Permit •: CITY OF T MECHAN I CAL
PERM
/Awe DEVELOPMENT SERVICES PERMIT # • MEC97 -0265
,„, 1 ,1 1
- '� '1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 EXPIRED ISSUED: 08/26/97
1 � PARCEL: 2S1 1 2DD-00500
SITE ADDRESS...: 15860 SW UPPER BOONES FERRY RD #B -15
SUBDIVISION • ZONING: I -L
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT FLOOR FURN • 0 EVAP COOLERS: 0
TYPE OF USE •COM UNIT HEATERS..: 0 VENT FANS...: 0
OCCUPANCY GRP..:B2 VENTS W/0 APPL: 0 VENT SYSTEMS: 0
STORIES • 0 BOILERS /COMPRESSORS HOODS • 0
FUEL TYPES 0 -3 HP • 1 DOMES. INCIN: 0
:GAS 3 -15 HP • 0 COMML. INCIN: 0
MAX INPUT: 150000 BTU 15 -30 HP • 0 REPAIR UNITS: 0
FIRE DAMPERS ?..: N 30 -50 HP • 0 WOODSTOVES..: 0
GAS PRESSURE...: M 50+ HP • 0 CLO DRYERS..: 0
NO. OF UNITS AIR HANDLING UNITS OTHER UNITS.: 0
FURN < 100K BTU: 0 <= 10000 cfm: 0 GAS OUTLETS.: 1
FURN > =100K BTU: 1 > 10000 cfm: 0
Remarks: Copytronix
Owner: FEES
PACIFIC REALTY type amount by date recpt
15350 SW SEQUOIA PKWY PRMT $ 25.00 B 08/26/97 97- 298692
PORTLAND OR 97224 PLCK $ 6.25 B 08/26/97 97- 298692
SPCT $ 1.25 B 08/26/97 97- 298692
Phone #:
Contract or:
PROTEMP ASSOCIATES INC
807 NE COUCH
$ 32.50 TOTAL
PORTLAND OR 97232
Phone #: 233 -6911
Reg #..: 000388
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 Mechanical Insp
applicable laws. All work will be done in accordance with Final Inspection
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 by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952-001-0910 through OAR 952 -001 -0080. You say
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue By: 6/14/CW&A.._.-- Permittee Signature: 0 -),
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + ++ + + + + + + + + + + + + + + + + + ++ + + ++
Call 639 -4175 by 6:00 p.m. for inspections needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + ++
Plan Chec 7 -l7S e
CITY OF TIGARD Mechanical Permit Application Rec'd By Lik ->.€0
13125 SW . BLVD. Commercial and Residential Date Rec'd 74,1 4
TIGARD, OR 97223 g® Date to P E. 0 7'79
(503) 639 -4171, x304 EXPIRED Date to DST t3!2s- 5 (c('1 �
Permit # fit C9 ?-GAS
Print or Type Called ('')-(. "c� 7- �/5 s
Incomplete or illegible applications will not be accepted ,v..._ _3
Name of Development/Project Description
ORE- icy/ BUS. t- / Table 1A Mechanical Code Orr PRICE Awl
Job Street Address SuileS A Permit Fee -0- 3w IA PPEtC -0- 10.00
Address / 584 0 e i ts f -Yell, -
Bldgu 15 City/State Zip B) Supplemental Permit 3.00
T16.4,24 o2 . 47o3s
Name (or name of business) 1.) Furnace to 100.000 BTU 6.00
Owner PA-C7Vu.s7- incl. ducts & vents I ( -
Mailing Address 2.) Furnace 100,000 BTU + 7.50
15350 5W,5'.' uD/a Pew/ incl. ducts & vents
CityrState Zip Phone 3) Floor Furnace 6 00
P2 TL4n./D 02 g7Z25 Ind. vent
Name (or name of business) 4.) Suspended heater, wall heater 6 00
(o,y 7 EnN/ I)( or floor mounted heater
Occupant Mailing Address 5.) Vent not incl. In 3.00
/586o sw upper bo.,Nrs FY
appliance permit
City/State Zip 1 Phone 6.) Boiler or comp, heat pump, air cond. 6.00
7 /7,Q 97,0 3 - to 3 HP: absorp unit to 100K BTU ' (p -- Name / 7.) Boiler or comp, heat pump, air cond. 11.00
/ Z T 7f i4$.5 C • 3-15 HP: absorp unit to 500K BTU
Contractor Mailing Address 8.) Boiler or comp, heat pump, air cond. 15.00
e07 Ale_ ( ti jji 4 15 -30 HP: absorp unit 5 -1 mil BTU
(Prior to City/State Zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
issuance a copy fit) /Q 7j),./Q Qe 97Z3Z 233 -69// 30-50 HP: absorp unit 1 -1.75 mil BTU
of an licenses are Oregon Const. Cont. Board Lic.# Exp. Date 10.) Boiler or comp, heat pump, air cond. 37.50
required if 3 g `a(D V /0/el $ > 50 HP; absorp unrt 1.75 mil BTU
expired in C.O.T COT Business Tax or Metro S Exp. Date 11.) Air handling unit to 4.50
data base) ' S37• / %q 7 10,000 CFM
Architect Name 12) Air handling unit 7.50
10,000 CTM +
or Mailing Address 13.) Non portable 4.50
evaporate cooler
Engineer City/State Zip - Phone 14.) Vent fan connected 3.00
to a single duct
Describe work New 0 Addition 0 Alteration, 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 industnattype 30.00
building or property incinerator
19.) Repair units 4 50
Proposed use of 20) Woodstove 4.50
building or property
21) Clothes dryer, etc. 4.50
Type of fuel - oil 0 natural gas ja- LPG 0 electnc 0 22) Other units 4.50
I hereby acknowledge that I have read this application, that the 23) Gas piping one to four outlets 2.00
information given is correct. that I am the owner or authorized agent of 1 Z
the owner, that plans submitted are in compliance with Oregon State 24) More than 4 -per outlet (each) .50
laws.
Signo ,e,.,.,, a , `1 -1 s -91
re of Owner /Agent Date QTY.SUBTOTAL
U
21
'SUBTOTAL - M=
K �4c4 -+4-s Z33 - G9I1 _
Contact Person Name Phone 5% SURCHARGE I 2.5 r
i
PLAN REVIEW 25% OF SUBTOTAL Z5
TOTAL i ° z S�
i:ldstknechpmt.doc (rev 7/96) *Minimum permit fee is 525 + 5% surcharge `..