.50
10,000 CTM +
or Mailing Address 13.) Non portable 4.50
evaporate cooler
Engineer Cdy/State Zip Phone 14.) Vent fan connected 3.00
to a single duct
Describe work New 0 Addition 0 Alteration 0 Repair 0 15.) Ventilation system not 4.50
to be done Residential 0 Non - residential 0 included in appliance permit
Additional Description of work 16.) Hood served by
mechanical exhaust 4.50
17) Domestic incinerators 7.50
Existing use of 18.) Commercial or industrial 30.00
building 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 0 LPG 0 electric 0 21) Gas piping one to four outlets f 2.00
I hereby 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 owner, that plans submitted are in compliance with Oregon State QTY. SUBTOTAL
laws.
• atu of Owner /Agent Date 'SUBTOTAL
25-'
I @ " Name e ., 11/4 I ^9 to 5% SURCHARGE % Z 5"
to c en Phone
PLAN REVIEW 25% OF SUBTOTAL
TOTAL _
i:\dshrnechpmtdoc 'Minimum permit fee is $25 + 5% surcharge
Rev 7/96
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. ech. Rough -in Gyp. Bd. -Bldg.
San. Sewer datEti Appr /Sdwlk Reins.
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IN:
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Inspector: J�' Date: �
PPROVED DISAPPROVED /CALL FOR REINSP. CF CO
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