Permit ., -2_ . 23.. 87 •• - a.61.1.4
Receipt #
CITY OF TIGARD MECHANICAL PERMIT - y6��.
Permit
Description
• _ Table 3A Mechanical Code QTY PRICE • , AMT
. City of Tigard , - -
13125 S.W. Hall Blvd.. . . 1) Permit Fee -0- : -0- . 10.00
P.O: Box 23397 ' . • `
Tigard,.OR _97223 2) Supplemental Permit, 3.00 .
639 -4175 Furnace to 100,000 BTU
();(15i ? i 9 '
..
r I' ' : 1) incl. ducts &vents 6.00
-• V • Furnace: 100,000 BTU +
• . 2 ) •
incl. ducts &.vents 7 .50.
Name of Development Floor Furnace . •
T - / A G 3) ' incl. vent 6.00 .
;Jbb' • , Address ' - • • j -•, , / 4 � S uspended heater, wall'heater . .
..
6.00 .
Address J ;22 lo: L> v S L-0 I 0,C:1 h , c . • r- i u ■ j or floor rnounted heater
Tax Lot • - Map No. ) Vent not incl. in • •
5 appliance permit. 3.00
Lot Block i 'Subdivision
Name (or name of business) 6) Repair of heating, refr ig., 6:00..
C G .{ r . � ;\`•�{ L..> I I�1 • ' cooling, absorption unit ..• . .
' Mailing Address •Pho B o i l e rorcompto3.HP. 6:00.
- ' Owner - ' . • 7 ) absorp. unit to 100;000 BTU ' •
.
. crty/state - , • Zip 8) . Boiler or comp to 3. HP- .15:HP• 11.00 •
. absorp. unit to 500;000 BTU . -
N ame ) Boiler or comp 15 =30 HP.. ' •
. 9 absorp'. uunity?, 1 million - 15.00.
M ailing Address - Phone • 1 �) Boiler or comp to 3().50 HP , 22.50
• - . absorp: unit 1 -1:75 million. • .
Contractor city /State ' Zip 11 ) Boiler or comp to 50 HP , . 31.50 .
absorp. unit 1,750,000 BTU; . . • . i
Air handling unit to /
State Registration No. City Bus Tax No. 12 j 0 C 4:50 - - /
Air handling unit /
I hereby acknowledge that I have read this application that the information given is 1 10,000 CFM + 7.50
correct, that I am the owner or authorized agent of the owner, that plans submitted are in .
compliance with State laws, that I am registered with the State Builders' Board, that the 14 . Non portable' - . - 4:50
number given is correct. (If exempt from State registration please give reason below) ) evaporate cooler . • . _
Vent fan connected. _ •
• 15) to a single duct - ` 3 `!
•
• 1 ' Ventilation system not
• 6 4:50 •
. ' ^ j._. ) included in appliance permit:• . ,
v ''- �� v . . - w^ - 17) Hood served by - . .
mechanical exhaust 4:50
im/
A. Signature (owner or agent)' — --------- Date 18). Domestic type s 7.50
Desc be work . - E • addition •❑ alteration ' l repair ❑ - incinerator . • . -
to be done residential ❑ non- residential ❑ 19) Commercial or industrial • - • 30:00
Existing use of t incinerator - ,
•
</ • /
building or properly • 64 -' 2 0 ) .Other i:e., woodstove, water � 4.8o / a)
Proposed,use of heater, s clothes dryers, etc. 7
building or property. " 21) ,Gas piping one to fouroutletn 2.00 .2 ' 1 d
Type-of fuel - oil . , natural gas` • LPG ❑ electric 0 . . 47 • .�=? �' ' % f � •' . ' .
. 22). More than 4 -per outlet ""--C .5 • , s, ' -0
NOTICE. ' . v SUB -TOTAL 30• 50 .
THIS PERMIT BECOMES NULL AND -VOID IF 'WORK, OR CON-. .
STRUCTION . AUTHORIZED IS NOT COMMENCED WITHIN. 180• " . 4 %. SURCHARG . E • / , • DAYS, OR IF CONSTRUCTION OR •WORK.•IS.SUSPE■DED OR PLAN RE IEW 25 % °.OF SUB -TOTAL ,
ABANDONED'FORA PERIOD OF 180 DAYS AT ANYTIME AFTER '• , , ' . ' : ' '
.. TOT
WORK IS COMMENCED..,...._....." :. — - :.._ - ;. - ,.: - .._ -- - , . _.. - AL. X1:..
Special Conditions / r -1��L " / • ' (/_4
�/ li �!3. �i .1 i� = � ' f Date i ssued 7 ��� / ,by r
Y (/
INSPECTION NOTICE
6 D City of Tigard Building Department
/0
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639 -4175
Type of Inspection ✓
Date Requested - Z 3 Ti A3 P.M.
Address n ) 3 L' b 0 p,arf L )h4 1 . Permit # y /p 2 1::: C
Owner A(A Q.�A- Lot #
Builder
The following Building Code deficiencies are required to be corrected:
11/ 1 51KI . it 111
i r_A - * - 4 4 :4v -- 1--
Presented to 1/ Approved
Inspector / � �/ ❑ Disapproved
Date 1. 7 1-)
CALL FOR REINSPECTION
El YES ❑ NO