Permit City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 SW HaII,BIvd. APPLICATION Permit # 3 0 1 4.&'
•
Tigard, OR 97223
(503) 639 -4171
- N., C,,,,GnNn •
am ,, Description
_ 1 fi le Table 3A Mechanical Code QTY PRICE AMT
Job LW/ SW Wd..s 7 h p 1 1) Permit Fee -0- -0- 10.00
Address . �o
2) Supplemental Permit 3.00
Nam t« maw a Imams) Furnace to 100,000 BTU
kiwi fit/ gh a'es (brp, 1) incl. ducts & vents 6.00
Making .__ Furnace 100,000 BTU +
Owner 2-g3 fa 2) incl. ducts & vents 7.50
1 p Floor Fumance
New o/ . 4J / og 7 q 3) incl. vent 6.00
J Suspended heater, wall heater
/�.'. C 4) or floor mounted heater 6.00
Occupant A'"'" Vent not ind. in
1/'/ Sw A+cAt fan .JCd, 5 ) appliance permit 3.00
c.i),su,. / Repair of heating, refrig.
/ ake 61e. 9r7 6) cooling, absorption unit / 6.00 6,00
N Boiler or camp, heat pump, air cond.
7) to 3 HP absorp unit to 100K BTU 6.00
M ' i " B Addri Paws Boiler or camp, heat pump, air cond.
8) 3 -15 HP absorp unit to 500K BTU 11.00
Contractor G ,,,, s „„
ic Boiler or comp, heat pump, air coma.
9) 15 -30 HP absorp unit .5-1 ml BTU 15.00
Saw Rpisr.uon No. Coy fica. Tax No. Boiler or comp, heat pump, air cond.
10) 30-50 HP absorp unit 1 -1.75 mil BTU 22.50
I hereby acknowledge that I have read this application, that the Boiler or comp, heat pump, air cond.
information given is correct, that I am the owner or authorized agent 11) > 50 HP absorp unit 1.75 mil BTU 31.50
of the owner, that plans submitted are in compliance with State Air handling unit to
laws, that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 4.50
that the number given is correct (If exempt from State registration, Air handling unit
please give reason below.) 13) 10,000 CTM + 7.50
Non portable
14) evaporate cooler 4.50
Vent fan connected '
15) to a single duct 300 3, b°
Ventilation system not
16) included in appliance permit 4.50
sq ao.o (owner « ogoa) • Dan Hood served by
17) mechanical exhaust 4.50
Describe work new Q addition Q alteration4r repair Q Commercial or industrial •
to be done residential Q non - residential 18) type incinerator 30.00
Existing use of Other i.e., woodstove, water '
building or property 19) heater, solar, dothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
Type of fuel - oil 0 natural gas Q LPG 0 electric 0 21) More than 4 -per outlet
NOTICE
Minimum Fee $25.00 SUBTOTAL PS,CiD
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE 1.2
IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL p g.g
AFTER WORK IS COMMENCED.
TOTAL 3;S::::
Special Conditions
Date issued by
k.IMEOIPMT /
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