Permit CITYJOF TIGARD Mechanical Permit Application R Plan Check
ec'dBy
A3125 SW HALL BLVD. Commercial and Residential Date Rec' - 3) - 6-
TIGARD, OR 97223 \(/ Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type ai,(�Permit # o't oCl� GYM 5.5
Incomplete or illegible applications will not be accepte Called
Name of Development/Project Description
%wap S . ,1i S � eeizew �� Table 1A Mechanical Code Qty Price Amt
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Job Street Address / Suite# A) Permit Fee 16.00
Address 1) Furnace to 100,000 BTU
including ducts & vents see footnote 1,2 9.65
Bldg# City/State zip 2) Furnace 100,000 BTU+
including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner Giezo(o / rn/9N . including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
or floor mounted heater see footnote 1,2 9.65
/ -2aan 5 3 s (peeler./ Pl. 5) Vent not included in appliance permit 4.75
City /State Zip Phone Check all that apply: 'Boiler Heat Air
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776/QR 23 q72„2 6 C For items 6 -10, see or Pu Cond Qty Price Amt
Name (or name of business) footnotes 1,2 Comp
6) <3HP;absorb unit to
1
100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name 9) 30-50 HP; absorb
unit 1 -1.75 mil BTU 36.00
/Gl/R RC D/i) / /Mc 10) >50HP; absorb unit
Prior to permit M ^ ding Address /3 >1.75 mil BTU 60.15
issuance, a copy /9 / j) ( �7 11 Air handling unit to 10,000 CFM
of all licenses City/State Zip Phone 7.00
are required if / 0,1? 7° 51 /1/ 42 Dn 77V S% / 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.85
database ygo2g 7--0 `O2 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or Mailing Address 4.75
15) Ventilation system not included in .
appliance permit 7.00
Engineer City /State Zip I Phone 16) Hood served by mechanical exhaust
7.00
Describe wo to be done: 17) Domestic incinerators
New Repair 0 Replace with like kind: Yes 0 No O 18) Commercial or industrial type incinerator 12.00
Residential 0 Commercial O _ 48.25
19) Repair units
Additional information or description of work: 8.40
20) Wood stove /gas FP /other units /clothe dryer /etc.
7.00
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NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas talcs. See footnote 1 3.75
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Type of fuel: oil 0 natural gas 0 LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 SUBTOTAL .
I hereby acknowledge that I have read this application, that the information 8% SURCHARGE
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
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the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL
Signs re of Owner /Agent Date
�J Other Inspections and Fees: - 1D6L, , - t_ - -F ° .00
i4 � P 4. , 8-3.---0Q 1. Inspections outside of normal business hours (mininum charge - o _
ontact`Person Name Phone hours) $50.00 per hour 6
2. Inspections for which no fee is specifically indicated (minimum 11/0
m .,S / /�� �� ` _. ? 4, 9 charge -half hour) $50.00 per hour 66
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge -one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
units. 'State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
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j'` SETTING THE STANDARD FOR SERVICE EXCELLENCE
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Company: City of Tigard 96e P
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Fax: (503)598-1960
Date: g! 3! 0 6
Pages including this page: 3
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City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223
I:\CITYWIDE\FAXCOVER.DOC ** PLEASE DELIVER THIS FAX IMMEDIATELY **
Document2 * *PLEASE DELIVER THIS FAX IMMEDIATELY .
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SETTING THE STANDARD FOR SERVICE EXCELLENCE
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City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223
I: \CITYWIDE\FAXCOVER.DOC ** PLEASE DELIVER THIS FAX IMMEDIATELY **
Document2 * *PLEASE DELIVER THIS FAX IMMEDIATELY
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2/9/2001 Activities for Case #: MEC2000 -00355
8:10:00 AM •
Assigned Hold Updated
Activity Description Date 1 Date 2 To Done By Disp. Level By Updated Notes
MECA007 Application receive 8/30/2000 RCP DONE No Hold RCP 8/30/2000
MECA799 Final Inspection _ No Hold RCP 8/30/2111
MECA020 Hold or 8/30/2000 No Hold Re • � 8/30/2000 started to issue permit, but
�, there's a parcel tag for double
fee. called four seasons to
�� inform them of additional $54
t due. Jeanne
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2/9/2001 Fees Associated with Case # MEC2000 -00355
8:36:56 AM
Fee Case Start End Trans. Create Created
Type Type Date Date Case No. Dept. Description Code Revenue Account No. Date By Amount Due
PRMT MEC 1/1/1990 12/31/2005 MEC2000 -00355 [MECH] Permit Fee _ 245 - 0000 - 431010 8/30/2000 RCP $50.00 $0.00
5PCT MEC 1/1/1990 12/31/2005 MEC2000 -00355 [TAX] 8% StateTax 100- 0000 - 207020 8/30/2000 RCP $4.00 $0.00
• PRM3 MEC 1/1/1990 12/31/2005 MEC2000 -00355 [MECH] Investigate 245 - 0000 - 431010 9/27/2000 DEB $50.00 $50.00
$104.00 $50.00
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9/27/00 Tag(s) for Parcel #: 2S103AB- 05200
12:50:55 PM
Use Update
Code Value Value Hold Description Notes Updated _
BLDG N Hold w\ Override Building Dept Action Mechanical work without permit (a/c). Double fees required prior to 8/24/00 HAP
issue....hap....this tag can be removed upon payment of the correct
fees.
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