Permit CITY TIGARD MECHANICAL PERMIT
Ah.tilp PERMIT #: MEC2000 -00203
DATE ISSUED: 5/26/00
-- DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S 135CC -00100
SITE ADDRESS: 10200 SW TIGARD ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS - HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Install a new gas furnace and gas piping.
Owner: FEES
RODGER DAY Type By Date Amount Receipt
10200 SW TIGARD PRMT GEO 5/26/00 $50.00 0002478
TIGARD, OR 97223 5PCT GEO 5/26/00 $4.00 0002478
Total $54.00
Phone:
Contractor:
D + R HEATING + AIR COND
PO BOX 1292
27251 S DAVE RD REQUIRED INSPECTIONS
CANBY, OR 97013
Gas Line Insp
Phone: Heating Unt Insp
Reg #: LIC 84489 Final Inspection
ORIG INAL . .
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other 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. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtai opi 1, 'es- r ' or direct questions to OUNC by calling ( 03)2 -9189.
Issue By: L // / - Permittee Signature:, _ —
i -
Call (503) : 9-4175 by 7:00 P.M. for inspections needed the next business day
Plan Check #
C TIGARD Mechanical Permit Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 Date to DST
Print or Type Permit # /
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
at.)X ,e D om/ Table 1A Mechanical Code Qty Price Amt
Job Street Address Sude# A) Permit Fee 16.00
Z00 •Still. 77C�A•2/) _ 1) Furnace to ducts & 0 BTU
Address /O
including ducts vents see footnote 1,2 I 9.65 9 .(oy
Bld city /State zip 2) Furnace 100,000 BTU+
77,44,1) O /2 9 7225 including ducts & vents see footnote 1,2 12.00
Name (or name of business) 3) Floor Furnace
Owner -jyy,‘" 4-S 4&ove 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
5) Vent not included in appliance permit 4.75
City/State Zip Phone Check all that apply: 'Boiler Heat Air
For items 6 -10, see or Pump Cond Qty Price Amt
Name (or name of business) footnotes 1,2 Comp --
6) <3HP;absorb unit to
SWinG AS 4 &Jc/E , 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
9) 30-50 HP;
Contractor Name unit 1 -1.75 mil BTU 36.00
b i / Z ,4 r7A/tr 10) >50HP; absorb unit
Prior to permit Mailing Address >1.75 mil BTU 60.15
issuance, a copy ,o • 80% 129 2. 11 Air handling unit to 10,000 CFM
of all licenses CA/State Zip Phone 7.00
are required if UZIAI 3\/ OR 970/3 2%g& /ZZ9 12) Air handling unit 10,000 CFM+
. expired in COT Oregon Coot st. Cont. Board Lic.# Exp. Date 11.75
database 8T489 051 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 Phone 16) Hood served by mechanical exhaust
7.00 -
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair Replace with like kind: Yes O No O 18) Commercial or industrial type incinerator
Residential Q� Commercial 0 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
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calks. / See footnote 1 1 3.75 3 7 5 -
Type of fuel: oil 0 natural gas fe LPG 0 electric 0 22) More than 4 -per outlet (each) .75
Minimum Permit Fee $50.00 , SUBTOTAL �,w�x 7�
I hereby acknowledge that I have read this application, that the information �/1 SURCHARGE 4 1
given is correc that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL
Signature of er/ nt Date Q
Other Inspections and Fees:
.2100/ 093/ ZO 1. Inspections outside of normal business hours (mininum charge -two
ontact Person Name Phone/ hours) $50.00 per hour
2. Inspections for which no fee is specifically indicated (minimum
.17/4"/r >Oi4 - iii S 2Ce69 ` /2 2-9 charge -half hour) $50.00 per hour
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 NC requires site plan showing placement of unit
I:knechperm.doc rev 02/4/99