Permit ' CITY OF TIGARD / MECHANICAL PERMIT
a rA DEVELOPMENT SERVICES/ PERMIT #: MEC2001 -00158
,.� I I 13125 SW Hall Blvd., Tigard, O 97223 (503) 639 -4171 DATE ISSUED: 5/11/01
PARCEL: 2S110BA -07100
SITE ADDRESS: 11975 SW WILDWOOD ST
SUBDIVISION: SHADOW HILLS NO.2 ZONING: R -2
BLOCK: LOT: 056 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 750 HP: REPAIR UNITS:
GAS PRESSURE: 50 HP: WOODSTOVES:
+
FURN < 100K BTU: AIR /HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <=/10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of new gas line from meter to house and spa boiler.
Owner: FEES
BULLER, JOHN J, IIUALMA J Type By Date Amount Receipt
11975 SW WILDWOOD ST PRMT CTR 5/11/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 5/11/01 $5.80 2720010000
Phone: Total $78.30
Contractor:
MCMINNVILLE GAS INC V 0 1 0
1384 NE HWY 99W
MCMINNVILLE, OR 97128 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 472 -7220 Final Inspection
Reg #: LIC 82937
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 obtain copies of these rules or direct questions to OUNC by
c cling (5 ,
, /d . I Issue By i , Atil �, '// t/ i ,
Permittee Signature:
Call • ) 639 -4175 by 7:00 P.M. for inspections need: d the ne ' t business day •
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, , 'Mechanical Permit Application 01:1:1( 1.: t si ()NIA 4 Date received: Permit no.:
g WASHINGTON COUNTY
Address:155 N. 1st AV, Suitc 350 -12, Hillsboro, OR 97124 ProjecUeppl. no.: Expire date:
OJ1EGO' Phone: 503 846 - 3470 Fax: 503 846 - 3993 Date issued: By: Receipt no.•
Internet Address: www.co.washington.or.us Case file no.: Payment type:
Land use approval: Building permit no.:
F YPF ( I'h \ •lI I
le I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SHE INFORMATION C(TMMI RCI: \L. VALUATION SCIIF :I)UI.l
Job address: - f, / Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: Block: N/A Subdivision: +See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
. � i ZIP: .22 1 3 I ' : \ \ 1 1 1 . 1 ' U \ \'I:I. I.I'd�:. I ' I : R ; \ 1 1 I I] I 5(..'1 II`.f)l'I.11
Description an. location of work on premises: 6A S Llwu berAta AND (.O1 \I;\IL:RICr \I,%INUUS I1:1: \L I_I)I'II'\II, \ I ( 11):1)1 I I-
4/ -/ A ' r 1 •1 ,! _ , / - ' _ _ _ _ Fee (es.) Total
Est. date of completion/inspection: Descri . lion • Rea. oat Rea. on
Tenant impmvement or change of use: Airhandlingunit CFM ■ 7.00
Is existing space heated or conditioned? 0 Yes 0 No • wain • Morn _ Q 'J0111111111111111110 W+ +
Is existing space insulated? 0 Yes 0 No
NII:( 1 \N1('. \1" CON "I RA(' I(OR :.lercompressor9
State boiler permit no.:
' - HP Tons HTU/H I N/A ■
Address: /., _ A a ce / smo c . am. • uctsmo c 'etcetera _ilka.
/ ✓// LJ/ . State:0 • ZIP: ' ' ,7,' 'eat pump a tep anrequ e • 1 .1'•
Phone: / - • 1� E -mail: nsta ► • ace a• .umer : 1 '
"'A''' Including ductwork/vent liner0 Yes 0 No 7.00
CCB no.. lnsta /rep a• it ocate caters - suspen.'?:,
CI /metro liar. no.: N/A 1lik, : I ortloormounted 11 7
Name (please print): 7 EP' - � W ent . lance o , er an mace +'+
\ ■ : \(' I I'I.R``Oi a : eritlon:
c'O
Absorption units BTU/H Ill N/A
Name: 7 if 4/ 7 e -, Chillers - - — HP `t
Address: C • . °K . is HP =WON
Environmental ezhaust and ventilation:
City: State: ZIP: Applianoevent 7.00
Phone: Fax: E-mail: Pi
( ) \V ;\ I R • . • ", Type _t res. tc aanat
hood fire suppression system . IMII
Name: Exhaust fan with sin : le duct bath fans 7.00
_
Mailing address: (♦MU:t]♦
City: State: ZIP. uel piping and drstnbutron�(up� o out eta III
T . LPG NG Y Oil 7.00
Phone: Fax: E - mail: Fue • + . u l eac .. Mona over out ets 111111111111.0111
I:NUI NI,I:It ' roceaapiping sc aticrequ re. ) MMN= =NMI
Numbero foutlets - N/A
Name: _
Other listed a , . lamer or e • ui • mart:
Address: 1 coratrve 1 . ace = i'i
City: State: ZIP: were-- r.. i i
"
Phone: oo• -tov pa etstov
E -mail: ��.�
fl
Applicant's signature: 4 drWit: � Date; 5 o Ot r. I
Name (print): _ / �/ ` _ •
Permit fee S
Cl Visa 0 MasterCard ' Notice: This permit ap Minimum fee $ - 10:00r let ,57)
Credit card number l / expires if a permit is not obtained Commercial Plan review
Hxplre. within 180 days after it has been (at 65%) $
Name of cardholder as shown on create card accepted as complete.
S State surcharge (8%) S ' SO
Cardholder signature Amount TOTAL S '7 ,3