Permit ' MECHANICAL
C,, `T'Y OF TIGARD ,. - PERMIT PERMIT MEC9C- 0�:�:4'
' OMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/24/95
' 13125 SW Hall Blvd. Tigard, Oregon 97223■8199 "(503) 639 -4171 - '
PARCEL: 151260C -01107
SITE ADDRESS...: 09469 SW WASHINGTON SQUARE RD
,SUBDIVISION ZONING: C -G '
BLOCK ° LOT ,
CLASS OF WORK. -:ALT FLOOR' FURN.....: EVAP COOLERS:
TYPE OF USE •COM UNIT 'HEATERS—: VENT FANS...: .
OCCUPANCY GRP.. : 62 'VENTS W/0 APPL : VENT' SYSTEMS:
STORIES ' °,1 BOILERS /COMPRESSORS' HOODS.......:
FUEL TYPES----- ,-- - - 4- - 0 -3 HP....:. • DOMES. I NC I N :
. 3 -15 HP COML.' INCIN: '
MAX INPUT: • BTU 15 •30 HP REPIR UNITS: 1 .
FIRE DAMPERS ?..: . 30 -50 HP...'.: WOODSTOVES..:
GAS PRESSURE...: . " , . 50+ HP.. ° . : CLO DRYERS. .: I .
NO. OF UNITS - - -: - -- AI HANDLING UNITS OTHER UNI TS. :1 I
FURN < 100K BTU i ' -,<= 10000 • cf m : GAS OUTLETS. : - -'
' FURN > =100K BTU: • > 10000 ., c f in : .
Remarks,: Tenant Mod: Health' Haus9 interior work only.' . ,
Owner: - - -- -- ,. • FEES -
HEALTH HflUS type . amount try date recpt
9469 SW WASHINGTON SQ - - PRIM $ 25.00. JD 07/24/9; 95- 268396 -
PLCK $ 10.00 JD 07/24/9.5 95- 268396
TIGARD OR 97223 . , 5PCT $ .. 1. 25 JD 07/24/95 '95- 268396
Phone #: . .
Contractor: -- --
ARRIS CORPORATION '
4795 NW 191ST AVENUE . ' "
PORTLAND OR 97`29 •- -•
Phone #: $ 36.25 TOTAL .
Reg ##.. : 58909 . .
. REQUI RED. INSPECT IONS --
This perait is issued subject to the regulations contained in the ' Mechanical Insp
Tioard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection ' -
applicable laws. Ali 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 oore '
than 180 days. - - - .'
. , • ' / f• : ,
P _Ar ' • : A ,- • •
' Issued
' Call .for inspect ion - 639 -4175 . • '
qv I)
City of Tigard , MECHANICAL PERMIT Planck/Rec. #
13' 25 SW Hall Blvd. APPLICATION Permit # v - - ' /2
Tigard, OR 97223 Permea I Gcr .ii- viv/ r
(503) 639 -417
v / <San a of Development Description
y691 ur i4 m Table 3A Mechanical Code QTY PRICE AMT
• Address
Job ✓ _N ii tasik e l , e 1) Permit Fee -0- -0- 10.00
Address ON /State
P (�� I `? 223 2) Supplemental Permit 3.00
Name or name of hatneat Furnace to 100,000 BTU
W l 1 1) incl. ducts & vents 6.00
Madmg Address ,O6 P"ene Furnace 100,000 BTU +
Owner Ice P/�-t1 Ain3 � �13 d/5 2) incl. ducts & vents 7.50
cawS'ate zo Floor Fumance
? (� ' 1O� 3) incl. vent 6.00
ma (. name of eee1 ,1. Suspended heater, wall heater
�� /J,AJS / Kr- , 4) or floor mounted heater 6.00
Maang Address �,/ 2 Pl.. Vent not mnci. in
Occupant ' 0'/1 JecA 417.5 ' 5) appliance permit 3.00
Gdy/State Repair of heating, refng.
\idt• 14--4 rj g�, /,lam 6) cooling, absorption unit 6.00
NaTe Boiler or comp, heat pump, air cond.
Ar-eis &clap 7) to 3 HP; absorp unit to 100K BTU 6.00
Melling Address Phone Boiler or comp, heat pump, air cond.
Contractor ?ZS" 5 . � -cjI/ . 8) 3-15 HP; absorp unit to 500K BTU 11.00
art/state Boiler or comp, heat pump, air cond.
612-11-44-4) q-72/ 4 9) 15-30 HP; absorp unit .5-1 mil BTU 15.00
State Regatrebon No. Gay has. Tax Boiler or comp, heat pump, air cond.
O qiQ9 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 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with Air handling unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State Air handling unit
registration, 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 3.00
�� Ventilation system not
_�� / q 16) included in appliance permit 4.50
0 er or agent ..'a Hood served by
17) mechanical exhaust 4.50
Descnbe work new 0 addition 0 alteration- f repair 0 Commercial or industrial
to be done residential 0 non - residential 18) type incinerator 30.00
Existing use of Other i.e., woodstove, water
building or property 'Z 4 e 7 L 19) heater, solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property 6 2 12 !'A I L___
21) More than 4 -per outlet
Type of fuel - oil 0 natural gas 0 LPG Q electric 0
NOTICE i /
Minimum Fee $25.00 SUBTOTAL 2,3 ,/
PERMITS BECOME VOID IF WORK OR CONSTRUCTION L S�
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE /
IF CONSTRUCTION OR WORK IS SUSPENDED OR /
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL /0 „
AFTER WORK IS COMMENCED. ��
TOTAL T` 2C—
Special Conditions _
Date issued �� � b /
ke/MEGIPMT
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