Permit �
CITY OF TIGARD MECHANICAL ~
DEVELOPMENT SERVICES PERM IT
13125 SW Hall Blvd7igeoiOR 97223 (503) 639-4171 PERMIT #. . . . . . . : MEC97-0065
DATE ISSUED: 03/26/97
•
PARCEL: 29112DD-007069
SITE ADDRESS...: 15770 SW UPPER BOONES FERRY RD #BLD.
SUBDIVISION....: ZONING: I�P
BLOCK. . . . . . . . . . : Ll][. . . . . . . . . . . . . : JURISDICTION: TIG
___-__ •
CLASS OF WORK..:ALT FLOOR FURN....: 0 EVAP COOLERS: 0
TYPE OF USE....:COM UNIT HEATERS..: 0 VENT FANS...: 1
OCCUPANCY GRP..:M VENTS W/O APPL: 0 VENT SYSTEMS: 0 '
STORIES........: 0 BOILERS/COMPRESSORS HOODS.......: 0
FUEL TYPES------------ 0-3 HP....: 0 DOMES. INCIN: 0
3-15 HP....: 0 COML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP....: 0 REPAIR UNITS: 0
FIRE DAMPERS?..: 30-50 HP....: 0 WOODSTOVES..: 0
GAS PRESSURE... : 50+ HP.... : 0 CLO DRYERS—: 0
NO. OF UNITS-- -- AIR HANDLING UNITS OTHER UNITS
FURN < 100K BTU: 0 <= 10000 cim: 0 GAS OUTLETS.: 0
FURN >=100K BTU: 0 ) 10000 cfm: 0
Remarks: Alltel •
Owner: ---- ------------• ----------------- FEES ----- ----
PACIFIC REALTY ASSOC LP type amount by �
� date recn
15115 SW SEQUOIA PKWY PRMT $ 25.00 DRA 03/26/97 97-292199
STE 200 PLCK $ , 6.25 DRA 03/26/97 97-292199
PORTLAND OR 97224 SPOT $ 1.25 DRA 03/26/97 97-292199
Ph #:
- '+ ----------------------- .
o 7k::CTF rnwTR0 J-4Fs217TWI
3315 MW 26TH AVE
PORTLAND OR 97210 ------------------------------------
Phone #: $ 32.50 TOTAL
Rf;g #.. : 000621
- REQUIRED INSPECTIONS - -
This' permit' is issued subject to the regulations contained, in the Mechanical Insp
Tigard Municipal Codei State of Ore. Specialty Codes and. all other Final Inspect
applicable laws. All work will Lmdone,io accordance wit
approved plans. This permit will expire if work is not started
within I8W days of issuance, or if work is suspended for,mme
than 180 days. '
'-------------'-- -----------------'
Per mittE
Issued B --- ' -------------'-----
_°_---- _ --_--_-_--__-____--_-
rall for inspection - 639-4175
Plan 6 p
CITY OF TIGARD Mechanical Permit Application
\ r, ea By
Chet
13125 SW HALL BLVD. Commercial and Residential � /7 'TIGARD,R 97223 ( , ,, ,, ) ate R e cd ate to P.E. 0319 9 (503v39 -4171, x304 ate to DST
Permit # 1(f - Print or T yp e Called 03 z6 5 i7 -
Incomplete or illegible applications will not be accepted -c
k Description
Table 1A Mechanical Code QTY PRICE AMT
Job Street Address Suite# A) Permit Fee -0- -0- - 10.00
Address / 577a Scv uPpNR 8 Gas yea
Bld - City/State Zip B) Supplemental Permit 3.00
"V ( /1 0,e•
Name (or name of business) � 1.) Furnace to 100,000 BTU 6.00
Owner P4 � - (It =(,,�5 ( incl. ducts & vents
Mailing Add ress 2.) Furnace 100,000 BTU + 7.50
/ 5 770 sec. ree, C Atzav4x, i c/,eA_ incl. ducts 8 vents
City/State Zip Phone 3.) Floor Furnace 6.00
776 / off, 972J incl. vent
Name (or name of bsiness) 4.) Suspended heater, wall heater 6.00
l/J A.elT Ivo.eve- or floor mounted heater
Occupant Mailing Address 5.) Vent not incl. in 3.00
appliance permit
' City/State Zip Phone 6.) Boiler or comp, heat pump, air cond. 6.00
to 3 HP; absorp unit to 100K BTU
Contractor N B R1 O 7.) Boiler or comp, heat pump, air cond. 11.00
(Prior to C LI Amiar G
L �' c,1p7X'6L ,Z,( /C.... 3.15 HP; absorp unit to 500K BTU '
issuance Mailing Address 8.) Boiler or comp, heat pump, air cond. 15.00
applicant 3 3/ 5 f4) ZG/ 15-30 HP; absorp unit .5-1 mil BTU
must provide all CA /State Zip Phone 9.) Boiler or comp, heat pump, air cond. 22.50
contractor i ey7/J,v4 at • q72/0 2Z3 30-50 HP; absorp unit 1 -1.75 mil BTU
license Oregon Coast. Clint. Board Lie.# Exp. Date 10.) Boiler or comp, heat pump, air cond. 37.50
information 42/9G /0 i > 50 HP; absorp unit 1.75 mil BTU
e
fo COT COT Business Tax or Metro # Exp. Date 11.) Air handling unit to 4.50 [
database). / (99 // - -?7 10,000 CFM
Architect Na1e (( 12.) Air handling unit 7.50 •
10,000 CTM +
or Mailing Address 13.) Non portable 4.50
evaporate cooler
Engineer City/State Zip I Phone 14.) Vent fan connected 3.00 •
to a single duct
Describe work New 0 Addition 0 Alterationy Repair 0 15.) Ventilation system not 4.50
to be done Residential 0 Non - residential Qr included in appliance permit I I
Additional Description of work 16.) Hood served by mechanical exhaust 4.50
17) Domestic incinerators 7.50
Existing use of 18.) Commercial or industrialtype 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 0 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
the owner, that plans submitted a in compli nce with Oregon State 24) More than 4 -per outlet (each) .50
laws.
���11.e 3 /7
Signature o Owner /Age Date QTY.SUBTOTAL • •
'SUBTOTAL - � ,.
,4E71 ( ZZ 3 - 4 7 - `37_
Contact Person Name Phone 5% SURCHARGE ` a,
PLAN REVIEW 25% OF SUBTOTAL
TOTAL 6.341'
:%
i:ldstlmechpmt.doc (rev 7/96) 'Minimum permit fee is S25 + 5% surcharg - �